• Munir Ahmad Abbasi Benazir Bhutto Shaheed Teaching Hospital Abbottabad.
  • Muhammad Nawaz Professor. Department of Surgery, Women Medical & Dental College / BBS Teaching Hospital, Abbottabad.
  • Adeel Alam Department of Pharmacology, Ayub Medical College, Abbottabad-Pakistan



AMR, Antibiotics, Resistance, antimicrobial resistance, URTIs, Pharyngitis, Rhinitis,


Background: Indiscriminate use of antibiotics is a well-known reason for increasing antimicrobial resistance. Upper respiratory tract infection presents with similar symptoms and signs irrespective of its bacterial or viral causes and is either ignored or managed aggressively by the primary care physicians. The objective was to determine the relationship between upper respiratory tract infections and treatment-seeking behaviour in healthy individuals attending the OPD clinics of BBS Teaching Hospital with their sick family members. Methods: Six hundred and eighty-five healthy individuals who accompanied patients to the OPD clinics of BBS Teaching Hospital, Abbottabad were enrolled in this cross-sectional survey. They were given a modified questionnaire to respond to and their replies were analyzed for assessment. Results: In a survey of 685 individuals, 98.2% were aware of antibiotics, but only 28.6% correctly understood their use against infections. Misconceptions about antibiotic resistance were common, with 54.5% believing it arises from human immunity. Only 31.53% consulted a doctor for upper respiratory symptoms and 72.6% of those expected antibiotics. Women showed higher antibiotic knowledge than men, but education level was a stronger predictor of both knowledge and attitudes. Conclusion: This study highlights a critical gap in public understanding and responsible usage of antibiotics, particularly in the context of upper respiratory tract infections. This study reveals that increased awareness and more informed attitudes about antibiotic resistance correlate with a decreased likelihood of inappropriate antibiotic prescription.

Author Biographies

Munir Ahmad Abbasi, Benazir Bhutto Shaheed Teaching Hospital Abbottabad.

District Chest / TB Specialist,Benazir Bhutto Shaheed Teaching HospitalAbbottabad.

Muhammad Nawaz, Professor. Department of Surgery, Women Medical & Dental College / BBS Teaching Hospital, Abbottabad.


Adeel Alam, Department of Pharmacology, Ayub Medical College, Abbottabad-Pakistan



Esposito C, Garzarella EU, Bocchino B, D’Avino M, Caruso G, Buonomo AR, et al. A standardized polyphenol mixture extracted from poplar-type propolis for remission of symptoms of uncomplicated upper respiratory tract infection (URTI): A monocentric, randomized, double-blind, placebo-controlled clinical trial. Phytomedicine 2021;80:153368.

Mortazhejri S, Patey AM, Stacey D, Bhatia RS, Abdulla A, Grimshaw JM. Understanding determinants of patients’ decisions to attend their family physician and to take antibiotics for upper respiratory tract infections: a qualitative descriptive study. BMC Fam Pract 2020;21(1):119.

Perera AI, Thomas MG, Petrie KJ, Frater J, Dang D, Schache KR, et al. Reducing expectations for antibiotics in patients with upper respiratory tract infections: a primary care randomized controlled trial. Ann Fam Med 2021;19(3):232–9.

Schwartz KL, Ivers N, Langford BJ, Taljaard M, Neish D, Brown KA, et al. Effect of antibiotic-prescribing feedback to high-volume primary care physicians on number of antibiotic prescriptions: a randomized clinical trial. JAMA Intern Med 2021;181(9):1165–73.

Kohut MR, Keller SC, Linder JA, Tamma PD, Cosgrove SE, Speck K, et al. The inconvincible patient: how clinicians perceive demand for antibiotics in the outpatient setting. Fam Pract 2020;37(2):276–82.

Rose J, Crosbie M, Stewart A. A qualitative literature review exploring the drivers influencing antibiotic over-prescribing by GPs in primary care and recommendations to reduce unnecessary prescribing. Perspect Public Health 2021;141(1):19–27.

Gojanovic B, Fourchet F, Gremeaux V. Cognitive biases cloud our clinical decisions and patient expectations: A narrative review to help bridge the gap between evidence-based and personalized medicine. Ann Phys Rehabil Med 2022;65(4):101551.

Strumann C, Steinhaeuser J, Emcke T, Sönnichsen A, Goetz K. Communication training and the prescribing pattern of antibiotic prescription in primary health care. PLoS One 2020;15(5):e0233345.

Boiko O, Burgess C, Fox R, Ashworth M, Gulliford MC. Risks of use and non-use of antibiotics in primary care: qualitative study of prescribers’ views. BMJ Open 2020;10(10):e038851.

Duan L, Liu C, Wang D, Lin R, Qian P, Zhang X, et al. The vicious cycle of the public’s irrational use of antibiotics for upper respiratory tract infections: A mixed methods systematic review. Front Public Health 2022;10:985188.

WHO. Global action plan on antimicrobial resistance [Internet]. Geneva: World Health Organization; 2015 p.28 [cited 2024 Jan 3]. Available from:

Jamhour A, El-Kheir A, Salameh P, Hanna PA, Mansour H. Antibiotic knowledge and self-medication practices in a developing country: A cross-sectional study. Am J Infect Control 2017;45(4):384–8.

Torres NF, Solomon VP, Middleton LE. Patterns of self-medication with antibiotics in Maputo City: a qualitative study. Antimicrob Resist Infect Control 2019;8:161.

Davis ME, Liu TL, Taylor YJ, Davidson L, Schmid M, Yates T, et al. Exploring Patient Awareness and Perceptions of the Appropriate Use of Antibiotics: A Mixed-Methods Study. Antibiot Basel Switz 2017;6(4):23.

