Antibiotic Use Practices and Awareness of Antimicrobial Resistance Among Adult Patients Visiting Outpatient Departments in Pakistan
TL;DR
Antibiotic misuse was common despite relatively favorable knowledge scores, and non-prescription access, poor adherence, and limited AMR awareness represent important modifiable stewardship targets.
Abstract
Background: Inappropriate antibiotic use, self-medication, treatment discontinuation, and limited understanding of antimicrobial resistance (AMR) remain important antimicrobial-stewardship challenges, particularly in settings where antibiotics can be accessed outside formal prescribing pathways. Objective: To assess antibiotic-use patterns, inappropriate practices, antibiotic knowledge, AMR awareness, and factors associated with appropriate antibiotic use among adult outpatients in Pakistan. Methods: A cross-sectional survey was conducted among 160 adults using convenience sampling. Sociodemographic characteristics, antibiotic use during the preceding six months, indications, antibiotics used, acquisition sources, treatment behaviors, knowledge, and AMR awareness were assessed. Antibiotic practice and knowledge scores were calculated. Data were analyzed using IBM SPSS Statistics version 26.0 using descriptive statistics, chi-square tests, Mann–Whitney U test, Spearman correlation, and odds ratios with 95% confidence intervals. Results: Ninety-one participants (56.9%) had used antibiotics during the preceding six months, of whom 50 (54.9%) obtained or used antibiotics through non-prescription pathways. Cough/cold/sore throat and fever/flu-like illness accounted for 52.7% of reported indications. Failure to complete treatment and stopping antibiotics after symptomatic improvement were each reported by 56.0% of users. Although 81.2% met the predefined criterion for good knowledge, only 31.9% demonstrated appropriate practice. Only 44.4% had heard of AMR and 35.0% reported understanding its meaning. Prescription users were substantially more likely to demonstrate appropriate practice than non-prescription users (OR=9.37, 95% CI 3.27–26.85; p<0.001). Conclusion: Antibiotic misuse was common despite relatively favorable knowledge scores. Non-prescription access, poor adherence, and limited AMR awareness represent important modifiable stewardship targets. Keywords: antibiotics; antimicrobial resistance; self-medication; outpatient care; antibiotic knowledge; medication adherence; antimicrobial stewardship; Pakistan