Determinants of antibiotic self-medication: A systematic review and meta-analysis

Knowledge of Antibiotic Management in Surgery, Periodontics and Endodontics Among Patients, Students and Dentistry Professors: A Cross-Sectional Study at the University of Barcelona (Spain)

Background/Objectives: The main objective of this study was to analyze the knowledge on the use and management of antibiotics in dentistry within three different groups of interest: patients, fifth-year dental students at the University of Barcelona and professors of the faculty of dentistry of the University of Barcelona. Methods: A cross-sectional pilot study was carried out using questionnaires addressed to the three groups of interest: patients (n = 250), students (n = 79) and professors (n = 50). Sociodemographic questions were asked of all the groups. The professor and student questions were related to antibiotic therapy in relation to dental procedures. The patients were asked questions related to antibiotic management. Results: Regarding the patient group, there were statistically significant differences between the participants of the group; people without higher education were more likely to self-medicate (p = 0.043) or to be unaware of the adverse effects (p = 0.045). Regarding the student and professor groups, there were no significant differences in the prescription of antibiotics. Amoxicillin 750 mg was the most commonly used in patients without an allergy to Penicillin, but there were significant differences in the antibiotic of choice for those patients allergic to Penicillin, the most commonly prescribed being either Clindamycin or Azithromycin (p = 0.002). Conclusions: The study revealed a lack of uniformity in the knowledge and management of antibiotics among both students and professors, which highlights the need to improve university training in pharmacology and for professors to continue education throughout their working lives. It also indicates the need for patient health education regarding antibiotics.

The global prevalence of antibiotic self-medication among the adult population: systematic review and meta-analysis

BACKGROUND

Antibiotic self-medication (ASM) is when a person takes antibiotics without a prescription or consulting a healthcare professional. These practices contribute to the misuse of medicines and antibiotic resistance which is a growing global health threat that can lead to longer hospital stays, higher healthcare costs, and increased mortality rates. Though various studies have been conducted on ASM in different countries, there has not yet been a systematic review that comprehensively assesses the problem in the entire globe. Hence, this systematic review and meta-analysis aimed to evaluate the global pooled prevalence of antibiotic self-medication and the reasons for its practice.

METHOD

A systematic search of electronic registers and databases was conducted on PubMed, Medline, Embase, Scopus, Web of Science, Google Scholar, and gray literature including institutional repositories, and national health databases. It used carefully selected keywords and indexing terms in the past ten years. The Joanna Briggs Institute's critical checklist extracted relevant data after appraisal. Narrative analysis was used for descriptive data while Comprehensive Meta-Analysis (CMA) Software was used to analyze quantitative data. Statistics were used to look for heterogeneity, publication bias, and correlations. Sensitivity tests and sub-group analysis were employed to compare outcomes. A p-value < 0.05 was considered significant in all cases.

RESULTS

Seventy-one studies were included in this systematic review and meta-analysis. The total number of participants was 63,251 with sample sizes ranging from 110 to 15,526. In primary outcomes, ASM ranged from 0.65 to 92.2%. The pooled prevalence of ASM globally was 43.0% (95% CI: 38.0, 48.1%). A high degree of heterogeneity across studies was shown with I2 = 99.2%, p < 0.001 assuming a random effect model. In subgroup analysis, the highest ASM pooled prevalence was 55.2% (95% CI: 47.2, 63.2) in sub-Saharan Africa followed by the Middle East, North Africa, and Greater Arabia at 48.3% (95% CI: 38.3, 58.4), Europe at 34.7% (95% CI:18.0, 56.4), and Asia at 25.8% (95% CI: 18.6, 34.6). Students have been identified as the major users of ASM at 62.1% (95% CI: 53.7, 69.7). The meta-regression showed a coefficient of 0.0365, -0.0117, and -0.0001 for a year of publication, recall time, and total sample size, respectively. Publication bias was demonstrated from the asymmetrical distribution of the funnel plot, and the Eggers regression p-value was greater than 0.05 (0.264). Moreover, knowledge of antibiotics (46.19% (95% CI: 27.99, 65.46)), previous successful experiences (39.13% (95% CI: 30.13, 48.93)), and perceiving illness as minor (38.10% (95% CI: 27.19, 50.37)) were the top three reasons pooled proportion for practicing ASM.

