Self-medication with antibiotics: a pervasive risk factor for antibiotic resistance and public health concerns

“Additionally, 223,900 cases of C. difficile led to 12,800 deaths in 2017, underscoring the need for continued vigilance and action[58].”

“Key drivers include inadequate sanitation, infection control, healthcare access, awareness, and regulatory enforcement[57] .”

“Overuse of antibiotics can accelerate this process, leading to the emergence of multidrug-resistant strains[22].”

“The rise of multidrug-resistant bacterial strains has heightened global concerns over antibiotic resistance, leading to longer illnesses, more frequent medical visits, extended hospitalizations, the use of costly alternative treatments, and, in some cases, fatalities[4].”

“This “antibiotic resistance crisis,” worsened by slow antibiotic development, threatens essential medical practices[6].”

“Most of these campaigns targeted both the public and physicians, and they showed a reduction in antibiotic consumption, although their impact on antimicrobial resistance remains unclear[28].”

“Factors include high healthcare costs and lack of strict regulations on antibiotic sales, as reported in studies with inconsistent findings[8].”

“Antibiotics, crucial for treating bacterial infections, are often obtained without prescriptions, accounting for 62% of purchases, particularly in developing nations[7].”

“The prevalence of antibiotic resistance in common disease-causing microorganisms is consistently observed to be greater in nations with higher rates of antibiotic consumption[21].”

“The lack of alternative antibiotics, ignorance and disregard of the risks of misuse, and the general public's lack of knowledge have contributed to the emergence of this global crisis[5].”

“Penicillins were often obtained from stored drugs and non-prescription sources, primarily for respiratory issues, with both positive and negative health outcomes observed[10].”

“However, high between-study heterogeneity and methodological issues limited the interpretation, with inappropriate prescribing rates ranging from 8% to 100%[38].”

“Key drivers included health conditions like respiratory infections, toothaches, affordability, and healthcare access[35].”

“The practice of taking antibiotics for self-diagnosed conditions without first consulting a qualified healthcare professional is referred to as antibiotic self-medication[2].”

“Practices had significant potential for reducing inappropriate prescribing, with reduction estimates ranging from 6.4% to 43.5%[62].”

“…studies and found that the prevalence of self-medication ranged from 12.8% to 77.1%, primarily for fever, gastrointestinal, and respiratory symptoms, involving the use of analgesics and antimicrobials often obtained from retail pharmacies or recommended by pharmacy staff and acquaintances[11].”

“The inappropriate drug use practices common in self-medication include short treatment duration, inadequate dosage, sharing of medicines, and discontinuation of treatment upon symptom improvement[3].”

“Central Africa reports high SMA rates, including 82.2% in Nigeria and 79% in Guatemala[36].”

“431 students were included, 50.1% self-medicated, 47.6% used antibiotics, and 77.3% were aware of adverse effects[26].”

“In resource-constrained settings with limited primary healthcare access, people conveniently use retail drug outlets to promptly treat some less severe illnesses[16].”

“SMA rates ranged from 50% to 93.8%, with antibiotics sourced mainly from pharmacies, family/friends, old prescriptions, home cabinets, and leftovers[37].”

“Antimicrobial resistance (AMR) poses a significant global public health threat, with projections suggesting up to 10 million deaths annually by 2050 if not effectively addressed[64].”

“Commonly used antibiotics included penicillins, and primary sources were pharmacies and family[41].”

“The detection of colistin resistance genes in community patients emphasizes the pressing need for effective AMR control measures in China[31].”

“However, effective implementation requires adapting conventional microbiological techniques, ensuring quality assurance, and integrating diagnostics into clinical care[72] [73].”

“Antibiotic self-medication accelerates resistance, endangering health, especially in low-and middle-income Misuse risks adverse effects, misdiagnosis, and resistant infections due to factors like limited healthcare, unregulated access, and lo w awareness of antibiotic resistance’s dangers [59].”

“Factors contributing to this included easy access, healthcare costs, and personal networks[15].”

“Over the last few decades, the use of antibiotics as primary care has changed dramatically, leading to more multidrug-resistant infections due to increased antibiotic usage[14].”

“However, effective implementation requires adapting conventional microbiological techniques, ensuring quality assurance, and integrating diagnostics into clinical care[72] [73].”

“Approximately one-third of pharmacy staff dispensed antibiotics without prescriptions, and improved knowledge was associated with a reduction in illegal dispensing[48].”

“Younger age was a risk factor in high-income countries, while greater antibiotic knowledge reduced self-medication in low-and middle-income countries[40].”

“This practice, especially prevalent in treating self-limiting illnesses in children, contravenes WHO guidelines and poses substantial public health risks[17].”

“In this study, 27% reported self-medication with antibiotics, which is higher than in Australia but lower than in Kosovo[32],[33].”

