Diagnostic Limitations and Antibiotic Overuse in Nigerian Primary Care

Antibiotic overuse in Nigerian primary care is not only a problem of prescribing behavior. It is also closely related to the diagnostic conditions under which primary care workers make everyday clinical decisions. In many primary health facilities, limited laboratory access, delayed test results, weak referral links, and shortage of basic diagnostic support make it difficult to distinguish bacterial infections from viral or self-limiting illnesses. Under this uncertainty, antibiotics may be used as a safer and faster option, especially when patients present with fever, respiratory symptoms, diarrhea, wound infection, or childhood illness. This paper discusses how diagnostic limitations contribute to empirical prescribing and antibiotic overuse in Nigerian primary care. It also considers the influence of patient expectations, community access to antibiotics, and weak antimicrobial stewardship at the primary care level. The paper argues that reducing antibiotic overuse should not rely only on asking clinicians to prescribe less. A more realistic response requires better diagnostic support, clearer prescribing guidance, continuing training for health workers, patient education, and stronger links between primary care, pharmacies, and surveillance systems. In this sense, antibiotic stewardship in Nigerian primary care should be built around clinical uncertainty rather than separated from it.