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Review
. 2025 May 20;113(2):253-263.
doi: 10.4269/ajtmh.25-0035. Print 2025 Aug 6.

Antimicrobial Resistance in Sub-Saharan Africa: A Comprehensive Landscape Review

Valentina Totaro  1 , Giacomo Guido  1 , Sergio Cotugno  1 , Elda De Vita  1 , Muhammad Asaduzzaman  2 , Giulia Patti  1 , Francesco Vladimiro Segala  1   2   3 , Giovanni Putoto  3 , Luisa Frallonardo  1 , Ferenc Balázs Farkas  4   5 , Botond Lakatos  6 , Nicola Veronese  7 , Pietro Locantore  8 , Francesco Di Gennaro  1 , Annalisa Saracino  1
Affiliations
Review

Antimicrobial Resistance in Sub-Saharan Africa: A Comprehensive Landscape Review

Valentina Totaro et al. Am J Trop Med Hyg. .

Abstract

Antimicrobial resistance (AMR) is a critical health challenge in sub-Saharan Africa (SSA), driven by socioeconomic disparities, weak healthcare systems, and inadequate pharmaceutical regulation. This review examines AMR prevalence, drivers, and consequences in SSA, emphasizing the need for urgent interventions. A literature review was conducted using PubMed, Web of Science, Scopus, and Google Scholar, including studies published from January 2000 to June 2024. The focus was on AMR epidemiology, public health impacts, and interventions specific to SSA. High resistance rates were identified in Escherichia coli, Klebsiella pneumoniae, and Staphylococcus aureus. Key drivers include limited healthcare access; antibiotic misuse; poor surveillance; inadequate water, sanitation, and hygiene infrastructure; and poverty. AMR leads to increased mortality, prolonged hospital stays, and higher healthcare costs, with SSA projected to face 4.1 million AMR-related deaths annually by 2050 without action. Addressing AMR in SSA requires strengthening healthcare systems, expanding surveillance, enforcing pharmaceutical regulations, and enhancing education. International collaboration and funding are essential to mitigate AMR's impacts and support progress toward universal health coverage and the Sustainable Development Goals.

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Figures

Figure 1.
Figure 1.
The complexity of drivers of antimicrobial resistance (AMR) in sub-Saharan Africa.
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