Through the Pharmacist’s Lens: A Qualitative Study of Antibiotic Misuse and Antimicrobial Resistance in Brazilian Communities

Background: AMR causes a large global health burden, with approximately 4.95 million deaths linked to bacterial AMR in 2019, 1.27 million due to AMR directly. Although Brazil mandated prescriptions for systemic antibiotics in 2010/2011, self-medication and access without prescriptions continue, with community pharmacists playing a vital part in antimicrobial stewardship (AMS). This study examined antibiotic misuse and AMR in Brazil through community pharmacists’ perspectives, emphasising their dual role as professional actors and frontline observers of public behaviour. Methods: We conducted 20 semi-structured interviews with community pharmacists and performed reflexive thematic analysis of their accounts, repeating five independent analytic cycles to confirm thematic robustness. Results: Six themes were consistently identified as recounted by pharmacists in their practice contexts: Access and Self-Medication; Relationships with Healthcare Professionals; Knowledge and Beliefs about Antibiotics; Use and Adherence; Healthcare System Barriers; and Regulation and Enforcement. Pharmacists mentioned regular requests for antibiotics without prescriptions, drug reuse, and significant impact from community, i.e., from relatives, and peers. The common misunderstanding was that antibiotics treat viral illnesses. Structural issues, for instance GP appointment costs and long waits, made patients seek help from pharmacies. Due to regulation being applied inconsistently, pharmacies struggled to refuse unsuitable requests. Conclusions: Framed through pharmacists’ dual vantage as professionals and frontline observers, the findings highlight intertwined factors underpinning inappropriate antibiotic use in Brazil and support a multi-pronged intervention spanning health system strengthening, professional education, economic considerations, and community engagement.