Antibiotic self‑medication and knowledge among pharmacy students: A cross‑sectional survey at Mosul University
DOI:
https://doi.org/10.46542/pe.2026.261.391401Keywords:
Antimicrobial resistance, Antibiotic self-medication, Attitude and practice, Iraq, Knowledge, Pharmacy studentAbstract
Background: Antimicrobial resistance (AMR) is a global health threat linked to antibiotic self-medication. Pharmacy students are particularly at risk due to their access to medications and confidence in self-prescribing. This study assessed the prevalence of antibiotic self-medication among pharmacy students at Mosul University, comparing knowledge and practices across different training stages, and explored their proposed solutions.
Methods: A cross-sectional online survey was conducted among 382 students (187 second-year, 195 fifth-year) to assess demographics, knowledge, awareness, attitudes, and practices. Data were analysed using descriptive statistics and various statistical tests.
Results: A total of 80.6% of students reported self-medication in the past year, with fifth-year students showing a higher prevalence (89.7%) compared to second-year students (71.1%; p < 0.0001). Fifth-year students had greater knowledge of antibiotic effectiveness (68.7% vs. 32.6%), AMR awareness (96.9% vs. 50.8%), and adverse consequences (94.4% vs. 27.8%). Despite these differences, multivariable analysis showed that the knowledge score was not independently associated with self-medication (p = 0.761), whereas fifth-year status remained significant (p < 0.0001).
Conclusion: The findings indicate that greater knowledge is associated with higher rates of self-medication among fifth-year students. Integrating stewardship principles early in curricula, enforcing prescription-only policies, and launching collaborative awareness campaigns could address this knowledge-behaviour gap.
References
Al-Ameri, R., Abd Al-Badri, H. J., & Lafta, R. K. (2017). Prevalence of self-medication among university students in Baghdad: A cross-sectional study from Iraq. Eastern Mediterranean Health Journal, 23(9), 643–649. https://doi.org/10.26719/2017.23.9.643
Alhomoud, F., Aljamea, Z., Almahasnah, R., Alkhalifah, K., Basalelah, L., & Alhomoud, F. K. (2017). Self-medication and self-prescription with antibiotics in the Middle East—do they really happen? A systematic review of the prevalence, possible reasons, and outcomes. International Journal of Infectious Diseases, 57, 3–12. https://doi.org/10.1016/j.ijid.2017.01.014
Al-Shawi, A. F., Ali, A. F., Enad, M. M., & Salih, J. A. (2018). Self-medication among medical students in Anbar and Fallujah Universities—Iraq. Journal of the Faculty of Medicine Baghdad, 60(2), 156–159
Baxerres, C., Sams, K., Houngnihin, R. A., Arhinful, D. K., & Le, J.-Y. (2021). Self-medication versus consultation: Individual autonomy and dependence in health decisions. In Understanding drugs markets (pp. 225–248). Routledge. https://doi.org/10.4324/9781003134781-12
Elo, S., & Kyngas, H. (2008). The qualitative content analysis process. Journal of Advanced Nursing, 62(1), 107–115. https://doi.org/10.1111/j.1365-2648.2007.04569.x
Elmahi, O. K. O., Musa, R. A. E., Shareef, A. A. H., Ali, A. M., Ali, E. M., Ali, S. E. A., Omer, A. O., Elhassan, M. A., Awad, M. M., El-Amin, E. O., Hassan, M. A., Mahmoud, A. H., & Elhassan, I. M. (2022). Perception and practice of self-medication with antibiotics among medical students in Sudanese universities: A cross-sectional study. PLOS ONE, 17(2), e0263067. https://doi.org/10.1371/journal.pone.0263067
Gashaw, T., Yadeta, T. A., Weldegebreal, F., Demissie, L., Jambo, A., & Assefa, N. (2025). The global prevalence of antibiotic self-medication among the adult population: Systematic review and meta-analysis. Systematic Reviews, 14(1), Article 44. https://doi.org/10.1186/s13643-025-02724-6
Jairoun, A. A., Hassan, N., Ali, A. A., Jairoun, O., Shahwan, M., & Hassali, M. A. (2019). University students’ knowledge, attitudes, and practice regarding antibiotic use and associated factors: A cross-sectional study in the United Arab Emirates. International Journal of General Medicine, 12, 235–246. https://doi.org/10.2147/IJGM.S210959
Jamil, S., Hossain, M. J., Mohammad Ali, H., Islam, M. A., Mehedi Hasan, A. S. M., Kabir, M. H., Salam, M. A., & Rahman, M. H. (2025). Association of knowledge and attitude toward antibiotic use and resistance with self-medication practice of antibiotics among Bangladeshi private university teachers: A cross-sectional study. Health Science Reports, 8(1), Article e70526. https://doi.org/10.1002/hsr2.70526
Lobanovska, M., & Pilla, G. (2017). Penicillin’s discovery and antibiotic resistance: Lessons for the future? The Yale Journal of Biology and Medicine, 90(1), 135–145. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5369031/
Mohammed, S. S., & Mustafa, W. W. (2025). Knowledge and practice of undergraduate medical students regarding self-medication: A cross-sectional survey in Baghdad, Iraq. Iraqi National Journal of Medicine, 7(1), 192–198. https://doi.org/10.46994/injm.v7i1.52
Popoola, O. O., Adepitan, D. S., Adeyemi, A. S., Oladeru, O. F., & Yusuff, S. I. (2024). A national survey of the antibiotic use, self-medication practices, and knowledge of antibiotic resistance among graduates of tertiary institutions in Nigeria. Scientific African, 23, Article e01978. https://doi.org/10.1016/j.sciaf.2024.e01978
Salih, M. R., & Abd, A. Y. (2021). Self-medication survey among pharmacy students in Iraq. Journal of Pharmacy and Bioallied Sciences, 13(3), 291–297. https://doi.org/10.4103/jpbs.JPBS_196_20
Siraj, E. A., Yayehrad, A. T., Kassaw, A. T., Enyew, E. F., Tadesse, M. L., Abebe, S. M., & Belew, A. K. (2022). Self-medication prevalence and factors associated with knowledge and attitude towards self-medication among undergraduate health science students at GAMBY Medical and Business College, Bahir Dar, Ethiopia. Patient Preference and Adherence, 16, 3157–3172. https://doi.org/10.2147/PPA.S384645
Tang, K. W. K., Millar, B. C., & Moore, J. E. (2023). Antimicrobial resistance (AMR). British Journal of Biomedical Science, 80, Article 11387. https://doi.org/10.3389/bjbs.2023.11387
World Health Organization. (2015). Global action plan on antimicrobial resistance. WHO Press. https://www.who.int/publications/i/item/9789241509763
