Antibiotic Self‑Medication Among Pharmacy Clients in Kabul, Afghanistan: Prevalence and Usage Patterns

Abstract

  ABSTRACT Background: Antibiotic self‑medication (ASM) is a major contributor to antimicrobial resistance (AMR), particularly in low‑ and middle‑income countries where regulatory oversight is limited. Afghanistan, with fragile healthcare infrastructure and widespread informal pharmaceutical access, represents a critical setting for examining ASM behaviors. Accordingly, this study aimed to quantify the prevalence of ASM among pharmacy clients in Kabul, identify its determinants, and assess awareness of AMR to inform national stewardship strategies. Methods: A cross‑sectional survey was conducted in 2025 among 635 adult pharmacy clients in Kabul. Data were collected using structured questionnaires covering socio‑demographics, antibiotic use in the past 12 months, indications, sources, adherence, and awareness of AMR. Descriptive statistics were applied to analyze prevalence and usage patterns. Results: In the past 12 months, 49.0% (n = 311; 95% CI: 45.0–53.0) of respondents reported antibiotic self‑medication, while 41.5% (n = 263; 95% CI: 37.5–45.5) reported a most recent episode of ASM. Respiratory tract infections and gastrointestinal complaints were the most common indications. Amoxicillin was the most frequently used antibiotic, followed by ciprofloxacin and azithromycin. Pharmacies were the main source, and nearly half of users reported incomplete courses. Awareness of AMR was limited. Conclusion: ASM is highly prevalent among pharmacy clients in Kabul, driven by misconceptions, easy access, and limited awareness. These findings highlight the urgent need for regulatory enforcement, public education, and healthcare system strengthening to mitigate AMR risks in Afghanistan. Keywords: Antibiotic self-medication, Antimicrobial resistance, Pharmacy clients.