Patients’ decision-making on antibiotic use for acute respiratory tract infections in a primary healthcare setting in Ethiopia: the role of antimicrobial resistance knowledge, concerns, and previous antibiotic use experience

In recent years, antimicrobial resistance (AMR) has become one of the leading health threats worldwide, mainly resulting from antibiotic misuse and misconceptions about resistance. This study investigated patients’ prior antibiotic use, their awareness and concerns about resistance, and how these factors influence decisions to use antibiotics for acute respiratory infections (ARTIs). A multicenter cross-sectional study was conducted, targeting patients aged ≥ 18 years attending primary healthcare facilities for medical examination. The data were gathered through structured face-to-face interviews with outpatients diagnosed with ARTIs. Multivariable logistic regression was used to investigate the influence of factors on the decision to use antibiotics for ARTIs. The study found that among 420 participants, 57.4% had used antibiotics without a prescription, 55.2% had stopped taking them early, and 50.5% had shared them with family or friends in the last year. Regarding AMR, 33.8% of respondents had a low level of awareness about it. In terms of concern about AMR, 34.3% of respondents believed they would not worry about AMR infections if they took antibiotics correctly. Participants who had previously used antibiotics without a prescription and those who shared antibiotics with family or friends were more likely to misuse antibiotics for ARTIs (OR =4.23, p < 0.001, OR = 6.38,  p<0.001, respectively) compared to those who had not engaged in those behaviours. Additionally, those with low awareness levels or no concern were more likely to misuse antibiotics (OR = 3.13, p<0.001; OR =2.48, p<0.001, respectively). Generally, public health interventions should focus on improving AMR awareness and promoting responsibility to reduce misuse.