“Higher perceived barriers to healthcare correlated with increased SMA, while higher perceived self-medication risks and self-efficacy correlated with reduced SMA (p 0.05)[43].”

“Increased public health education is needed to promote responsible antibiotic use[19].”

“While interventions improved awareness and reduced children's self-medication, parental patterns of irrational antibiotic provision remained unchanged[23].”

“%) understood that antibiotic resistance develops when the body becomes resistant to these medications[13].”

“Greater perceived threats and self-efficacy were associated with reduced self-medication, whereas perceived barriers increased the likelihood of it[34].”

“Conversely, self-medication increased with frequent non-prescription antibiotic purchases, family advice, older child age, and recent antibiotic use[25].”

“Educating the public about AMR risks increased the willingness to prioritize societal health over personal use, though the symbolic value and perceived necessity of antibiotics remained significant influences[29].”

“No significant associations were identified with demographic factors[47].”

“In this study, 27% reported self-medication with antibiotics, which is higher than in Australia but lower than in Kosovo[32],[33].”

“Participants aged 36 – 40 and 51+, married/divorced, employed, or with chronic illnesses exhibited higher self-medication rates (p 0.05)[42].”

“Community pharmacies were the main source (87.1%), driven by convenience and access, and amoxicillin/clavulanic acid was the most commonly used antibiotic[12].”

“Successful AMR containment requires the implementation of antimicrobial stewardship programs (ASPs), which aim to optimize antibiotic use, enhance patient outcomes, minimize adverse effects, slow the development of resistance, and preserve valuable healthcare resources [66].”

“The World Health Organization considers antimicrobial resistance a threat to global security and a detriment to health initiatives[63].”

“Medical and allied health students often lack adequate education on antimicrobial resistance and stewardship, highlighting the importance of improving curricula to support future healthcare professionals[71].”

“This collaborative approach fosters policy development, research, and regional expansion[69].”

“The study also highlighted significant antimicrobial resistance, including multidrug-resistant strains and increased resistance to nitrofurantoin and Fosfomycin [74].”

“Main antibiotics were azithromycin (34%), amoxicillin/clavulanic acid (22%), and metronidazole (16%), commonly for respiratory and gastrointestinal symptoms[45].”

“%) of medical students self-medicated with antibiotics, primarily for common ailments, using azithromycin and amoxicillin, often relying on previous prescriptions or their knowledge, despite recognizing the risks of antibiotic resistance[18].”

“Factors associated with self-medication were older parental age, familiarity with antibiotics, and a knowledge score greater than 2[27].”

“While the participants expressed concern over AMR, they felt uncertain about its societal impact and viewed antibiotics as necessary, indicating a lack of confidence in managing their condition without antibiotics[30].”

“%) and cold medicines (29.5%)[46].”

“High income, healthcare-employed family members, antibiotic stockpiling, and purchasing without prescriptions increased SMA likelihood, with contributing factors spanning individual, healthcare, pharmacy, and social influences[39].”

“A study in Aden, Yemen, found that many people misused antibiotics, often taking them for viral infections like the common cold, despite recognizing the risk of antibiotic resistance and relying on self-medication without completing full courses of antibiotics[20].”

“The rising threat of AMR is closely linked to increasing antibiotic dependence, often driven by pharmaceuticalization in disease programs, with tuberculosis (TB) being a major contributor [65] [66].”

“Inappropriate antibiotic use, including self-medication, has also resulted in adverse drug reactions and altered disease manifestations, further exacerbating the issue of antimicrobial resistance in low-and middle-income countries[9].”

“In Shastri Nagar, Patna, a study of 173 caregivers found that mothers and post-graduates had better awareness of antibiotic use, while fathers understood side effects more, though misconceptions about treating viral infections were still widespread[24].”

“The key factors associated with this behavior were rural residency, easy access to antibiotics, and pharmacy staff recommendations for the general public, while for health professionals, it was gender, health perceptions, and antibiotic knowledge[44].”

“Clinicians also noted issues in medical education and health system improvements[61].”

“A study in Belgian hospitals developed 38 process quality indicators (QIs) to evaluate and improve antimicrobial stewardship, focusing on adherence to guidelines, documentation, resistance patterns, and antibiotic prescribing practices[70].”

“Additionally, a study by Sezerano and Niyonkuru in 2024 highlights that self-medication is a key driver of antibiotic resistance, with a pooled global prevalence of 27.7% [14].”

“Global prevalence of antibiotic self-medication averages 27.7%, with wide regional variation, and national surveys report high rates in countries like Thailand, Jordan, and Brazil [3,11–14].”

“Self-medication with Antibiotics (SMA), the practice of obtaining and using antibiotics without formalized medical guidance, serves as a major systemic vulnerability bypassing critical diagnostic and prescribing safeguards [2, 3].”