Household Antibiotic Storage Practices and Seasonal Respiratory Infection Transmission Patterns in Crowded Urban Communities
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Background: Household retention of antibiotics may facilitate self-medication and delayed healthcare-seeking, particularly in crowded communities experiencing frequent respiratory illness. Objective: To determine the prevalence and characteristics of household antibiotic storage and examine its associations with crowding, self-medication, respiratory illness episodes, symptom duration, and healthcare consultation delay. Methods: A community-based analytical cross-sectional study included 85 households from high-density industrial and urban communities in Punjab, Pakistan, between October 2025 and January 2026. Household antibiotic inventories, respiratory illness reports, crowding indices, and healthcare-use measures were assessed. Group comparisons, correlation analysis, and multivariable regression were performed. Results: Antibiotic stockpiles were identified in 58 households (68.2%). Of 412 stored doses, 44.2% were beta-lactams and 32.8% were macrolides. Crowding correlated with stored doses (r = 0.61, p < 0.001), respiratory episodes (r = 0.48, p = 0.003), and symptom duration (r = 0.39, p = 0.012). Stockpile-positive households reported longer symptoms (8.4 ± 2.1 vs 5.9 ± 1.8 days), more self-medication incidents (2.3 ± 1.1 vs 0.4 ± 0.6), and longer consultation delays (4.8 ± 1.6 vs 2.1 ± 1.2 days; all p < 0.001). Stored antibiotic volume (β = 0.47, p < 0.001) and crowding (β = 0.38, p = 0.002) were independently associated with self-medication frequency. Conclusion: Household antibiotic storage was common and was associated with crowding, self-medication, prolonged reported symptoms, and delayed consultation. Prospective research is required to determine temporality
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