CONCLUSION

ASM practice was higher among African and student users. The previous successful experience was the most frequent reason reported. Educational level, gender, and age were often mentioned as predictor factors. Hence, designing interventional approaches that consider the different burdens among the target population and tackle the reasons for the practices might benefit averting antimicrobial resistance.

Knowledge, and attitude as determinants of healthcare professionals' self-medication practice to antibacterials in Tertiary Care hospitals, North West Ethiopia

The rise of antimicrobial resistance, driven largely by the inappropriate use of antibiotics, presents a significant global health challenge. Healthcare professionals (HCPs) self-medication practice (SMP) with antibiotics is a concerning practice. The role of knowledge, and attitudes, in shaping SMP has not been explored, in the context of Ethiopia. This study aims to investigate the patterns of antibiotic use, knowledge, attitudes, and associated the factors with SMP among healthcare professionals in tertiary hospitals in Bahir Dar, North West Ethiopia. A cross-sectional study was conducted from September 2023 to February 2024 in two tertiary hospitals in Bahir Dar, Ethiopia. The study included 410 healthcare professionals selected using proportional allocation and convenience sampling. A structured, self-administered questionnaire was used to assess participants' demographics, knowledge, attitudes, and practices regarding antibiotic use. Knowledge was assessed through scoring, and attitudes were evaluated using a Likert scale. Data were analyzed using SPSS version 27.0, employing bivariate and multivariate logistic regression analyses to identify factors associated with SMA. Knowledge assessment revealed that 58.5% had good knowledge. In terms of job categories, nurses comprised the largest group (48.8%). A majority (60.2%) had 1-5 years of experience. 57.8% of participants exhibited a poor attitude to SMP. Respiratory infections (20.61%) were the most common health condition reported, followed by gastrointestinal infections (15.43%). The most frequently used antibiotics were amoxicillin (35%), augmentin (25%), and azithromycin (25%). Key factors influencing SMA included ease of access to antibiotics (36%), cost-effectiveness (23%), and knowledge/expertise (22%). Time constraints, perceived severity of conditions, and past self-medication experiences were also significant factors. While 83.8% considered self-medication to be safe, 75% recognized the potential adverse effects of medications. The multivariate analysis revealed that being a physician (AOR = 23.39) or a pharmacist (AOR = 7.79) was strongly associated with self-medication. Degree holders, MSc holders, and specialized physicians were also more likely to self-medicate. A poor attitude was a significant determinant, with healthcare professionals displaying poor attitudes being almost twice as likely to self-medicate (AOR = 1.91). The findings highlight the prevalent practice of self-medication with antibiotics among healthcare professionals in Ethiopia, influenced by factors such as knowledge, access to antibiotics, and professional attitudes. The study highlights the urgent need for targeted interventions to enhance healthcare professionals' knowledge and attitudes regarding responsible antibiotic use while addressing their own practices of self-medication.

Self-Medication Practice and Associated Factors Among Health Professionals in Spain

(1) Background: Self-medication, defined as the use of medications without professional supervision, is a common practice that presents both potential benefits and significant risks. This study analyzes the prevalence, patterns, and determinants of self-medication among health professionals in Spain. (2) Methods: A cross-sectional descriptive design was employed with 438 health professionals, predominantly women (81.1%), with a median age of 42 years. The majority of the healthcare workers were nurses (45%). (3) Results: The results revealed a high prevalence of self-medication (59.4%). Analgesics and anti-inflammatory drugs were the most commonly used. Age and professional knowledge emerged as significant factors influencing this behavior. The main reasons for self-medication included the mildness of symptoms, easy access to medications, and previous successful experiences. Digital sources, especially websites, were the most consulted. Confidence in artificial intelligence tools as a clinical resource was moderate, with 18% of participants consulting AI tools, a rate comparable to the 19.5% for scientific databases. Logistic regression analysis identified age, knowledge of recommended doses, and perceived efficacy as significant predictors, while concern about risks acted as a protective factor. (4) Conclusions: This study highlights the need for educational interventions aimed at promoting responsible self-medication practices and mitigating associated risks among healthcare professionals.

Influences on use of antibiotics without prescription by the public in low- and middle-income countries: a systematic review and synthesis of qualitative evidence

Objectives

Self-medication with antibiotics is common practice in many low- and middle-income countries (LMIC). This review synthesizes the qualitative evidence on influences on perceptions and practices in relation to self-medication by the public with antibiotics in LMIC.

