The overuse of antibiotics has emerged as a significant global public health concern, contributing to the growing issue of antibiotic resistance. This problem threatens not only individual patient outcomes but also the effectiveness of healthcare systems worldwide. Antibiotic overuse, often driven by misconceptions about their efficacy and improper prescribing practices, is particularly problematic in countries with less stringent drug regulations. In Saudi Arabia, like many other regions, antibiotic overuse has led to an alarming increase in resistant bacterial strains, calling for urgent public health interventions. However, limited research exists on this topic, particularly from a Saudi Arabian public health perspective. This study seeks to investigate the public health consequences of antibiotic overuse, providing critical insights for future policy and intervention strategies.

The issue of antibiotic overuse has been extensively researched in various parts of the world, with numerous studies demonstrating its detrimental effects on public health and healthcare systems ( Ventola, 2015). Overprescription, self-medication, and misuse of antibiotics have been linked to the rapid increase in resistant pathogens, rendering many common treatments ineffective ( Gupta et al., 2017). Despite global efforts to address this issue, antibiotic overuse remains prevalent, especially in regions where public awareness and regulatory measures are inadequate ( Zhao et al., 2013).

2000-2005: Early studies on antibiotic use highlighted the importance of physician prescribing practices and public education. Research from this period, such as the work by Coenen et al. (2006), emphasized that although some populations adhered to medical guidelines for antibiotic use, others frequently engaged in the misuse of these medications. The overuse of antibiotics in both medical settings and through self-medication was linked to an increase in resistant bacterial strains, a trend observed globally ( Palmer et al., 2000).

2006-2015: During this period, research expanded to include the social and economic factors contributing to antibiotic overuse. