Promoting antibiotic pharmacotherapy in community pharmacies in low- and middle-income countries: why and how?

Background Antimicrobial resistance (AMR) disproportionately affects low- and middle-income countries (LMICs), where community pharmacies frequently serve as the first point of care for common infections. Inappropriate antibiotic dispensing, limited stewardship integration, regulatory weaknesses and gaps in pharmacy education contribute to suboptimal antibiotic use. Objectives To highlight why and how antibiotic pharmacotherapy should be promoted and strengthened within community pharmacy settings in LMICs. Discussion Community pharmacists are uniquely positioned to optimise antibiotic selection, dosing and duration; however, their stewardship potential is constrained by insufficient training, limited access to locally adapted guidelines, and inadequate decision-support tools. Strengthening antibiotic pharmacotherapy requires targeted education and continuing professional development, integration of AMS competencies into pharmacy curricula, local adaptation of evidence-based resources (e.g. AWaRe-informed tools), and scalable “train-the-trainer” models. Global North–South collaborations and sustainable financing mechanisms are essential to support implementation and scale-up. Conclusion Empowering community pharmacists with the knowledge, skills, competencies, and resources required to deliver evidence based antibiotic pharmacotherapy should be recognised as a core policy priority for antimicrobial stewardship in LMICs. Embedding structured pharmacy-targeted pharmacotherapy guidance within national AMR action plans and WHO-aligned frameworks is critical to reducing inappropriate antibiotic use, strengthening health system resilience, and preserving antimicrobial effectiveness.