Fletcher-Lartey S, Yee M, Gaarslev C, Khan R. Why do general practitioners prescribe antibiotics for upper respiratory tract infections to meet patient expectations: a mixed methods study. BMJ Open 2016;6(10):e012244.

Little P, Dorward M, Warner G, Stephens K, Senior J, Moore M. Importance of patient pressure and perceived pressure and perceived medical need for investigations, referral, and prescribing in primary care: nested observational study. BMJ 2004;328(7437):444.

Van Driel ML, De Sutter A, Deveugele M, Peersman W, Butler CC, De Meyere M, et al. Are Sore Throat Patients Who Hope for Antibiotics Actually Asking for Pain Relief? Ann Fam Med 2006;4(6):494–9.

Van Der Velden AW, Bell J, Sessa A, Duerden M, Altiner A. Sore throat: effective communication delivers improved diagnosis, enhanced self-care and more rational use of antibiotics. Int J Clin Pract 2013;67:10–6.

Lim JM, Duong MC, Cook AR, Hsu LY, Tam CC. Public knowledge, attitudes and practices related to antibiotic use and resistance in Singapore: a cross-sectional population survey. BMJ Open 2021;11(9):e048157.

Tsuzuki S, Fujitsuka N, Horiuchi K, Ijichi S, Gu Y, Fujitomo Y, et al. Factors associated with sufficient knowledge of antibiotics and antimicrobial resistance in the Japanese general population. Sci Rep 2020;10(1):3502.

Aslam A, Gajdács M, Zin CS, Binti Abd Rahman NS, Ahmed SI, Jamshed SQ. Public Awareness and Practices towards Self-Medication with Antibiotics among the Malaysian Population. A Development of Questionnaire and Pilot-Testing. Antibiotics 2020;9(2):97.

Lim JM, Chhoun P, Tuot S, Om C, Krang S, Ly S, et al. Public knowledge, attitudes and practices surrounding antibiotic use and resistance in Cambodia. JAC Antimicrob Resist 2021;3(1):dlaa115.

WHO. Antibiotic resistance: multi-country public awareness survey [Internet]. Geneva: World Health Organization; 2015 [cited 2024 Jan 3]. Available from:

Spurling GK, Del Mar CB, Dooley L, Clark J, Askew DA. Delayed antibiotic prescriptions for respiratory infections. Cochrane Database Syst Rev 2017;(9):CD004417.

Little P, Moore M, Kelly J, Williamson I, Leydon G, McDermott L, et al. Delayed antibiotic prescribing strategies for respiratory tract infections in primary care: pragmatic, factorial, randomised controlled trial. BMJ 2014;348:g1606.

Légaré F, Labrecque M, Cauchon M, Castel J, Turcotte S, Grimshaw J. Training family physicians in shared decision-making to reduce the overuse of antibiotics in acute respiratory infections: a cluster randomized trial. Can Med Assoc J 2012;184(13):E726–34.

Coxeter P, Del Mar CB, McGregor L, Beller EM, Hoffmann TC. Interventions to facilitate shared decision making to address antibiotic use for acute respiratory infections in primary care. Cochrane Acute Respiratory Infections Group, editor. Cochrane Database Syst Rev [Internet]. 2015 [cited 2024 Jan 3];2017(2). Available from:

Gulliford M, Latinovic R, Charlton J, Little P, Van Staa T, Ashworth M. Selective decrease in consultations and antibiotic prescribing for acute respiratory tract infections in UK primary care up to 2006. J Public Health 2009;31(4):512–20.

Chahwakilian P, Huttner B, Schlemmer B, Harbarth S. Impact of the French campaign to reduce inappropriate ambulatory antibiotic use on the prescription and consultation rates for respiratory tract infections. J Antimicrob Chemother 2011;66(12):2872–9.

Lee TH, Wong JG, Lye DC, Chen MI, Loh VW, Leo YS, et al. Medical and psychosocial factors associated with antibiotic prescribing in primary care: survey questionnaire and factor analysis. Br J Gen Pract 2017;67(656):e168–77.

Chua A, Kwa A, Tan T, Legido-Quigley H, Hsu L. Ten-year narrative review on antimicrobial resistance in Singapore. Singapore Med J 2019;60(8):387–96.

Singh SR, Chua AQ, Tan ST, Tam CC, Hsu LY, Legido-Quigley H. Combating Antimicrobial Resistance in Singapore: A Qualitative Study Exploring the Policy Context, Challenges, Facilitators, and Proposed Strategies. Antibiotics 2019;8(4):201.

Al Omari S, Al Mir H, Wrayde S, Merhabi S, Dhaybi I, Jamal S, et al. First Lebanese Antibiotic Awareness Week campaign: knowledge, attitudes and practices towards antibiotics. J Hosp Infect 2019;101(4):475–9.

Huttner B, Saam M, Moja L, Mah K, Sprenger M, Harbarth S, et al. How to improve antibiotic awareness campaigns: findings of a WHO global survey. BMJ Glob Health 2019;4(3):e001239.

Thomson K, Berry R, Robinson T, Brown H, Bambra C, Todd A. An examination of trends in antibiotic prescribing in primary care and the association with area-level deprivation in England. BMC Public Health 2020;20(1):1148.

Adekanmbi V, Jones H, Farewell D, Francis NA. Antibiotic use and deprivation: an analysis of Welsh primary care antibiotic prescribing data by socioeconomic status. J Antimicrob Chemother 2020;75(8):2363–71.

Additional Files