This study analyzed antimicrobial consumption (AMC) data in Tanzania for the years 2020–2022, building on previous work from 2017–2019, to assess emerging trends. The average defined daily dose (DDD) per 1000 inhabitants (DID) was 38.27. Notably, there was a nearly 3-fold increase in macrolide consumption, driven by azithromycin, mainly due to its inappropriate use during the COVID-19 pandemic. Private-sector consumption increased significantly, from 75.73% in 2020 to 84.02% in 2021, before slightly decreasing to 66.82% in 2022. Access category antimicrobials met the WHO target of 60% of national consumption, while the Watch category showed a steady increase in 2021 and 2022. The findings highlight the need for urgent antimicrobial stewardship, with routine reporting by WHO’s Access, Watch, and Reserve categories to manage AMC effectively.