Antibiotic Knowledge and Non-Prescription Antibiotic Use Among Jordanian Adults: A Community-Based Cross-Sectional...

Background: Antimicrobial resistance (AMR) is one of the most significant current public health issues, which is driven crucially by the misuse and overuse of antibiotics. Antibiotics are still available without a prescription in many underdeveloped countries, including Jordan, allowing for self-medication and incorrect usage, which contributes to the establishment and spread of resistant bacteria. This cross-sectional study aimed to evaluate antibiotic-use practices and assess knowledge and awareness of antimicrobial resistance among the Jordanian population. Methods: We conducted a cross-sectional observational survey between September 2023 and January 2025, targeting males and females in Jordan. A QR code was used to distribute an online convenience sampling strategy with 57 questions across social media channels. The survey investigated a variety of aspects, including demographic traits, antibiotic knowledge and behaviour, and public awareness of resistance. The questionnaire was completed by 1031 people. The data was analysed using descriptive statistics. The chi-square test was performed to compare demographic groupings, and p < 0.05 was considered significant. Results: Among the 1031 participants, 61.3% were female and 37.8% were male. Recent utilization of antibiotics was prevalent, with 37.8% indicating usage in the preceding month and 26.4% within the last six months. It is noteworthy that 61% (n = 624) of participants indicated that they had consumed antibiotics without a prescription, while 33.6% (n = 345) reported acquiring antibiotics for children without a prescription. Furthermore, pharmacies constituted the predominant source of antibiotics, accounting for 90.4% of the total. Common misconceptions regarding the indications for antibiotics were observed, with a segment of participants under the impression that antibiotics are effective in treating symptoms such as fever (40.6%) and body pain (15%). Additionally, participants exhibited a moderate level of awareness regarding antimicrobial resistance, with 69.2% demonstrating familiarity with the concept, while 90% acknowledged the increased difficulty in treating infections caused by antimicrobial-resistant organisms. Nevertheless, major misconceptions persisted, including 84.8% incorrectly believing that antibiotic resistance occurs when the human body becomes resistant to antibiotics and then antibiotics cannot work properly. More than half of the respondents (n = 569; 57.1%) also believed that AMR only or mainly affects individuals who frequently take antibiotics and does not concern others. Conclusions: This study has identified that non-prescription antibiotic use remains prevalent in Jordan and is accompanied by substantial misconceptions regarding antimicrobial resistance. Although general awareness of the seriousness of AMR was relatively high, important knowledge gaps persisted. In the adjusted analysis, among the covariates, participants aged 51-60 years had higher odds of reporting non-prescription antibiotic use than those aged 18-30 years (aOR = 1.872, 95% CI 1.072-3.268; p = 0.028). Moreover, participants with a high-school education (aOR = 0.415, 95% CI 0.196-0.879; p = 0.022) and those with a master's degree (aOR = 0.411, 95% CI 0.181-0.933; p = 0.034) had lower odds than the no-formal-education reference group. No other covariate was statistically significant. The findings clearly indicate the need for strengthened enforcement of prescription-only antibiotic dispensing regulations, targeted public education to address specific misconceptions, and expanded antimicrobial stewardship initiatives involving community pharmacists to promote responsible antibiotic use and lessen the growing threat of antimicrobial resistance.