Background: Antimicrobial resistance (AMR) constitutes a major threat to global health security. Overuse of antimicrobials is particularly common in low and middle-income countries (LMICs); however, little is known regarding the extent to which this is due to lacking national efforts to enforce rational antibiotic use in these settings. Methods: To assess the current coverage of policies and interventions reducing the risk of AMR, we invited public health experts from all 138 current LMICs to participate in an online survey. Key coverage measures were compared to those collected in the 2021 Tripartite AMR Country Self-assessment Survey (TrACSS). Results: A total of 352 completed surveys from 118 LMICs were analysed. Out of these 118 LMICs, 67% had a national action plan on AMR, 64% had legislative policies on antibiotic use, 58% had national training programs for health professionals, and 10% had a national monitoring system for antimicrobials. 51% of LMICs had specific targeted policies to limit the sale and use of protected or reserved antibiotics and 64% had policies to reduce the over-prescription of antibiotics by health workers. Even though 72% LMICs had prescription requirements, getting antibiotics without a prescription was reported to be possible in practice in 74% of LMICs. Discussion: The Results presented here suggest that there are major gaps in the implementation and enforcement of policies to reduce the risk of AMR in many LMICs. Improved monitoring of national efforts particularly in the areas of enforcement, as well as improved monitoring of antibiotic use are urgently needed. Conclusions: Legislative policies to restrict the sale and use of antimicrobials appear to be lacking in many LMICs today. Stricter enforcement of existing policies as well as improved surveillance of actual use are likely key to controlling antimicrobials use in LMICs settings. Keywords: Antimicrobial resistance, antibiotics, policies, low and middle-income countries