Prevalence, patterns, and factors associated with antibiotic self-medication among university students in Erbil, Iraq: a cross-sectional study

Inappropriate antibiotic use is a major driver of the emergence and spread of antimicrobial resistance. This study aimed to assess the prevalence, patterns, and factors associated with antibiotic self-medication among university students in Erbil, Iraq, as the student population serves as a sentinel group for monitoring antibiotic-use behaviors. A cross-sectional study was conducted in Erbil, Iraq, from November 27, 2025, to March 3, 2026. Data were collected from a convenience sample of 354 university students using a researcher-developed self-administered questionnaire. The prevalence of antibiotic self-medication over the last three months was 26.6% (95% CI 22.0-31.2). The main illnesses leading to self-medication were upper respiratory tract infection (63.8%) and fever (16%). The reasons for self-medication rather than visiting a health facility included considering the disease not serious (28.7%) and seeking quick relief (26.6%). Self-medication with antibiotics was significantly higher ( P = 0.010) among students living in student hostels (40.4% (95% CI 27.6–53.1)) than among those living with family (23.9% (95% CI 19.1–28.8)). It was also significantly higher ( P = 0.018) among those enrolled in health-related disciplines (31.6% (95% CI 25.0-38.2)) than among those enrolled in non-health-related disciplines (20.5% (95% CI 14.3–26.7)). Living in a student hostel was significantly independently associated with antibiotic self-medication (aOR = 3.67, 95% CI: 1.40–9.64, P = 0.008). Antibiotic self-medication was relatively common among university students in Erbil, particularly among hostel residents and students in health-related disciplines. Inappropriate practices, including antibiotic use for minor illnesses, use without medical consultation, and premature treatment discontinuation, were frequently reported. Based on these findings, universities need targeted antimicrobial stewardship interventions through educational programs for students in health-related disciplines and hostel residents, emphasizing appropriate antibiotic use and the importance of completing treatment. Health authorities should also strengthen enforcement of existing regulations against dispensing antibiotics without a prescription and emphasize the role of community pharmacies in promoting responsible antibiotic use. It is recommended to regularly monitor antibiotic self-medication among university students to assess the effectiveness of these measures.