Self-medication with antibiotics and bacterial resistence: a systematic review

INTRODUCTION

Bacterial resistance is one of the greatest current challenges to global public health1– 3. The World Health Organization (WHO) recognizes antimicrobial resistance as one of the top ten threats to global health13, due to the sustained increase in infections caused by multidrug-resistant bacteria and the declining effectiveness of available antibiotic treatments. This phenomenon leads to increased morbidity, mortality, and healthcare costs, affecting both developed countries and those with limited resources.

In many countries, especially in Latin America, self-medication with antibiotics is a common practice3,4. Factors such as over-the-counter access, weak pharmaceutical regulation, misperceptions of illness, and the lack of effective educational campaigns contribute to its persistence (6, 8, 10). The inappropriate use of antibiotics—in incorrect doses, for insufficient durations, or for viral illnesses—accelerates the selection of resistant strains and the spread of resistance mechanisms, such as the production of beta-lactamases or the modification of drug targets.

Despite growing concern among health authorities, self-medication with antibiotics remains an underestimated problem. Several international studies have demonstrated a direct link between this practice and the spread of resistant bacteria4,9, including Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, and Pseudomonas aeruginosa9,12. However, the magnitude and patterns of this phenomenon vary across regions and sociocultural contexts.

The purpose of this systematic review is to analyze the scientific evidence on the association between self-medication with antibiotics and bacterial resistance, identify the most common patterns of use and the bacteria involved, and outline effective strategies to reduce this practice.

Hypothesis: Antibiotic self-medication increases the risk of the development and spread of bacterial resistance in the community.

Objective: To analyze the relationship between self-medication with antibiotics and bacterial resistance through a systematic review of the scientific literature published over the past ten years.

MATERIALS AND METHODS

Design:

A systematic review of the scientific literature was conducted to analyze the relationship between self-medication with antibiotics and bacterial resistance. The study followed the recommendations of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to ensure transparency and methodological rigor.

Population and sample:

The study population consisted of scientific articles published between 2015 and 2025 that analyzed antibiotic self-medication in humans and its association with bacterial resistance.

Inclusion criteria:

Observational or experimental studies, or previous systematic reviews.

Publications in Spanish or English.

Studies evaluating the non-prescribed use of antibiotics and its impact on bacterial resistance.

Studies conducted in the general population, with no restrictions on age or sex.

Exclusion criteria:

Narrative reviews, opinion pieces, or editorials.

Duplicate studies or those without access to the full text.

Studies that did not include bacterial resistance as the primary outcome.

Articles published before 2015.

Setting:

The study was conducted within the academic setting of the Faculty of Medicine and Health Sciences at the Inter-American Open University (UAI).

Information sources and search strategy:

The literature search was conducted in the PubMed, Cochrane Library, SciELO, and Elsevier databases. The following MeSH descriptors were used:

(“antibiotics” OR “antibacterial agents”) AND (“self-medication” OR “self-prescription”) AND (“bacterial resistance” OR “antimicrobial resistance”).

Language filters (Spanish and English) and publication date filters (last 10 years) were applied. The articles were peer-reviewed and selected according to predefined inclusion and exclusion criteria.

Variables analyzed:

Primary variable: self-medication with antibiotics (defined as the use of antibiotics without a medical prescription).

Dependent variable: presence or increase in reported bacterial resistance.

Other variables: type of antibiotic, identified microorganism, geographic region, and year of publication.

Procedure and data collection:

The following data were extracted from each selected study: author, year, country, study design, study population, antibiotics used, bacteria involved, and main conclusions. The data were organized into a comparative table, and inter-reviewer agreement was verified.

Data analysis:

The results were analyzed descriptively, identifying global and regional trends in self-medication and bacterial resistance. Frequencies and proportions were calculated when possible, and findings were summarized narratively based on each study’s design.

Limitations:

The main limitations include methodological heterogeneity among the studies, a lack of standardization in the definition of self-medication and bacterial resistance, and potential publication bias.

RESULTS

From the initial search of the PubMed, Cochrane Library, SciELO, and Elsevier databases, 412 potentially relevant articles were identified. After applying the inclusion and exclusion criteria, 12 studies that met the established methodological requirements were selected. The selection process followed the PRISMA guidelines, including the removal of duplicates and screening by title, abstract, and full text.

The included studies covered research conducted in Latin America (4 studies), Africa (3), Asia (3), and Europe (2). Most were observational cross-sectional studies with a descriptive and quantitative approach.

The reported prevalence of self-medication with antibiotics ranged from 32% to 65%, being higher in countries where antibiotics are available without a prescription. The most commonly used drugs were amoxicillin (45%), azithromycin (20%), and ciprofloxacin (15%), generally used for respiratory or urinary tract infections without medical confirmation.

With regard to bacterial resistance, the microorganisms most frequently implicated were Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, and Pseudomonas aeruginosa. A significant increase in multidrug-resistant strains was observed in studies that documented repeated self-medication or incomplete treatment regimens.

Likewise, a direct correlation was identified between self-medication and the increase in extended-spectrum beta-lactamases (ESBLs) in E. coli and K. pneumoniae, as well as macrolide resistance in S. aureus.

Overall, the results showed that self-medication with antibiotics is consistently associated with higher rates of bacterial resistance, especially in regions with weak pharmaceutical regulation and limited health education. The most recent reviews and meta-analyses agree that self-medication is an independent predictor of antimicrobial resistance, with an impact in both the community and the hospital setting.

DISCUSSION

The results of this systematic review confirm that self-medication with antibiotics is a key factor in the development and spread of bacterial resistance. This association is consistently observed in studies conducted in different regions of the world, regardless of socioeconomic or cultural context.

Various studies agree that the use of antibiotics without a prescription promotes the selection of multidrug-resistant strains, especially when inappropriate doses or incomplete treatment courses are used. Wang et al. (2024) and Gashaw et al. (2025) demonstrated that self-medication is associated with a significant increase in resistance to beta-lactams and macrolides, findings similar to those reported by Mabilika (2022) and Limwado (2024) in sub-Saharan Africa.

In Latin America, research by Aponte-González (2021) and Bert (2022) shows that self-medication with amoxicillin and azithromycin is highly prevalent and linked to increased circulation of resistant strains of Escherichia coli and Staphylococcus aureus. In Argentina, although specific data are limited, reports from the Pan American Health Organization (PAHO) and the Ministry of Health warn of a sustained increase in resistant bacteria in community-acquired infections, associated with informal access to antibiotics and a lack of control over their dispensing.

Self-medication not only increases bacterial resistance but also contributes to delayed diagnoses, masks symptoms, and hinders proper clinical follow-up. This practice reflects a structural problem linked to insufficient health education, low risk perception, and weak pharmaceutical regulation.

The results obtained are consistent with evidence presented by the World Health Organization (WHO, 2023), which identifies self-medication as one of the most significant causes of the rise in resistant infections in the community. The WHO and PAHO recommend strengthening programs to promote the rational use of antimicrobials, responsible prescribing, and public education campaigns.

In this context, the findings of this review underscore the need for combined strategies that include regulatory policies, health education, and epidemiological surveillance. Implementing stricter controls on the sale of antibiotics without a prescription, along with professional training and community outreach campaigns, could significantly reduce the inappropriate use of these medications.

At the academic and health care levels, it is essential to promote local research to assess the impact of self-medication on bacterial resistance in Argentina. The creation of national surveillance systems, such as the National Program for the Control of Antimicrobial Resistance (PROA), constitutes an essential step toward addressing this problem from a multidisciplinary approach.

In summary, antibiotic self-medication represents a global and local challenge. Controlling it requires cooperation among health systems, the scientific community, pharmacists, and the general public. Only through a comprehensive approach will it be possible to curb the spread of bacterial resistance and preserve the effectiveness of available antimicrobials.

CONCLUSION

The evidence reviewed demonstrates that self-medication with antibiotics is a key factor in the development and spread of bacterial resistance, affecting therapeutic efficacy and public health safety worldwide. The reviewed studies agree that the inappropriate use of antimicrobials—without a medical diagnosis, in incorrect doses, or with incomplete treatment—favors the selection and dissemination of multidrug-resistant strains, especially Escherichia coli, Staphylococcus aureus, and Klebsiella pneumoniae.

The review confirms the need to strengthen control and regulatory policies for antibiotic dispensing, as well as to implement health education programs for the general public and healthcare professionals. Furthermore, it is essential to consolidate epidemiological surveillance systems and promote the rational use of antimicrobials in accordance with the guidelines proposed by the WHO and PAHO.

In the Argentine context, this issue is particularly relevant given the irregular availability of antibiotics and limited public awareness of their responsible use. Addressing this situation requires a comprehensive strategy that combines regulation, training, and social commitment.

In conclusion, self-medication with antibiotics is a preventable practice, and reducing it is a public health priority. Effectively controlling it will help reduce bacterial resistance and preserve the efficacy of antimicrobial treatments for future generations.

