Parental Awareness and Practices of Self-medication with Antibiotics among Hospitalised Children in Pakistan: Findings and Implications from a Cross-sectional Study

Introduction: Antimicrobial resistance (AMR) is a global threat appreciably impacting on morbidity, mortality and costs, especially in low- and middle-income countries. The excessive use of antibiotics, especially in ambulatory care, is a primary factor increasing AMR. This includes inappropriate dispensing of antibiotics without a prescription for essentially viral infections, which is prevalent in Pakistan. This needs addressing to reduce AMR. Materials and Methods: A cross-sectional study was conducted among three district hospitals to extract data from parents of children up to 12 years concerning their awareness, practices and rationale of self-medication with antibiotics for their children. Results: Four hundred and thirty-eight parents participated in the study, with the majority between 30 and 39 years (65.5%) and possessing secondary school education (28.5%). 27.6% of parents stated that they knew the name of at least one antibiotic, with the majority knowing the name of amoxicillin (33%) and co-amoxiclav (19%). The prevalence of self-medication for their children was high at 63%, principally for self-limiting conditions including sore throats (27.1%), high fever (22.4%), nasal discharges (20.9%) and coughs (17.7%). The most commonly consumed antibiotics among their children were amoxicillin (33.6%), co-amoxiclav (18.1%) and azithromycin (15.2%), with the common reasons for self-medication including similar signs and symptoms to before (42.6%) and financial constraints (39%). Increasing education levels and familiarity with antibiotic names were associated with higher antibiotic usage ( P < 0.001). Conclusions: Self-medication with antibiotics among their children for essentially self-limiting conditions was common. Appropriate corrective measures, including targeted educational initiatives, are urgently need to address ongoing concerns and associated rising AMR.