Knowledge, attitudes and practices of Tunisian paramedic students regarding antibiotics and factors associated with self-medication: a cross-sectional study

Abstract

OBJECTIVES: To assess the knowledge, attitudes and practices of students at the School of Health Sciences and Techniques of Monastir regarding antibiotic use and self-medication and to identify associated factors. DESIGN: Descriptive and analytical cross-sectional knowledge, attitude and practice study. SETTING: School of Health Sciences and Techniques of Monastir, Tunisia, during the 2023-2024 academic year. PARTICIPANTS: 324/500 students (64.8% response rate) recruited through inclusion criteria (enrolled students with informed consent). PRIMARY AND SECONDARY OUTCOME MEASURES: Knowledge assessment, prevalence of self-medication and factors associated with self-medication (OR with 95% CI). RESULTS: Participants had a mean age of 21.6±2.4 years. Most (62.3%) had not received a specific course on antibiotics. While 91.4% correctly identified bacteria as the target of antibiotics, 40.1% mistakenly believed they were also effective against viruses.Regarding practices, 60.5% of students reported self-medication with antibiotics, mainly amoxicillin (78.2%) and amoxicillin-clavulanic acid (46.2%). The main reasons included previous positive experience (45.2%) and perceiving symptoms as minor (40.6%). Keeping leftover antibiotics (OR=2.6 (1.532-4399)), having antibiotics for emergency use (OR=3.3 (1.905-5723)) and prior training in antibiotic use (OR=1.9 (1.135-3263)) were significantly associated with self-medication. CONCLUSIONS: Self-medication is prevalent in paramedic students even with prior training in antibiotic use. Targeted educational strategies along with behaviour modification approaches are needed to raise awareness about microbial resistance and limit self-medication.