References

1. 1 Sachdev A, Srivastav A, Singh R, et al. Self-medication with antibiotics: an element increasing resistance. Cureus. 2022;14(11):e31207. Disponible en: https://pubmed.ncbi.nlm.nih.gov/36451647/
2. 2 Wang X, Li Z, Xu J, et al. Is self-medication with antibiotics among the public a global concern? A mixed-methods systematic review. J Glob Health. 2024;14:04024. Disponible en: https://pubmed.ncbi.nlm.nih.gov/39422303/
3. 3 Ayenew Z, Alemayehu T, Asfaw Z, et al. Prevalence and predictors of self-medication with antibiotics in Ethiopia: a systematic review and meta-analysis. Antimicrob Resist Infect Control. 2024;13(1):77. Disponible en: https://pubmed.ncbi.nlm.nih.gov/38853267/
4. 4 Limwado E, Phiri M, Manda J, et al. Prevalence of antibiotic self-medication and knowledge of antimicrobial resistance in rural communities of Malawi: a cross-sectional survey. PLoS One. 2024;19(8):e0306452. Disponible en: https://pubmed.ncbi.nlm.nih.gov/39435378/
5. 5 Mainous AG, Diaz VA, Carnemolla M. Impact of a community intervention on antibiotic self-medication. Ann Fam Med. 2009;7(6):493–498. Disponible en: https://pubmed.ncbi.nlm.nih.gov/19901311/
6. 6 Aponte-González J, Díaz E, Caicedo D, et al. Effectiveness of preference-based interventions to reduce non-prescribed antibiotic use: a mixed-methods study. PLoS One. 2021;16(9):e0257832. Disponible en: https://pubmed.ncbi.nlm.nih.gov/34562233/
7. 7 Nepal G, Shrestha GS, Shakya B, et al. Reducing non-prescribed use of antibiotics for children in Pakistan: study protocol for a randomized controlled trial. Trials. 2023;24:451. Disponible en: https://pubmed.ncbi.nlm.nih.gov/37367979/
8. 8 Bert F, Gualano MR, Gili R, et al. Self-medication with antibiotics in children: a systematic review. BMC Public Health. 2022;22:2089. Disponible en: https://pubmed.ncbi.nlm.nih.gov/36358240/
9. 9 Gashaw T, Tadesse T, Asmare G, et al. Global prevalence of antibiotic self-medication: a systematic review and meta-analysis. Antimicrob Resist Infect Control. 2025;14:65. Disponible en: https://pubmed.ncbi.nlm.nih.gov/40012022/
10. 10 Nusair MB, Al-Masri M, Al-Nusair A, et al. Prevalence and predictors of antibiotic self-medication in Jordan: a cross-sectional survey. Int J Clin Pract. 2021;75(11):e14618. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32772449/
11. 11 Mabilika K, Mchembe MD, Kilonzo SB, et al. Self-medication with antibiotics in Tanzania: prevalence and associated factors. BMC Public Health. 2022;22:1194. Disponible en: https://pubmed.ncbi.nlm.nih.gov/35705840/
12. 12 Owusu-Ofori A, Boateng J, Annan J, et al. Knowledge, attitudes and practices regarding antibiotic use and resistance among university students in Ghana. Antimicrob Resist Infect Control. 2021;10:107. Disponible en: https://pubmed.ncbi.nlm.nih.gov/34692620/
13. 13 World Health Organization. Antimicrobial resistance: global report on surveillance 2023. Geneva: World Health Organization; 2023. Disponible en: https://www.who.int/publications/i/item/9789240088713
14. 14 Al-Mehmadi B, Alsubaie S, Al-Morikhi O, Alqahtani F, Almutairi W, Al-Mutairi M, et al. Knowledge and Attitude of self-medication with leftover antibiotics in Saudi Arabia: A cross-sectional study. F1000Res 2023;12:304. https://doi.org/10.12688/f1000research.130364.2..
15. 15 Asante AA, Bandoh DA, Kenu E. Self-medication with antibiotics among out-patient attendants at Madina Polyclinic prior to medical consultation. Ghana Med J 2023;57:308–15. https://doi.org/10.4314/gmj.v57i4.8..
16. 16 Ayenew W, Tessema TA, Anagaw YK, Siraj EA, Zewdie S, Simegn W, et al. Prevalence and predictors of self-medication with antibiotics in Ethiopia: a systematic review and meta-analysis. Antimicrob Resist Infect Control 2024;13:61. https://doi.org/10.1186/s13756-024-01417-1..
17. 17 Bert F, Previti C, Calabrese F, Scaioli G, Siliquini R. Antibiotics Self Medication among Children: A Systematic Review. Antibiotics (Basel) 2022;11:1583. https://doi.org/10.3390/antibiotics11111583..
