Self-Medication with Antibiotics and Its Association with Antimicrobial Resistance Among the Pakistani Public: A Cross-Sectional Study

Abstract

Background: Self-medication with antibiotics (SMA) contributes to inappropriate antimicrobial exposure and remains a public-health concern in Pakistan, but factors associated with willingness to repeat SMA are incompletely understood. Objective: To determine future SMA intention among Pakistani adults with a recent history of SMA and examine its relationships with antibiotic-related knowledge, attitudes, and educational qualification. Methods: A cross-sectional study was conducted in Pakistan from January 2026 using non-probability convenience sampling and an online questionnaire. A total of 364 participants completed the survey. Descriptive statistics, Spearman rank correlations, and chi-square tests with Cramér’s V were applied using available-case analysis. Results: Among 343 participants with intention data, 45.5% intended to self-medicate again, 43.1% did not, and 11.4% were unsure. Moderate or good knowledge was observed in 78.4% of participants, while 47.5% demonstrated a positive attitude. Future SMA intention correlated weakly with knowledge (ρ=0.245, p<0.001) and attitude (ρ=−0.125, p=0.022). Educational qualification was associated with intention, χ²(4, N=338)=26.93, p<0.001, Cramér’s V=0.200. Conclusion: Repeat SMA intention remained common despite generally moderate-to-good knowledge, suggesting that knowledge alone may not account for continued unsupervised antibiotic use.