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Self-medication with Antibiotics in WHO Southeast Asian Region: A Systematic Review
Open accessAbstract
Antibiotics are essential treatments, especially in the developing world like World Health Organization (WHO) Southeast Asian region where infectious diseases are still the most common cause of death. In this part of the world, antibiotics are purchased and used without the prescription of a physician. Self-medication of antibiotics is associated with the risk of inappropriate drug use, which predisposes patients to drug interactions, masking symptoms of an underlying disease, and development of microbial resistance. Antibiotic resistance is shrinking the range of effective antibiotics and is a global health problem. The appearance of multidrug-resistant bacterial strains, which are highly resistant to many antibiotic classes, has raised a major concern regarding antibiotic resistance worldwide. Even after decades of economic growth and development in countries that belong to the WHO Southeast Asian region, most of the countries in this region still have a high burden of infectious diseases. The magnitude and consequence of self-medication with antibiotics is unknown in this region. There is a need for evidence from well-designed studies on community use of antibiotics in these settings to help in planning and implementing specific strategies and interventions to prevent their irrational use and consequently to reduce the spread of antibiotic resistance. To quantify the frequency and effect of self-medication with antibiotics, we did a systematic review of published work from the Southeast Asian region.
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“Among the different channels from which patients in LMICs can access antibiotics, CDROs have been identified to be a predominant source of antibiotics for the wider population [19–22].”
From No prescription? No problem: drivers of non-prescribed sale of antibiotics among community drug retail outlets in low and middle income countries: a systematic review of qualitative studies (2021) · cites this paper as [21]
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“This finding aligns with research by Gaurav Nepal et al, which reported that 79.6% of pharmacies in Nepal dispensed antibiotics for URI without a prescription. 17”
From Evaluation of antibiotic dispensing without prescription by community pharmacies: a simulated patient study (2025) · cites this paper as [17]
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“Self-medication with antibiotics (SMA) contributes to accelerating the emergence and spread of antimicrobial resistance (AMR) [1, 7, 8].”
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“In addition, studies were conducted in Indonesia and WHO Southeast Asia region revealed that amoxicillin was predominated [17,31].”
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“In the Southeast Asian region, antibiotics are used without proper prescription from doctors, which leads to the development of drug-resistant microorganisms (Nepal and Bhatta 2018).”
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“A systematic review showed that the prevalence of self-medication of antibiotics is around 50% in the southeast Asian region [24].”
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“It was encouraging to see no self-purchasing of antibiotics to treat ARIs in this study in Namibia unlike the situation in a number of other African countries or those in Asia.[5,6,18,20-22] This confirms our hypothesis.”
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“In addition to this, the most common reasons behind the frequent practice of self-medication with antibiotics (SMA) among the population of LMICs were prior good experience, easy availability of antibiotics, ignorance regarding the seriousness of the disease, and easily affordable in terms of time and money, knowledge…”
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“A lack of public knowledge about antibiotic use, attitudes toward antibiotic use and resistance, easy access to antibiotics in many places, and a lack of awareness of the policies regarding rational antibiotic use are all factors that can influence irrational antibiotic use [11, 12].”
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“However, SMPs can promote the occurrence of drug addiction, enhance the risk of drug interactions and adverse drug reactions, foster the occurrence of drug toxicity, increase resistance to pathogens, waste resources, increase polypharmacy, and ultimately lead to incorrect diagnosis and poor outcomes.(3,9,12,13) Accord…”
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“Additionally, SMA is promoted by lack of antibiotic use knowledge [44], previous recovery experiences [45], and keeping antibiotics at home [46].”