Methods

A systematic search was conducted of relevant medical, international and social science databases. Searching, screening, data extraction and quality appraisal followed standard methods. A meta-ethnographic approach was used for synthesis, starting with translation of studies and using a line-of-argument approach to develop the final themes.

Results

The search identified 78 eligible studies. Antibiotics were understood as a powerful, potentially dangerous but effective medicine for treating infections. This perception was strongly influenced by the common experience of being prescribed antibiotics for infections, both individually and collectively. This contributed to an understanding of antibiotics as a rational treatment for infection symptoms that was sanctioned by medical authorities. Accessing antibiotics from medical professionals was often difficult logistically and financially. In contrast, antibiotics were readily available over the counter from local outlets. People viewed treating infection symptoms with antibiotics as rational practice, although they were concerned about the risks to the individual and only took them when they believed they were needed.

Conclusions

A new model to explain self-medication with antibiotics is presented. This uses the socio-ecological model to integrate influences that operate at individual, community and wider socioeconomic levels, drawing on theories of medical authority and the medicalization and commercialization of health. Interventions to reduce overuse of antibiotics in LMIC need to address both clinical practice and community self-medication practices together.

Content Validation of the Self-Medication Scale and Trust in Online Resources: Deepening Digital Access to Health

(1) Background: The rise of online health resources and AI has reshaped the diagnosis and treatment of disease, altering the relationship between patients and healthcare professionals and encouraging self-medication. However, questionnaires validated in the literature on self-medication seem to lack questions on the possible causes that induce such behaviors, including items that explore trust toward websites and artificial intelligence. The aim of this study is to design and validate the content of a questionnaire designed to assess self-medication in health professionals, delving into the underlying etiologies, the pharmacological categories involved and the degree of confidence placed in clinical assessments derived from AI tools. (2) Methods: Validation study of the content of an instrument consisting of two phases: 1. The content validation phase involved evaluation by a selected group of health experts, who, using a Likert-type scale, analyzed the clarity, coherence and relevance of the items. 2. Pilot study of health professionals who have indicated the practice of self-administration of medications. (3) Results: In the first phase of the study, the experts considered most of the questionnaire items to be clear, representative and consistent with the construct to be measured. In its second phase, the preliminary results of our pilot study suggest a significant trend toward self-medication among healthcare workers, along with a strong inclination to use online resources to search for health-related information. (4) Conclusions: The development of a validated instrument to measure the influence of the different causes that lead healthcare personnel to practice self-medication, guaranteeing validity and efficacy, allows us to establish strategies to reduce this growing problem.

Antibiotic prescribing patterns among dentists in Italy and Albania: A comparative questionnaire analysis

Objective

To investigate the therapeutic and prophylactic use of antibiotics in dentistry in two countries.

Methods

This study used questionnaires to examine the prescribing habits of dentists in Italy (9th country in Europe for systemic antibiotic administration) and Albania an Extra European Union Country. A total of 1300 questionnaires were sent to Italian and Albanian dentists.

Results

In total, 180 Italian and 180 Albanian dentists completed the questionnaire. Penicillin use was higher in Italy (96.6 %) than Albania (82.8 %). Only 26.1 % of Italian dentists and 32 % of Albanian dentists followed the national guidelines for antibiotic administration.

Conclusions

Dentists tend to overprescribe antibiotics for treating existing conditions or as prophylaxis. They also highlighted a lack of adherence to established guidelines for antibiotic use. In addition, factors such as age, nationality, and sex appeared to influence the choice of antibiotics.

Clinical significance

Recently, the growth of antibiotic-resistant bacteria has become a global concern. The authors of this article highlight how dentists often prescribe antibiotics without a real need. Limiting the use of antibiotics in this category may help mitigate antibiotic resistance.

Maternal-Fetal Exposure to Antibiotics: Levels, Mother-to-Child Transmission, and Potential Health Risks

