When Knowledge Fails: The Paradox of Education and Antibiotic Misuse in Sulaymaniyah, Northern Iraq

Background: Antibiotics have revolutionized modern medicine, drastically reducing morbidity and mortality from bacterial infections. Antibiotic misuse is a global health concern, despite increased education levels, antibiotic misuse remains a persistent public health challenge in Iraq. This study explores the prevalence and predictors of inappropriate antibiotic use in Sulaymaniyah, with a special focus on the unexpected relationship between higher education and misuse. Objective: This study investigates the prevalence, patterns, and predictors of inappropriate antibiotic use in Sulaymaniyah City, with a focus on the paradoxical link between education and misuse. Methods: A descriptive cross-sectional survey was conducted between August and November 2024. A total of 100 general public participants and 50 community pharmacists were surveyed using structured questionnaires. Descriptive statistics, chi-square tests, and binary logistic regression were performed to evaluate factors associated with misuse. Results: Antibiotic misuse was highly prevalent: 60% self-medicated without professional advice, 80% stopped treatment prematurely, and 72% used antibiotics for viral infections like colds. Surprisingly, individuals with higher education were significantly more likely to misuse antibiotics (OR = 2.68; 95% CI: 1.02–7.03; p = 0.045), as were males (OR = 6.78; 95% CI: 2.56–17.99; p < 0.001). Amoxicillin was the most commonly used antibiotic (31%). Conclusion: This study reveals a behavioural paradox—where higher education correlates with misuse—highlighting the need for behaviour-specific interventions, improved prescription policies, and targeted community education.