Investigating forthcoming strategies to tackle deadly superbugs: current status and future vision
Mitra, S., Sultana, S. A., Prova, S. R., Uddin, T. M., Islam, F., Das, R. C., Nainu, F., Sartini, S., Chidambaram, K., Alhumaydhi, F. A., et al. (2022) · Expert Review of Anti-infective Therapy · doi:10.1080/14787210.2022.2122442 · Cited by 29
Rapid diagnosis and precision treatment of Helicobacter pylori infection in clinical settings
Umar, Z., Tang, J., Marshall, B. J., Tay, C. Y., & Wang, L. (2024) · Critical Reviews in Microbiology · doi:10.1080/1040841x.2024.2364194 · Cited by 27
“…which encompasses eight countries and constitutes a quarter of the global population, there exists a notable incidence of antibiotic resistance (Nepal and Bhatta 2018; Shrestha et al. 2023). to attain thorough elimination of H. pylori infections and alleviate their persistent diseases, a deep…”
Lin, L. K., Fearon, E., Harbarth, S., Wang, X., Lu, C., Zhou, X., & Hargreaves, J. (2020) · BMJ Open · doi:10.1136/bmjopen-2020-039332 · Cited by 27
Public knowledge, attitudes and practices surrounding antibiotic use and resistance in Cambodia
Lim, J. M., Chhoun, P., Tuot, S., Om, C., Krang, S., Ly, S., Hsu, L. Y., Yi, S., & Tam, C. C. (2021) · JAC-Antimicrobial Resistance · doi:10.1093/jacamr/dlaa115 · Cited by 26
Mannan, A., Chakma, K., Dewan, G., Saha, A., Chy, N. U. H. A., Mehedi, H. M. H., Hossain, A., Wnaiza, J., Ahsan, M. T., Rana, M. M., et al. (2024) · BMJ Open · doi:10.1136/bmjopen-2022-071504 · Cited by 25
“29 30 An investigation in Dhaka revealed that 75% of the people polled used over- the-counter drugs, of which 16.90% were antibiotics.”
BackgroundInfluentialSunpuwan, M., Punpuing, S., Jaruruengpaisan, W., Kinsman, J., & Wertheim, H. F. L. (2019) · BMC Public Health · doi:10.1186/s12889-019-7300-5 · Cited by 27
“The use of self-medication is also related to a lack of enforcement of law and regulations, which enables easy over-the-counter access to medicine [27].”
BackgroundMandal, N. K., Rauniyar, G. P., Rai, D. S., Panday, D. R., Kushwaha, R. P., Agrawal, S. K., & Regmee, P. (2020) · Journal of Nepal Medical Association · doi:10.31729/jnma.4914 · Cited by 26
Ghimire, K., Banjara, M. R., Marasini, B. P., Gyanwali, P., Poudel, S., Khatri, E., & Dhimal, M. (2023) · Microbiology Insights · doi:10.1177/11786361231167239 · Cited by 25
“4,23,24,46 Dispensing antibiotics without prescription have became common practices especially in low income countries.”
BackgroundNursing students’ perceived consequences of self-medication: a qualitative study
Khatony, A., Soroush, A., Andayeshgar, B., & Abdi, A. (2020) · BMC Nursing · doi:10.1186/s12912-020-00460-8 · Cited by 28
Khan, F. U., Mallhi, T. H., Khan, Q., Khan, F. U., Hayat, K., Khan, Y. H., Ahmad, T., & Fang, Y. (2022) · Frontiers in Medicine · doi:10.3389/fmed.2022.962657 · Cited by 24
The epidemiology of typhoid fever in the Dhulikhel area, Nepal: A prospective cohort study
Petersiel, N., Shresta, S., Tamrakar, R., Koju, R., Madhup, S. K., Shresta, A., Bedi, T., Zmora, N., Paran, Y., Schwartz, E., et al. (2018) · PLoS ONE · doi:10.1371/journal.pone.0204479 · Cited by 24
Wang, L., Liang, C., Yu, H., Zhang, H., & Yan, X. (2022) · BMC Public Health · doi:10.1186/s12889-022-13729-1 · Cited by 23
“A review showed that the prevalence of antibiotic selfmedication in South East Asia is around 50% [10], and approximately 43% of patients worldwide use antibiotics to treat respiratory infections [11].”
BackgroundHirwa, E. M., Mujawamariya, G., Shimelash, N., & Shyaka, A. (2024) · PLoS ONE · doi:10.1371/journal.pone.0300742 · Cited by 22
Patterns of Drug Utilization and Self-Medication Practices: A Cross Sectional Study
Al-Omrani, H., Marwah, M. K., Al-Whaib, R., Mekkawy, M., & Shokr, H. (2023) · Pharmacy · doi:10.3390/pharmacy11060183 · Cited by 27
“…is primarily prevalent in economically deprived countries and developing nations, where health literacy, fewer restrictions on the sale of drugs, limited healthcare resources, and high healthcare costs can make it difficult for individuals to seek medical attention for minor health issues [22–24].”
