Distribution and Determinants of Antibiotic Self-Medication: A Cross-Sectional Study in Chinese Residents

Antimicrobial resistance (AMR) represents a critical global health threat, with inappropriate antibiotic self-medication (ASM) being a key contributor. China—as the world's largest antibiotic consumer—faces significant challenges despite regulatory efforts, compounded by limited contemporary data during the COVID-19 pandemic. A nationwide cross-sectional study was conducted using the 2021 China Family Health Index Survey (n=11,031 participants across 120 cities). Trained investigators administered face-to-face questionnaires assessing ASM practices, decision-making factors, and sociodemographic characteristics. Multivariate logistic regression identified determinants of ASM. Overall ASM prevalence was 33.7% (n=3,717), with no urban-rural difference (p>0.05). Physician advice (78.2%), drug safety (67.1%), and efficacy (64.2%) were primary selection criteria; rural residents prioritized drug price and salesperson recommendations more than urban counterparts (p< 0.01). Key predictors included higher ASM odds among females (OR=1.30, 95%CI:1.18-1.43), middle-aged adults (46-59 years; OR=1.20, 95%CI:1.02-1.42), those with health insurance (resident: OR=1.33; commercial: OR=1.62), and individuals with drinking histories (OR=1.20, 95%CI:1.10-1.31). Lower odds were associated with primary education (OR=0.69, 95%CI:0.58-0.81), unemployment (OR=0.88, 95%CI:0.79-0.98), and absence of chronic diseases (OR=0.56, 95%CI:0.47-0.67). One-third of Chinese residents engaged in ASM during the pandemic, driven by intersecting demographic and behavioral factors. Despite converging urban-rural prevalence rates, distinct decision-making drivers necessitate context-specific interventions, including strengthened pharmacy regulation in rural areas, tailored education programs for high-risk groups, and insurance system reforms to disincentivize self-medication.