This review aims to assess the extent of microbial contamination in over-the-counter (OTC) drugs, highlighting the importance of quality control in the pharmaceutical industry. Microbial contamination in OTC drugs poses significant risks to public health, particularly as these products are widely available for self-administration without healthcare supervision. It explores the common sources of contamination, including manufacturing practices, storage conditions, and packaging materials. The review further examines regulatory guidelines from organizations such as the WHO, USP, and BP, which set acceptable microbial limits for pharmaceuticals. A comprehensive search was conducted across multiple databases, including PubMed, Google Scholar, ScienceDirect, and JSTOR. Various microbial testing methods, including traditional techniques such as Total Viable Count (TVC) and newer rapid testing methods, are discussed as tools for ensuring the microbiological safety of OTC products. Additionally, the review addresses case studies of contaminated OTC drugs, identifying factors contributing to contamination and their public health impact. Finally, emerging technologies and strategies for minimizing microbial contamination are explored, with a focus on advancements in filtration, nanotechnology, and regulatory enforcement. The review concludes by emphasizing the need for stringent quality control measures, robust microbial testing, and continued innovation to safeguard public health and improve the safety of OTC drugs.