This systematic review examines the prevalence of substandard and falsified (SF) antimicrobials in selected East African countries. The study searched scientific literature from 2017 to February 2023, focusing on peer-reviewed articles in English published in journals and studies conducted in East Africa. Fifteen studies were included, covering four countries: Ethiopia, Kenya, Rwanda, and Tanzania. The overall percentage of samples failing at least one quality test was 22.6%, with specific failures in antibiotics (17%), antimalarials (24%), and anthelmintics (56%). Quality control parameters such as API content determination were the most commonly examined, with 93% of studies assessing this parameter. The review highlights the need for improved regulatory frameworks and technical capacity to combat the proliferation of SF antimicrobials, emphasizing the importance of well-designed prevalence studies for better understanding and addressing this issue.This systematic review examines the prevalence of substandard and falsified (SF) antimicrobials in selected East African countries. The study searched scientific literature from 2017 to February 2023, focusing on peer-reviewed articles in English published in journals and studies conducted in East Africa. Fifteen studies were included, covering four countries: Ethiopia, Kenya, Rwanda, and Tanzania. The overall percentage of samples failing at least one quality test was 22.6%, with specific failures in antibiotics (17%), antimalarials (24%), and anthelmintics (56%). Quality control parameters such as API content determination were the most commonly examined, with 93% of studies assessing this parameter. The review highlights the need for improved regulatory frameworks and technical capacity to combat the proliferation of SF antimicrobials, emphasizing the importance of well-designed prevalence studies for better understanding and addressing this issue.