Due to its widespread applications in various fields, antibiotics are continuously released into the environment and ultimately enter the human body through diverse routes. Meanwhile, the unreasonable use of antibiotics can also lead to a series of adverse outcomes. Pregnant women and developing fetuses are more susceptible to the influence of external chemicals than adults. The evaluation of antibiotic exposure levels through questionnaire surveys or prescriptions in medical records and biomonitoring-based data shows that antibiotics are frequently prescribed and used by pregnant women around the world. Antibiotics may be transmitted from mothers to their offspring through different pathways, which then adversely affect the health of offspring. However, there has been no comprehensive review on antibiotic exposure and mother-to-child transmission in pregnant women so far. Herein, we summarized the exposure levels of antibiotics in pregnant women and fetuses, the exposure routes of antibiotics to pregnant women, and related influencing factors. In addition, we scrutinized the potential mechanisms and factors influencing the transfer of antibiotics from mother to fetus through placental transmission, and explored the adverse effects of maternal antibiotic exposure on fetal growth and development, neonatal gut microbiota, and subsequent childhood health. Given the widespread use of antibiotics and the health threats posed by their exposure, it is necessary to comprehensively track antibiotics in pregnant women and fetuses in the future, and more in-depth biological studies are needed to reveal and verify the mechanisms of mother-to-child transmission, which is crucial for accurately quantifying and evaluating fetal health status.

Development and psychometric properties of a self-medication behavior inventory

Introduction

Self-medication is a prevalent behavior with significant health implications. Understanding its psychosocial determinants can inform preventative strategies and interventions.

Methods

We evaluated the psychometric properties of the Self-Medication Behavior Inventory (SMBI-9) in a binational study with 779 Colombian and Mexican participants. Concurrent validity was assessed through correlations with related inventories, and confirmatory factor analysis tested the proposed four-factor model.

Results

The SMBI-9 demonstrated high model fit (CFI = 0.995, TLI = 0.991) and invariance across countries. The factors-Social Influence, Attitude toward Medicine, Avoidance, and Prevention-varied significantly with knowledge of medicine, schooling, health insurance status and gender, underscoring the role of social and personal beliefs in self-medication practices.

Discussion

SMBI-9 emerged as a reliable tool for capturing the multifaceted nature of self-medication behaviors. Findings highlight the influence of social norms and personal attitudes, suggesting targeted approaches for behavioral interventions.

Self-medication prevalence and associated factors among adult population in Northern India: A community-based cross-sectional study

Objectives

This study aimed to determine self-medication prevalence and its associated factors.

Methods

A community-based cross-sectional study was conducted in the urban and rural catchment areas of Uttar Pradesh, India, among 440 adults using a pretested, semistructured questionnaire. The Chi-square test and logistic regression were used to determine the association of self-medication prevalence with various independent variables. The associations were reported as adjusted odds ratios and 95% confidence intervals.

Results

The prevalence of medication use was 66.4%. The majority of participants (45%) took medicine for fever, cough (40.1%), and cold (31.8%). Allopathy (83.2%) was the most common medicine system used for self-medication. More than half reported taking medicine such as paracetamol (52%), followed by cough syrup (21%) and antihistaminic (17%). Convenience (46%) and lack of time (35.3%) were commonly cited reasons for self-medication. Also, 64.4% of the respondents practiced self-medication on the pharmacist's recommendation. Urban participants (adjusted odds ratio: 9.85, 95% confidence interval: 5.32-18.23), females (adjusted odds ratio: 2.32, 95% confidence interval: 1.18-4.57), skilled workers (adjusted odds ratio: 5.62, 95% confidence interval: 1.80-17.5), and those who completed primary school (adjusted odds ratio: 2.48, 95% confidence interval: 1.16-5.25) were more likely to self-medicate than rural, male, unemployed, and illiterate participants, respectively. Also, participants whose income was 30,000 Indian rupees (adjusted odds ratio: 3.21, 95% confidence interval: 1.00-10.21) were more likely to self-medicate than those whose income was less than 4000.

Conclusions

A high prevalence of self-medication was found, particularly in urban areas. Convenience and lack of time were commonly cited reasons for self-medication. Allopathy was the most widely used medicine system for self-medication. Antipyretics, cough syrups, and antiallergics were most commonly self-medicated. Gender, education, and income were associated with self-medication. The study highlighted the increased usage among females which could be further explored and role of pharmacists' recommendation as a major driver for self-medication.

Relation of poverty with treatment-seeking behavior and antibiotic misuse among UTI patients in Pakistan

Objective

The current study aimed to assess the relation between multi-dimension poverty, treatment-seeking behavior, and antibiotic misuse among urinary tract infection (UTI) patients.

Method

A cross-sectional approach was utilized to recruit patients who had a history of UTI in the previous month from two provinces of Pakistan. The treatment-seeking behavior and antibiotic misuse data were collected on a self-developed questionnaire, whereas the poverty data were collected on a modified multi-dimension poverty index (MPI). Descriptive statistics were applied to summarize the data. The logistic regression analysis was carried out to assess the association of multi-dimension poverty with patient treatment-seeking behavior and antibiotic misuse.