BackgroundKong, L. S., Islahudin, F. H., Muthupalaniappen, L., & Chong, W. W. (2021) · Patient Preference and Adherence · doi:10.2147/ppa.s328890 · Cited by 25
Khirikoekkong, N., Asarath, S.-A., Munruchaitrakun, M., Blay, N., Waithira, N., Cheah, P. Y., Nosten, F. H., Lubell, Y., Landier, J., & Althaus, T. (2023) · BMC Infectious Diseases · doi:10.1186/s12879-023-08482-8 · Cited by 21
Duan, Z., Liu, C., Han, M., Wang, D., Zhang, X., & Liu, C. (2020) · Research in Social and Administrative Pharmacy · doi:10.1016/j.sapharm.2020.07.033 · Cited by 23
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Sono, T. M., Mboweni, V., Golić-Jelić, A., Campbell, S., Marković‐Peković, V., Ramdas, N., Schellack, N., Kumar, S., Godman, B., & Meyer, J. C. (2024) · Advances in Human Biology · doi:10.4103/aihb.aihb_119_24 · Cited by 19
Saleem, Z., Faller, E. M., Godman, B., Malik, M. S. A., Iftikhar, A., Iqbal, S., Akbar, A., Hashim, M., Amin, A., Javeed, S., et al. (2021) · Medicine Access Point of Care · doi:10.1177/23992026211064714 · Cited by 19
“One of the reasons for the increasing spread of AMR in this region is the high rate of irrational use of antibiotics (37-40).”
BackgroundAlmalki, M. E., Almuqati, F. S., Alotaibi, M. O., Makki, S. Y., Alqasem, M. A., Alsharif, F., & Hassan-Hussein, A. (2022) · Cureus · doi:10.7759/cureus.29944 · Cited by 24
“For example, the WHO has cautioned against growing antibiotic resistance due to self-medication with antibiotics [7].”
Knowledge and practices related to antibiotic use among women in Malang, Indonesia
Yunita, S. L., Yang, H.-W., Chen, Y., Kao, L., Lu, Y.-Z., Wen, Y.-L., To, S.-Y., & Huang, Y. (2022) · Frontiers in Pharmacology · doi:10.3389/fphar.2022.1019303 · Cited by 19
“Inappropriate antibiotic use is reportedly higher in low- and middle-income countries (Nepal and Bhatta, 2018).”
BackgroundHassan, B. A. R., Mohammed, A. H., Al‐Jewari, W. M., Blebil, A. Q., Dujaili, J. A., Wayyes, A. M., Malaeb, D. N., Dabbous, M., Othman, G. Q., Madani, A. M., et al. (2023) · Journal of Pharmaceutical Health Services Research · doi:10.1093/jphsr/rmad014 · Cited by 19
Ayenew, W. A., Tessema, T. A., Anagaw, Y. K., Siraj, E. A., Zewdie, S., Simegn, W., Limenh, L. W., Tafere, C., & Yayehrad, A. T. (2024) · Antimicrobial Resistance and Infection Control · doi:10.1186/s13756-024-01417-1 · Cited by 19
“…conducted globally corroborate these findings and suggest a consistent pattern where individuals tend to self-medicate with antibiotics for similar perceived illnesses/symptoms across different regions, emphasizing the need for targeted education on appropriate antibiotic use [13, 16, 34, 40].”
BackgroundResultInfluentialDarweesh, O., Kurdi, A. B., Merkhan, M. M., Ahmed, H., Ibrahem, S., Al-Zidan, R. N., Meyer, J. C., & Godman, B. (2025) · Antibiotics · doi:10.3390/antibiotics14040376 · Cited by 23
“The misuse of antibiotics is a complex issue influenced by a variety of factors, incorporating cultural and behavioral characteristics, including self-medication for mild childhood infections, socioeconomic factors, and educational aspects [41–43].”