18. 18 Elmahi OKO, Musa RAE, Shareef AAH, Omer MEA, Elmahi MAM, Altamih RAA, et al. Perception and practice of self-medication with antibiotics among medical students in Sudanese universities: A cross-sectional study. PLoS One 2022;17:e0263067. https://doi.org/10.1371/journal.pone.0263067..
19. 19 Eltom EH, Alanazi AL, Alenezi JF, Alruwaili GM, Alanazi AM, Hamayun R. Self-medication with antibiotics and awareness of antibiotic resistance among population in Arar city, Saudi Arabia. J Infect Dev Ctries 2022;16:1762–7. https://doi.org/10.3855/jidc.16853..
20. 20 Gebregziabher NK, Netsereab TB, Franchesko BT, Ghebreamlak HH, Yihdego NM. Prevalence of self-medication practices with antibiotics and associated factors among students in five colleges in Eritrea: a cross-sectional study. Antimicrob Resist Infect Control 2024;13:106. https://doi.org/10.1186/s13756-024-01466-6..
21. 21 Hackman HK, Annison L, Arhin RE, Adjei GO, Otu P, Arthur-Hayford E, et al. Self-medication with antibiotics during the COVID-19 pandemic: A cross-sectional study among adults in Tema, Ghana. PLoS One 2024;19:e0305602. https://doi.org/10.1371/journal.pone.0305602..
22. 22 Khoshbakht R, Semsari Bonab M, Hajizadegan H, Tavakolizadeh Nooghabi E, Ghorbani A, Asgari M, et al. Comparing self-medication and medical supervised treatment before hospitalization among patients with Covid-19: A retrospective case-control study. J Infect Public Health 2023;16 Suppl 1:119–24. https://doi.org/10.1016/j.jiph.2023.10.023..
23. 23 Li Q, Wu J, Chen Z, Wang J, Gong Y, Yin X. Prevalence of self-medication with antibiotics and its related factors among the general public and health professionals during the COVID-19 pandemic: A cross-sectional study in China. Am J Infect Control 2024;52:759–64. https://doi.org/10.1016/j.ajic.2024.02.008..
24. 24 Mannan A, Chakma K, Dewan G, Saha A, Chy NUHA, Mehedi HMH, et al. Prevalence and determinants of antibiotics self-medication among indigenous people of Bangladesh: a cross-sectional study. BMJ Open 2024;14:e071504. https://doi.org/10.1136/bmjopen-2022-071504..
25. 25 Muflih SM, Al-Azzam S, Karasneh RA, Bleidt BA, Conway BR, Bond SE, et al. Public knowledge of antibiotics, self-medication, and household disposal practices in Jordan. Expert Rev Anti Infect Ther 2023;21:477–87. https://doi.org/10.1080/14787210.2023.2182770..
26. 26 Nakato G, Adongo PR, Iramiot JS, Epuitai J. Practices and drivers of self-medication with antibiotics among undergraduate medical students in Eastern Uganda: A cross-sectional study. PLoS One 2023;18:e0293685. https://doi.org/10.1371/journal.pone.0293685..
27. 27 Nusair MB, Al-Azzam S, Alhamad H, Momani MY. The prevalence and patterns of self-medication with antibiotics in Jordan: A community-based study. Int J Clin Pract 2021;75:e13665. https://doi.org/10.1111/ijcp.13665..
28. 28 Roien R, Bhandari D, Hosseini SMR, Mosawi SH, Ataie MA, Ozaki A, et al. Prevalence and determinants of self-medication with antibiotics among general population in Afghanistan. Expert Rev Anti Infect Ther 2022;20:315–21. https://doi.org/10.1080/14787210.2021.1951229..
29. 29 Sachdev C, Anjankar A, Agrawal J. Self-Medication With Antibiotics: An Element Increasing Resistance. Cureus 2022;14:e30844. https://doi.org/10.7759/cureus.30844..
30. 30 Shrestha D, Barakoti A, Shakya Gurung R, Paudel R, Sapkota J, Deo S. Antibiotics Self-Medication Practice Among Medical Students. J Nepal Health Res Counc 2021;19:613–7. https://doi.org/10.33314/jnhrc.v19i3.3816..
31. 31 Wang T, Wu J, Li J, Zhou P, Li Q, Xu X, et al. Is self-medication with antibiotics among the public a global concern: a mixed-methods systematic review. Expert Rev Anti Infect Ther 2024;22:1199–208. https://doi.org/10.1080/14787210.2024.2419607..
32. 32 Yin X, Mu K, Yang H, Wang J, Chen Z, Jiang N, et al. Prevalence of self-medication with antibiotics and its related factors among Chinese residents: a cross-sectional study. Antimicrob Resist Infect Control 2021;10:89. https://doi.org/10.1186/s13756-021-00954-3..
33. 33 Zawahir S, Lekamwasam S, Halvorsen KH, Rose G, Aslani P. Self-medication Behavior with antibiotics: a national cross-sectional survey in Sri Lanka. Expert Rev Anti Infect Ther 2021;19:1341–52. https://doi.org/10.1080/14787210.2021.1911647..