Level of antibiotic knowledge and misuse of antibiotics by students in Kazan (Russia): a cross-sectional study

Nowadays, antimicrobial resistance is one of the most important threats to public health. Inappropriate use of antibiotics is a primary driver of antibiotic resistance. The aim of the study to assess the level of knowledge and the appropriateness of antibiotic use among students from Kazan universities and to determine the factors associated with nonprescription antibiotic consumption. Materials and methods. A cross-sectional analytical study was conducted, based on an anonymous survey of students from various universities in Kazan. Data are presented as proportions (%). Binary logistic regression was applied to identify factors associated with nonprescription antibiotic use. Adjusted odds ratios (aOR) with 95 % confidence intervals (95 % CI) were calculated. Results. A total of 260 students participated in the survey (45,4 % of men and 54.6 % of women). Students from Russia accounted for 65,8 %, 34,2 % were from other countries (India, Algeria, Jordan, Bangladesh, Egypt, Iran, Kuwait, Lebanon, Pakistan, Saudi Arabia, Kazakhstan, Ukraine, Israel). 83,1 % of students were from medical and pharmaceutical faculties. The proportion of respondents from medical and pharmaceutical faculties who answered all knowledge-assessment questions correctly was significantly higher compared with students from nonmedical faculties (60,6 % vs. 20,5 %, p < 0.001). Overall, 54,6 % of participants reported using antibiotics without a doctor’s prescription. Male gender was associated with non-prescription antibiotic use (aOR 1,824; 95 % CI: 1,060–3,139; p = 0.030). International students were also more likely to use antibiotics without a prescription compared with Russian students (aOR 1,921; 95 % CI: 1,009–3,658; p = 0.047). Only 81.5 % of students take antibiotics strictly according to the doctor's prescription or instructions for use, following the dosage and interval. 49,2 % of students stated that prescriptions were not required when purchasing these medicines. Furthermore, 12,3 % of respondents reported that if a pharmacy refused to sell antibiotics without a prescription, they were able to obtain them from another pharmacy. Conclusion. The obtained results highlight the need to strengthen educational work in the field of rational use of antibiotics, alongside improving the legal regulation of antibiotic supply.

1. Dadgostar P. Antimicrobial Resistance: Implications and Costs. Infect. Drug Resist. 2019;12:3903–3910. https://doi.org/10.2147/IDR.S234610

2. GBD 2021 Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance 1990-2021: a systematic analysis with forecasts to 2050. Lancet. 2024;404(10459):1199–1226. https://doi.org/10.1016/S0140-6736(24)01867-1

3. WHO. Antimicrobial resistance. 21 November 2023. URL : https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance. Accessed: 29 August 2025.

4. Browne A. J., Chipeta M. G., Haines-Woodhouse G., Kumaran E. P. A., Hamadani B. H. K., Zaraa S., et al. Global antibiotic consumption and usage in humans, 2000-18: a spatial modelling study. Lancet. Planet. Health. 2021;5(12):e893–e904. https://doi.org/10.1016/S2542-5196(21)00280-1

5. Klein E. Y., Impalli I., Poleon S., Denoel P., Cipriano M., Van Boeckel T. P., et al. Global trends in antibiotic consumption during 2016-2023 and future projections through 2030. Proc. Natl. Acad. Sci. U S A. 2024;121(49):e2411919121. https://doi.org/10.1073/pnas.2411919121

6. Alhomoud F., Aljamea Z., Almahasnah R., Alkhalifah K., Basalelah L., Alhomoud F. K. Self-medication and self-prescription with antibiotics in the Middle East-do they really happen? A systematic review of the prevalence, possible reasons, and outcomes. Int. J. Infect. Dis. 2017;57:3–12. https://doi.org/10.1016/j.ijid.2017.01.014

7. Yeika E. V., Ingelbeen B., Kemah B. L., Wirsiy F. S., Fomengia J. N., van der Sande M. A. B. Comparative assessment of the prevalence, practices and factors associated with self-medication with antibiotics in Africa. Trop. Med. Int. Health. 2021;26(8):862–881. https://doi.org/10.1111/tmi.13600

8. Jirjees F., Ahmed M., Sayyar S., Amini M., Al-Obaidi H., Aldeyab M. A. Self-Medication with Antibiotics during COVID-19 in the Eastern Mediterranean Region Countries: A Review. Antibiotics (Basel). 2022;11(6):733. https://doi.org/10.3390/antibiotics11060733

9. WHO. Regional Office for Europe. Interventions for the rational use of antimicrobials: a practical guide. 2021. (in Russ). Available at: https://iris.who.int/bitstream/handle/10665/348354/9789289056274-rus.pdf. Accessed: 29 August 2025.

