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Abstract
The use of self-prescribed antibiotics is a public health problem, which could lead to the development of antimicrobial resistance (AMR) and inappropriate antibiotic use. Students at university are an important population to evaluate antibiotic usage and awareness of antibiotic resistance. The objectives of this study were to find the prevalence and trend of antibiotic self-medication, knowledge and awareness level of AMR and factors associated with AMR self-medication among the students of Bahauddin Zakariya University (BZU), Multan, Pakistan. A total of 427 undergraduate and post graduate students were used in an analytical cross-sectional study. The sociodemographic data, use of antibiotics, source of antibiotics and reasons for self-medication were collected with a structured questionnaire and AMR knowledge was evaluated using a closed-ended questionnaire. Descriptive statistics, chi-square tests and binary logistic regression were used to explore the prevalence and risk factors of antibiotic self-medication. 60.0% of the participants reported self-medication with antibiotics in the last 12 months. Pharmacies with no current prescription were the most frequently reported site of purchase of antibiotics (55.9%) and the most common indication for use was upper respiratory symptoms (35.5%). While 88.1% agreed that using antibiotics inappropriately helps to spread AMR, only 64.2% were correct that antibiotics are not effective against viral infections. There was a negative association between high AMR knowledge and self medication (adjusted odds ratio: 0.53; 95% confidence interval: 0.31–0.90; P = 0.019). The results emphasize the need to enhance AMR awareness, responsible use of antibiotics, and access to healthcare professionals among university students. Training for antimicrobial stewardship campaigns could be a way of addressing knowledge gaps and inappropriate antibiotic-use practices.