Public understanding and misuse of antibiotics in China: insights from a comprehensive national survey.

Abstract

Antimicrobial resistance (AMR) is a major global health threat, with antibiotic misuse as a key driver. This study assessed public understanding and misuse of antibiotics in China to inform targeted interventions. Data were extracted from the Psychology and Behaviour Investigation of Chinese Residents (2024), including 25,047 respondents over the age of 18 years. The study evaluated antibiotic knowledge, use practices, and associated factors using validated electronic health literacy scales. Of the 25,047 respondents, 59.1% (14,806/25,047) reported having heard about antibiotics, with 34.8% (5154/14,806) correctly identifying their function. Regarding antibiotic use, 49.3% (7292/14,806) reported purchasing antibiotics without prescription at least once; 36.8% (5454/14,806) did not follow physicians' instructions specifically, 15.1% (2235/14,806) discontinued their medication independently, 9.4% (1391/14,806) adjusted their doses, and 16.6% (2457/14,806) stopped taking the antibiotic immediately after their symptoms disappeared during the treatment. Female (OR = 0.843, 95% CI: 0.790-0.900), minority (OR = 0.786, 95% CI: 0.674-0.917) and rural respondents (OR = 0.812, 95% CI: 0.743-0.887) were less likely to have a correct knowledge of antibiotics. Minority respondents and those with children were likelier to purchase antibiotics without prescription, whereas those without companion animals (OR = 0.680, 95% CI: 0.631-0.733) were less so. Higher educated respondents were less likely to follow medication instructions (OR = 0.848, 95% CI: 0.765-0.941), so were those with children or companion animals. Public understanding and use of antibiotics in China fall short of national targets. The study reveals complex relationships between demographic factors and antibiotic practices, suggesting the need for targeted interventions to address AMR effectively. This work was supported by the National Natural Science Foundation of China (NO. 72474119) and National Health Commission Key Lab of Health Economics and Policy Research (NO. NHC-HEPR202401).