Discussion: Regulatory Oversight and Antimicrobial Stewardship
The widespread over-the-counter availability of critical therapeutics directly undermines antimicrobial stewardship and intensifies resistance selective pressures across diverse healthcare settings. In community practice, the unregulated distribution of broad-spectrum antimicrobials remains a principal driver of emerging resistance mechanisms, as seen where retail pharmacies frequently dispense agents from the World Health Organization Watch category without formal diagnostic validation (Challa et al., 2023). This unrestricted dispensing behaviour, combined with limited awareness among pharmacy personnel regarding antimicrobial resistance dynamics, fosters unchecked drug exposure for common, self-limiting ailments (Challa et al., 2023). Such community-level practices exert profound downstream consequences on therapeutic efficacy by facilitating the proliferation of resistant bacterial lineages. Specifically, the emergence of extended-spectrum beta-lactamase (ESBL) enzymes in Enterobacteriaceae severely restricts standard antibiotic therapies, rendering carbapenems one of the few remaining viable options for severe infections (Rawat & Nair, 2014). However, the unchecked over-the-counter acquisition of reserve classes, including carbapenems, progressively diminishes even these critical last-line treatments against Gram-negative pathogens (Laxminarayan & Chaudhury, 2016). When non-prescription procurement circumvents clinical oversight, it dismantles standard institutional protocols that depend on tailored hospital policies and local antibiograms to curb broad-spectrum consumption (Gomathy et al., 2025). Mitigating these intersecting challenges therefore demands strict regulatory enforcement against illicit pharmacy dispensing alongside rapid diagnostic testing to identify resistance profiles before empirical options fail (Rawat & Nair, 2014). Without coordinated structural interventions that align retail dispensing restrictions with institutional stewardship guidelines, escalating resistance will continue to erode the utility of conventional antimicrobial agents.