Evaluation of factors influencing self-medication practices with antibiotics and their impact on antimicrobial resistance among rural populations in Bangladesh.

OBJECTIVES

This study aimed to identify the determinants of self-medication of antibiotics (SMA) and assess its impact on the development of antimicrobial resistance (AMR).

METHODS

Data were collected from 456 participants randomly, and analyzed using binary logistic regression and chi-square tests in IBM SPSS and Microsoft Excel. Subsequently, 90 rectal swab samples from both SMA and non-SMA participants were collected to isolate and identify E. coli and Klebsiella spp. through cultural, biochemical and molecular techniques. Phenotypic and genotypic resistance patterns were determined using the disc diffusion method and PCR.

RESULTS

Prevalence of self-medication (84.65 %) was found to be higher among males (86.83 %) and the uneducated (97.3 %). Employment status (p < 0.01, 95 % CI: 0.048-0.474), family members on health sector (p < 0.05 95 % CI: 0.190-0.856), preference of self-treatment for minor illness (p < 0.05, 95 % CI: 1.144-5.125), and knowledge of antibiotics adverse effects (p < 0.01, 95 %CI: 1.991-26.449) were the significant factors which influence this behavior. Family income showed little significance in this practice. Isolated E. coli (47.78 %) and Klebsiella spp. (17.78 %) exposed significant resistance patterns to different antibiotics. E. coli demonstrated 100 % resistance to penicillin and cefixime, while Klebsiella spp. to azithromycin and penicillin. Genotypic analysis detected widespread resistance genes, with all E. coli from SMA participants harboring tetA, tetB, and blaTEM, while 77.78 % of Klebsiella spp. carried the blaCMY gene. Both the genotypic and phenotypic resistance were found to be higher among SMA participants.

CONCLUSIONS

Poor antibiotic knowledge and the high levels of resistance among bacterial isolates underscore the need for public health interventions to reduce self-medication and mitigate the rise of AMR.