Antibiotic dispensing practices and antimicrobial stewardship gaps in community pharmacies in Kakamega County, Kenya

BackgroundAntimicrobial resistance (AMR) is a major global health threat, with sub-Saharan Africa bearing a disproportionate burden. Community-level antibiotic dispensing practices remain poorly described in Kenya outside Nairobi. MethodsA total of 504 antibiotic dispensing events were prospectively recorded across 22 community pharmacies in Kakamega County, western Kenya, between 3rd and 22nd August 2025. Data collected included dispensing source (over-the-counter [OTC] versus prescription), clinical indication, antibiotics dispensed, course completion, and self-reported repeat antibiotic use within the preceding month. Descriptive analyses were performed, and {chi}2 tests were used to examine associations between dispensing source and selected non-antibiotic dispensing characteristics. ResultsOf the 504 dispensing events, 224 (44.4%) involved OTC dispensing and 278 (55.2%) were prescription-based. The most frequent indications for antibiotic dispensing were upper respiratory tract infections (URTI; n = 156, 31.0%), lower respiratory tract infections (LRTI; n = 95, 18.8%), gastrointestinal infections (n = 65, 12.9%), and skin or soft-tissue infections (n = 55, 10.9%). Across all events, amoxicillin, azithromycin, and metronidazole were the most frequently dispensed antibiotics, with broad-spectrum agents--including fluoroquinolones and cephalosporins--commonly used for lower respiratory tract infections, urinary tract infections, and sepsis. Partial antibiotic courses were supplied in 33 (6.5%) dispensing events, most commonly due to financial constraints (15/33, 45.5%). Self-reported antibiotic use within the preceding month occurred in 156 (31.0%) cases. ConclusionsOTC antibiotic access remains widespread in Kakamega County, with substantial use of broad-spectrum agents across multiple clinical indications. Financial barriers contribute to incomplete antibiotic courses. These findings highlight the importance of incorporating community pharmacy dispensing data into county-level antimicrobial stewardship programmes and informing national strategies to optimise antibiotic use.