Antimicrobial Resistance: Global Threat Deepened by Nigeria’s Fragile Health System – By Adewale A. Adetoye

By Adewale A. Adetoye

The conversation on antimicrobial resistance (AMR) cannot be confined to a single awareness week. While the world marked the 2025 AMR Awareness Week recently, the reality confronting us in Nigeria is that this threat is alive every day, in every hospital ward, every pharmacy counter, every community, and every home. AMR has become one of the most significant public health challenges of our time—quiet, persistent, and devastating. Antimicrobial resistance occurs when microorganisms develop the ability to withstand drugs designed to eliminate them. The consequences are stark: infections that were once easy to treat now linger dangerously; hospital stays are prolonged; treatment costs rise sharply; and mortality rates creep upward. Many Nigerians have experienced this firsthand, taking an antibiotic only to find that the infection stubbornly persists. Across the country, resistance to commonly used antibiotics such as amoxicillin, ciprofloxacin, and ceftriaxone is rising with worrying speed. Even medicines considered “last line” in global practice are gradually losing their effectiveness here. Doctors now frequently resort to expensive, hard-to-access alternatives, placing additional financial strain on already burdened families.
A global problem with local consequences: AMR is not a Nigerian problem alone. It is a global crisis, one that travels as easily and freely as human beings do. In an interconnected world where international travel is routine, resistant microbes can move from one continent to another in a matter of hours. A person may acquire a resistant strain in one country and, without knowing it, introduce it into another. This reality underscores why the global health community treats AMR as a borderless threat. Yet, while AMR spreads globally, the severity of its impact varies dramatically across nations. And this is where Nigeria finds itself in a uniquely vulnerable position.
Why Nigeria’s outcomes may be worse: Antimicrobial resistance may be global in origin, but its consequences are disproportionately harsher in countries with weak health systems. Nigeria, like many low- and middle-income nations, faces a combination of challenges that worsen AMR outcomes: – overcrowded health facilities, inadequate diagnostic capacity, inconsistent infection prevention practices, widespread over-the-counter access to antibiotics, poor sanitation, and high out-of-pocket healthcare costs. Even when resistant infections travel across borders, they produce grave outcomes in countries where early detection is limited and treatment delays are common. In nations with strong health systems, a resistant infection may be detected early and contained. In Nigeria, the same infection can escalate rapidly, with far more serious consequences. This imbalance makes AMR not only a medical problem but also a matter of health equity and social justice.

Every exposure matters—Even the correct ones

A common belief is that AMR arises only from misuse of antibiotics. While misuse is indeed a major driver, science shows that every exposure to antibiotics, whether correct or incorrect creates selection pressure that strengthens resistant bacteria. This means that reducing unnecessary infections and limiting antibiotic exposure is one of the most effective ways to slow resistance. Good hygiene, vaccination, access to clean water, and improved sanitation are not just public health ideals. They are the frontline tools in the fight against AMR.
The food chain and the one health reality: Globally, more than two-thirds of antibiotics are used in animals, often not to treat illness but to promote growth or prevent disease in crowded farms. Nigeria’s growing livestock and aquaculture sectors contribute to this challenge. Resistant bacteria from farms can move into the human population through food, the environment, and direct contact. AMR demands a One Health response, integrating human health, animal health, and environmental systems.
What must be done? For individuals, avoid self-medication, do not pressure health workers for antibiotics, complete prescriptions as directed, practice good hygiene, ensure proper food handling and cooking. For health workers: prescribe antibiotics only when necessary, use diagnostic tests where possible, strengthen infection prevention and control, educate patients and communities. For government: enforce prescription-only antibiotic sales, improve access to clean water and sanitation, strengthen surveillance and laboratory systems, regulate antibiotic use in agriculture, invest in research, vaccines, and alternative therapies.

The future we must prevent

Without urgent action, Nigeria risks sliding into a post-antibiotic era where minor infections become life-threatening, surgeries become high-risk, cancer treatment becomes hazardous, and medical advances painstakingly built over decades are eroded. This is not a distant fear. It is a trajectory we have already begun. The battle against AMR is, at its core, a battle for survival—of our health system, our communities, and future generations. The awareness week may have passed, but our responsibility remains. The choices we make today will determine whether antibiotics remain a cornerstone of modern medicine or become a relic of the past. Nigeria must act now. The cost of inaction is continued threat to our health and future!

•Dr Adetoye is a pharmaceutical microbiologist / AMR & probiotic researcher