Inappropriate antibiotic dispensing in private pharmacies is a key driver of antimicrobial resistance in Ghana. The Antibiotic Guardian Programme was introduced in Accra as a stewardship intervention to improve prescribing practices. Its impact requires systematic assessment. This systematic review aimed to evaluate the impact of the Antibiotic Guardian Programme on antibiotic prescribing patterns in private pharmacies in Accra, Ghana. The primary objective was to quantify changes in dispensing practices following the programme's implementation. A systematic search of electronic databases was conducted following PRISMA guidelines. Peer-reviewed studies and relevant grey literature evaluating the programme within Accra's private pharmacy sector were included. Studies were screened, selected, and data extracted independently by two reviewers. Study quality was appraised using appropriate tools. No primary empirical studies meeting the inclusion criteria were identified. The search revealed a significant evidence gap. Available literature consisted solely of programme descriptions and commentary pieces. Consequently, no quantitative or qualitative data on changes in prescribing patterns could be synthesised. There is a paucity of peer-reviewed evidence evaluating the impact of the Antibiotic Guardian Programme on prescribing in Accra's private pharmacies. The absence of empirical studies prevents any conclusion on the programme's effectiveness in altering dispensing behaviour. Urgent investment in robust, controlled studies is required to evaluate the programme's impact. Future research should employ standardised metrics for prescribing patterns and include longitudinal designs to measure sustained change. Programme reports should be formally published to aid evidence synthesis. Antimicrobial stewardship, antibiotic dispensing, private sector, pharmacy practice, antimicrobial resistance, Ghana, systematic review This review highlights a critical evidence gap regarding a key public health intervention and provides a methodological framework for future impact evaluations of pharmacy-based stewardship programmes in similar settings.