10. Bursac Z., Gauss C. H., Williams D. K., Hosmer D. W. Purposeful selection of variables in logistic regression. Source Code Biol. Med. 2008;3:17. https://doi.org/10.1186/1751-0473-3-17

11. Centers for Disease Control and Prevention (U.S.) Antimicrobial resistance threats in the United States, 2021–2022. 07.01.2024. Available at: https://www.cdc.gov/antimicrobial-resistance/media/pdfs/antimicrobial-resistance-threats-update-2022-508.pdf. Accessed: 29 August 2025.

12. Chezganova EA, Medvedeva NV, Sakharova VM, Brusina EB. Epidemic process of respiratory infections and particulate matter as a route for transmission of multidrug-resistant microorganisms in medical organisations. Fundamental and Clinical Medicine. 2021;6(1):47–52. (in Russ). https://doi.org/10.23946/2500-0764-2021-6-1-47-52

13. Mendelson M., Matsoso M. P. The World Health Organization Global Action Plan for antimicrobial resistance. S. Afr. Med. J. 2015;105(5):325. https://doi.org/10.7196/samj.9644

14. Fedotova MM, Malchuk VN, Churilin VA, Zapevalova AA, Yakovleva DO, Olenius DD, et al. The use of antibacterial drugs and awareness about the antibiotic resistance problem among the students of a medical university. Antibiotics and Chemotherapy. 2022;67:1-2:45–52. (in Russ). https://doi.org/10.37489/0235-2990-2022-67-1-2-45-52

15. Chigrina VP, Tyufilin DS, Deev IA, Kobyakova OS. Taking antibacterial drugs without a doctor’s prescription in the Russian Federation. Bulletin of Siberian Medicine. 2023;22(4):147–153. (in Russ). https://doi.org/10.20538/1682-0363-2023-4-147-155

16. Iskakova NS, Khismetova ZA, Sarsenbayeva G ZH, Sadibekova ZH U, Urazalina ZH M, Nurakhmetova ZH B. Awareness of the population of different countries on the use of antibiotics. literature review. Science and healthcare. 2021;2:51–57. (in Russ). https://doi.org/10.34689/SH.2021.23.2.005

17. Mahalik J. R., Backus Dagirmanjian F. R. Working Men's Constructions of Visiting the Doctor. Am. J. Mens Health. 2018;12(5):1582–1592. https://doi.org/10.1177/1557988318777351

18. Larramendy S., Deglaire V., Dusollier P., Fournier J. P., Caillon J., Beaudeau F., et al. Risk Factors of Extended-Spectrum Beta-LactamasesProducing Escherichia coli Community Acquired Urinary Tract Infections: A Systematic Review. Infect. Drug Resist. 2020;13:3945–3955. https://doi.org/10.2147/IDR.S269033

19. Wang Y., Oppong T. B., Liang X., Duan G., Yang H. Methicillinresistant Staphylococcus aureus and vancomycin-resistant Enterococci co-colonization in patients: A meta-analysis. Am. J. Infect. Control. 2020;48(8):925–932. https://doi.org/10.1016/j.ajic.2019.11.010

20. Khodorovich МА, Fomina АV. The features of medical care to foreign citizens studying in russian universities. Medical Journal of the Russian Federation, Russian journal. 2019;25(4):238–241. (in Russ.). https://doi.org/10.18821/0869-2106-2019-25-4-238-24

21. Zakharenkova PV, Rachina SA, Kozlov RS, Mamchich DS, Strelkova DA, Shishkina KK. Patterns of antibiotic use in the population of various regions of the russian federation: a qualitative, comparative analysis. Clinical microbiology and antimicrobial chemotherapy. 2023;25(3):247–259. (in Russ). https://doi.org/10.36488/cmac.2023.3.247-259

22. Selivanov GA, Smolyankina PYu. Assessment of students' awareness of the problem of antibiotic resistance. Science bulletin. 2024;3(4(73):681–687. (in Russ.).

23. Chigrina VP, Tyufilin DS, Deev IA, Kobyakova OS, Salagai OO. Sources of information for the population of the Russian Federation about antibacterial drugs. Public health. 2023;3(2):31–40. (in Russ.). https://doi.org/10.21045/2782-1676-2023-3-2-31-40