Non-Prescription Antibiotic Use and Unsafe Household Medicine Disposal in Indonesia: Implications for Antimicrobial Stewardship

Non-prescription access to antibiotics remains widespread in low and middle-income countries and is a major contributor to antimicrobial resistance. Unsafe household storage and disposal of medicines further reinforce inappropriate antibiotic use and environmental contamination. Yet, national evidence integrating antibiotic knowledge, medicine safety awareness, and household practices remains limited. This study examined associa-tions between antibiotic-related knowledge, awareness of damaged medicines, and non-prescription antibiotic purchase among adults in Indonesia using nationally representative survey data. A cross-sectional analysis was conducted using the 2023 Indonesian Health Survey, including 430,204 adults with complete outcome data. The primary outcome was self-reported purchase of antibiotics without a prescription. Survey-weighted modified Poisson regression models were used to estimate adjusted relative risks accounting for individual and household characteristics. Overall, 19.7% of adults reported purchasing antibiotics without a prescription. Higher risk was observed among adults aged 26 to 44 years, females, rural residents, individuals with chronic conditions or physical disabilities, and those from poorer households. Each 10-pp increase in antibi-otic-specific knowledge was associated with a lower risk of non-prescription antibiotic purchase (adjusted RR 0.97, 95% CI 0.97 - 0.98). In contrast, awareness related to damaged or expired medicines was associated with a higher risk (adjusted RR 1.04, 95% CI 1.03 - 1.04). Household medicine disposal practices were dominated by discarding medicines in household trash, while formal return to pharmacies or health facilities was rare. These findings indicate that antimicrobial stewardship requires integrated strategies addressing both rational an-tibiotic use and safe household medicine management to support progress toward Sustainable Development Goals related to health and responsible consumption.