A Systematic Review of Antibiotic Use in Humans in Nigeria and Its Potential Contribution to Rising Antimicrobial Resistance

Abstract

INTRODUCTION: The value of medicines is lost when these resources are not used rationally. Out of 12 developing countries, Nigeria has the third highest percentage of antibiotic prescriptions, at 48%. Antibiotic misuse results in limited efficacy of antibiotics, which can lead to the emergence of antimicrobial resistance. We conducted systematic review to synthesise the evidence on antibiotic use in humans in Nigeria. METHODS: We conducted a systematic review of medicine use behaviour by patients and prescription behaviour by health workers, which were searched for in articles published in English from 2000 to 2017. Data was entered into purpose-built templates. Key quantitative indicators were extracted and summarised as frequencies and proportions, while free-text responses were synthesised. RESULTS: The systematic review determined that the median prevalence of persons using antibiotics without prescription is 46.7%. The drivers of irrational antibiotic use included poor regulation of medicines and premises, a chaotic medicine distribution system, limited licensed medicine prescribers, over-the-counter (OTC) sales of antibiotics, patients’ demand for antibiotics, and access to health insurance. DISCUSSION: Irrational antibiotic use is widespread in humans and animals. We recommend that the government enforce regulations on antibiotic sales to humans and animals and increase awareness of irrational antibiotic use and AMR in Nigerian communities through a whole-of-society approach. The collated information was used to develop a National Action Plan on AMR in 2017.