Results

A total of 461 participants who had UTI symptoms in the previous month were recruited. Most of the participants in the severely deprived stage treated the UTI (p < 0.001); however, there was a high proportion of the participants who consulted with friends and family for UTI treatment (p < 0.001). The patients with deprivation status (deprived and severely deprived) were less associated with formal consultation. The poorer subgroups were less likely to practice antibiotic course completion.

Conclusion

The current study highlighted that poverty plays an important role in antibiotic misuse. Poorer subgroups were associated with informal consultations and the incompletion of the antibiotic course. Further studies are needed to explore the potential role of poverty in treatment-seeking behavior and antibiotic misuse.

The public's antibiotic use behavioural patterns and their determinants for upper respiratory tract infections: a latent class analysis based on consumer behaviour model in China

Background

The irrational use of antibiotics among the public is a major contributor to antimicrobial resistance (AMR), which is a serious global threat. Prior studies have demonstrated that there are different behavioural patterns regarding antibiotic use among the public, and targeted interventions for subgroups with different behavioural patterns may be more effective. Thus, this study aimed to identify the public's behavioural patterns of antibiotic use for upper respiratory tract infections (URTIs) and their influencing factors.

Methods

A cross-sectional survey was conducted among the general population in Chongqing, China. Consumer decision-making (Consumer Behaviour Model, CBM) was used to assess the public's behaviours regarding antibiotic use, including need recognition, information searching, alternative evaluation, obtaining antibiotics, antibiotic consumption, and postuse evaluation. Furthermore, a latent class analysis was used to identify the underlying behavioural patterns among the public. The identified behavioural patterns of antibiotic use were further linked with individuals' capacity, opportunity, and motivation factors of antibiotic use based on a multinominal logistic regression to explore possible determinants.

Results

A total of 815 respondents were enrolled in the study. The public's irrational use of antibiotics was prevalent, including antibiotic self-medication (39.63%), nonprescription antibiotic purchasing (59.02%), and early stopping of antibiotic prescriptions (76.56%). Participants had inadequate knowledge of antibiotics (Mean = 2.33, SD = 1.71), reported high availability to antibiotics (Mean = 7.13, SD = 2.41), held strong belief in antibiotic effectiveness (Mean = 10.29, SD = 2.71), and demonstrated a high perceived threat of AMR (Mean = 12.30, SD = 3.20). Four behavioural patterns regarding antibiotic use for URTIs were identified, namely, "antibiotic self-medicators" (n = 165, 20.25%), "formal health care seekers" (n = 216, 26.50%), "various treatment users" (n = 198, 24.20%), and "self-medication without antibiotics" (n = 236, 28.96%). Individuals' self-efficacy of antibiotic use, belief in antibiotic effectiveness, awareness of antibiotic side effects, perceived antibiotic availability, social influence, and demographics (age, education, medical insurance, and having a medical background) were significantly associated with the public's different behavioural patterns of antibiotic use for URTIs.

Conclusion

This study calls for collaborative efforts among the public, physicians, policy makers, and the implementation of precise and multifaceted interventions to effectively reduce irrational use of antibiotics in the public. Such interventions include identifying subgroups within the public to provide more targeted education about antibiotics and the management of URTIs, reinforcing the regulation of antibiotic dispensing, and improving physicians' rational antibiotic prescriptions.

Rational Drug and Antibiotic Use Status, E-Health Literacy in Syrian Immigrants and Related Factors: A Cross-Sectional Study

Rational drug use is a pivotal concept linked with morbidity and mortality. Immigration plays a significant role as a determinant affecting individuals' health-related attitudes, behaviors, and the pursuit of health services. Within this context, the study was initiated to assess the factors influencing health literacy and rational drug use among Syrian immigrants in Istanbul. A cross-sectional study was undertaken on 542 Syrian adults utilizing a three-part questionnaire encompassing sociodemographics, rational drug use, and the e-health literacy scale (eHEALS). With an average age of 39.19 ± 13.10 years, a majority of participants believed medications should solely be doctor-prescribed (97%) and opposed keeping antibiotics at home (93.7%). Yet, 62.5% thought excessive herbal medicine use was harmless. The mean eHEALS score stood at 20.57 ± 7.26, and factors like age, marital status, income, and duration of stay in Turkey influenced e-health literacy. Associations were seen between low e-health literacy and being female, being older, having a lower education level, and regular medication use. Syrian immigrants displayed proper knowledge concerning antibiotics yet exhibited gaps in their understanding of general drug usage, treatment adherence, and herbal medicines. Approximately 80.3% had limited health literacy, pointing to the need for targeted interventions for enhanced health and societal assimilation.