(2021) · Pharmacy Education · doi:10.46542/pe.2021.212.152162 · Cited by 18
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Evaluation of Self-Medication with Antibiotics in Primary Care Clinics in Palestine
Naseef, H., Joza’, D., Awawdeh, A., Hasan, A., Abukhalil, A. D., Al-Shami, N. A., & Rabba, A. (2022) · Patient Preference and Adherence · doi:10.2147/ppa.s384671 · Cited by 17
“A very high prevalence of SM has been reported in Southeast Asian countries.(15) The problem is more apparent in undeveloped countries since access to medications without a prescription is simple and easy, resulting in several adverse effects, particularly bacterial resistance.”
BackgroundAntimicrobial Dispensing Practices during COVID-19 and the Implications for Pakistan
Gul, B., Sana, M., Saleem, A., Mustafa, Z. U., Salman, M., Khan, Y. H., Mallhi, T. H., Sono, T. M., Meyer, J. C., & Godman, B. (2023) · Antibiotics · doi:10.3390/antibiotics12061018 · Cited by 17
Antibiotics resistance mechanism
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Holm, M., Zellweger, R. M., Poudyal, N., Smith, K. H., Joh, H. S., & Marks, F. (2022) · Frontiers in Tropical Diseases · doi:10.3389/fitd.2022.805833 · Cited by 16
Nguyen, N. V., Marothi, Y., & Sharma, M. (2022) · Antibiotics · doi:10.3390/antibiotics11111473 · Cited by 18
“Additionally, according to a systematic review, URTI was the most common reason for self-medication with antibiotics in the southeast Asian region, including India [20].”
BackgroundKalpana, P., Yasobant, S., Saxena, D. B., & Schreiber, C. (2024) · Microorganisms · doi:10.3390/microorganisms12112267 · Cited by 16
Infodemic, self-medication and stockpiling: a worrying combination
Ahmad, S., Babar, M. S., Essar, M. Y., Sinha, M., & Nadkar, A. A. (2021) · Eastern Mediterranean Health Journal · doi:10.26719/emhj.21.010 · Cited by 16
“For example, irrational usage of amoxicillin may have adverse effects such as medication tolerance and nil response to treatment in acute otitis media, pneumonia, and urinary tract infections where amoxicillin is considered as a firstline antibiotic (6).”
BackgroundHasanuzzaman, M., Saha, S., Malaker, R., Rahman, H., Sajib, M. S. I., Das, R. C., Islam, M., Hamer, D. H., Darmstadt, G. L., & Saha, S. K. (2021) · The Journal of Infectious Diseases · doi:10.1093/infdis/jiab073 · Cited by 15
“Use of antibiotics prior to seeking care is widespread in many low- and middle-income countries, making it difficult to detect pathogenic bacteria by traditional bacteriological culture [6, 18].”
BackgroundMustafa, Z. U., Iqbal, S., Asif, H. R., Salman, M., Jabbar, S., Mallhi, T. H., Khan, Y. H., Sono, T. M., Schellack, N., Meyer, J. C., et al. (2023) · Antibiotics · doi:10.3390/antibiotics12030481 · Cited by 24
Metadata
- Authors
- Nepal, G., & Bhatta, S.
- Affiliations
- Tribhuvan University (NP)
- Corresponding author
- Nepal, Gaurav
- ORCID
- Nepal, Gaurav
- Venue
- Cureus
- Published
- 2018-04-05
- Volume
- 10
- Issue
- 4
- Pages
- e2428-e2428
- ISSN
- 2168-8184 (ISSN-L)
- PMC
- PMC5988199
- OpenAlex
- W2796257797
- Cited by
- 272
- References
- 38
- Citations by year
- 2026: 6 · 2025: 36 · 2024: 35 · 2023: 55 · 2022: 42 · 2021: 43 · 2020: 31 · 2019: 23 · 2018: 1
- FWCI
- 3.00
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by
- Locations
- Cureus (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antibiotic Use and Resistance
- Health Sciences › Medicine › Microbiology (medical) › Antibiotic Resistance in Bacteria
- Physical Sciences › Environmental Science › Pollution › Pharmaceutical and Antibiotic Environmental Impacts
- Keywords
- self-medication, antibiotics, antibiotic resistance, multidrug resistance, inappropriate medication use, community antibiotic use, Southeast Asia, infectious diseases, antimicrobial stewardship
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