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Challenges to antibiotic stewardship: A cross-sectional study on self-reuse and disposal practices of leftover
Uroosa Kanwal1, Syed Shaukat Ali Muttaqi Shah2, Saba Razzak3
1Department of Pharmacy Practice, Faculty of Pharmacy, Salim Habib University, Karachi, Pakistan.
Background:
Antimicrobial resistance (AMR) is a growing global health threat, primarily driven by the inappropriate use of antibiotics and unsafe disposal practices. In developing countries like Pakistan, the misuse of leftover antibiotics through self-medication and improper disposal remains a poorly addressed public health concern.
Objectives:
This study aimed to describe the prevalence, patterns and associated factors of self-reuse and disposal practices of leftover antibiotics among residents of Karachi, Pakistan and to identify gaps affecting antibiotic stewardship.
Methods:
A descriptive, cross-sectional study was conducted using a validated online questionnaire targeting adults (≥18 years) residing in Karachi. A total of 385 responses were collected via non-probability sampling. The study was conducted from 10/02/2025 to 03/06/2025. Descriptive statistics and chi-square tests were applied using SPSS version 26 to evaluate associations between sociodemographic factors and antibiotic-related behaviours.
Results:
Approximately 24% of participants did not complete their prescribed antibiotic course, predominantly because of symptom resolution. Over half (56%) reported retaining leftover antibiotics and 43% admitted to reusing them without professional consultation, largely due to previous successful outcomes. A significant association was observed between educational level and perceptions of the safety of antibiotic reuse (p < 0.001). Disposal practices were suboptimal, with 70% discarding expired antibiotics in household trash and only 8% utilizing pharmacy take-back services. Counselling on proper disposal varied significantly by socioeconomic status (SES) (p = 0.009), with the highest rate reported among low SES participants (37.5%), but overall awareness of disposal programs remained low.
Conclusion:
The findings highlight concerning patterns in antibiotics storage, self-use and disposal practices in Karachi. These patterns suggest a need for public educational, pharmacist-led interventions and improved access to medication take-back programs to promote safer practices and reduce AMR risk.
Insights
Many in Pakistan misuse leftover antibiotics, reusing them without consultation and disposing of them improperly. This contributes to antimicrobial resistance (AMR) and highlights the need for public education and better disposal programs.
Area of Science:
- Public Health
- Infectious Diseases
- Pharmacology
Background:
- Antimicrobial resistance (AMR) is a significant global health challenge.
- In Pakistan, the misuse of leftover antibiotics via self-medication and improper disposal is a critical public health issue.
Purpose of the Study:
- To determine the prevalence and patterns of leftover antibiotic self-reuse and disposal in Karachi, Pakistan.
- To identify factors associated with these practices and pinpoint gaps in antibiotic stewardship.
Main Methods:
- A descriptive, cross-sectional study utilizing an online questionnaire.
- 385 adult residents of Karachi participated via non-probability sampling.
- Data were analyzed using descriptive statistics and chi-square tests.
Main Results:
- 24% did not complete prescribed antibiotic courses; 56% kept leftover antibiotics, with 43% reusing them without consultation.
- Educational level correlated with perceptions of antibiotic reuse safety (p < 0.001).
- Suboptimal disposal was common (70% in household trash); only 8% used pharmacy take-back services. Disposal counseling varied by socioeconomic status (p = 0.009).
Conclusions:
- Concerning antibiotic storage, self-use, and disposal practices were observed in Karachi.
- Public education, pharmacist interventions, and accessible take-back programs are needed.
- These interventions can promote safer practices and mitigate AMR risks.
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