Empowering Low- and Middle-Income Countries to Combat AMR by Minimal Use of Antibiotics: A Way Forward

Antibiotic overuse poses a critical global health concern, especially in low- and middle-income countries (LMICs) where access to quality healthcare and effective regulatory frameworks often fall short. This issue necessitates a thorough examination of the factors contributing to antibiotic overuse in LMICs, including weak healthcare infrastructure, limited access to quality services, and deficiencies in diagnostic capabilities. To address these challenges, regulatory frameworks should be implemented to restrict non-prescription sales, and accessible point-of-care diagnostic tools must be emphasized. Furthermore, the establishment of effective stewardship programs, the expanded use of vaccines, and the promotion of health systems, hygiene, and sanitation are all crucial components in combating antibiotic overuse. A comprehensive approach that involves collaboration among healthcare professionals, policymakers, researchers, and educators is essential for success. Improving healthcare infrastructure, enhancing access to quality services, and strengthening diagnostic capabilities are paramount. Equally important are education and awareness initiatives to promote responsible antibiotic use, the implementation of regulatory measures, the wider utilization of vaccines, and international cooperation to tackle the challenges of antibiotic overuse in LMICs.

Acculturation and Subjective Norms Impact Non-Prescription Antibiotic Use among Hispanic Patients in the United States

Using antibiotics without medical guidance (non-prescription antibiotic use) may contribute to antimicrobial resistance. Hispanic individuals are a growing demographic group in the United States (US) with a high prevalence of non-prescription antibiotic use. We investigated the effects of acculturation and subjective norms on Hispanic individuals' intentions to use antibiotics without a prescription from the following sources: (1) markets in the United States (not legal), (2) other countries (abroad), (3) leftovers from previous prescriptions, and (4) friends/relatives. We surveyed self-identified Hispanic outpatients in eight clinics from January 2020 to June 2021 using the previously validated Short Acculturation Scale for Hispanics (SASH). Of the 263 patients surveyed, 47% reported previous non-prescription use, and 54% expressed intention to use non-prescription antibiotics if feeling sick. Individuals with lower acculturation (Spanish-speaking preferences) expressed greater intentions to use antibiotics from abroad and from any source. Individuals with more friends/relatives who obtain antibiotics abroad were over 2.5 times more likely to intend to use non-prescription antibiotics from friends/relatives (p = 0.034). Other predictors of intention to use non-prescription antibiotics included high costs of doctor visits and perceived language barriers in the clinic. Antibiotic stewardship interventions in Hispanic communities in the United States should consider the sociocultural and healthcare barriers influencing non-prescription use and promote language-concordant healthcare.

How can we tackle the overuse of antibiotics in low- and middle-income countries?

INTRODUCTION

Antibiotic overuse is a pressing global health concern, particularly in low- and middle-income countries (LMICs) where there is limited access to quality healthcare and insufficient regulation of antibiotic dispensation. This perspective piece highlights the challenges of antibiotic overuse in LMICs and provides insights into potential solutions to address this issue.

AREAS COVERED

This perspective explores key factors contributing to antibiotic overuse in LMICs, encompassing weak healthcare infrastructure, limited access to quality services, and deficiencies in diagnostic capabilities. It discusses regulatory frameworks to curb non-prescription sales, the role of accessible point-of-care diagnostic tools, challenges in implementing effective stewardship programs, the expanded use of vaccines, and the importance of health systems, hygiene, and sanitation.

EXPERT OPINION

In this article, we emphasize the need for a comprehensive approach involving collaboration among healthcare professionals, policymakers, researchers, and educators. We underscore the importance of improving healthcare infrastructure, enhancing access to quality services, and strengthening diagnostic capabilities. The article also highlights the significance of education and awareness in promoting responsible antibiotic use, the role of regulatory measures, the expanded utilization of vaccines, and the need for international collaboration to address the challenges of antibiotic overuse in LMICs.