Drivers of Irrational Antibiotic Use in Thailand: A Multilevel Analysis of Post-COVID-19 Trends

Background The misuse of antibiotics has become a significant problem in Thailand and was particularly exacerbated after the COVID-19 pandemic. Increased access to antibiotics during the pandemic has led to a heightened risk of irrational antibiotic use. This study aimed to analyze the relationships and identify factors associated with antibiotic usage behavior among the Thai population. Methods To examine the factors influencing antibiotic use behavior in Thailand post-COVID-19 and to provide recommendations for targeted interventions. This study utilized secondary data from the 2021 health and welfare survey conducted by the National Statistical Office of Thailand. A total sample of 22,173 individuals was analyzed using multilevel logistic regression, controlling for covariates including region, province, and municipal areas. Results The key factors influencing antibiotic use included experiencing illness (adjusted OR: 4.96, 95% CI: 4.40–5.60), sustaining injuries from accidents (adjusted OR: 2.82, 95% CI: 2.19–3.64), hospital admission due to illness (adjusted OR: 1.64, 95% CI: 1.41–1.92), receiving dental care (adjusted OR: 1.31, 95% CI: 1.04–1.65), being ill but not receiving hospital treatment (adjusted OR: 1.84, 95% CI: 1.39–2.44), having problems and being unable to care for oneself (adjusted OR: 1.72, 95% CI: 1.42–2.08), ceasing prescribed medication (adjusted OR: 2.72, 95% CI: 2.40–3.09), and receiving information about antimicrobial resistance (adjusted OR: 5.09, 95% CI: 4.52–5.73). Conclusion The findings highlight the need for targeted interventions to address inappropriate antibiotic use. The government and relevant agencies should promote health awareness and literacy, develop effective medication reimbursement policies, and implement stricter regulations to minimize the adverse effects of antibiotic misuse. Enhanced public education and ensuring access to accurate information from healthcare professionals are essential for mitigating the threat of antimicrobial resistance in Thailand.