Prevalence and risk of self -medication with antibiotic and determinants factors in patients admitted to the emergency department in a resource-limited setting: a cross-sectional study

Abstract

The overuse of antibiotics without medical prescription is a major public health concern, leading to bacterial resistance that causes severe infections and increases global mortality. This study aimed to determine the prevalence and identify the main risk factors of antibiotic self-medication among patients admitted to the emergency department. This cross-sectional, descriptive, and analytical study was conducted over a five-month period (July to November 2024) among patients aged 18 years and older admitted to the emergency department. We collected sociodemographic data, data on self-medication practices, and data on access to care. Multivariable logistic regression was applied to identify independent factors associated with antibiotic self-medication. The prevalence of antibiotic self-medication among participants was 77.7%, with amoxicillin (38.3%) and metronidazole (27.6%) being the most commonly used antibiotics, followed by penicillin V (19.0%) and chloramphenicol (17.1%). Bivariate analyses showed that age was strongly associated with antibiotic self-medication (χ² = 25.4, p < 0.001), with the highest prevalence among individuals aged 35–44 years (32.9%), while marital status (χ² = 18.5, p < 0.001), occupation (χ² = 17.1, p = 0.002), monthly income (χ² = 29.0, p < 0.001), and distance to the health facility (χ² = 9.2, p = 0.027) were also significantly associated; in contrast, sex, education level, and health insurance status were not significant. In the multivariable logistic regression analysis, age emerged as the only independent predictor of antibiotic self-medication, with participants aged 55–64 years having significantly higher odds compared with those aged 18–24 years (OR = 6.98, 95% CI 1.77–27.58; p = 0.006), and those aged 65 years and older showing markedly increased odds (OR = 43.36, 95% CI 4.06-462.91; p = 0.002). Although self-employed participants demonstrated higher odds of self-medication compared with employed participants, this association was not statistically significant after adjustment (OR = 1.38, 95% CI 0.86–2.22; p = 0.184), and none of the monthly income categories remained independently associated in the adjusted model. The study highlights the influence of demographic and socioeconomic factors on antibiotic self-medication, emphasizing the need for awareness programs and stricter control of over-the-counter antibiotic sales.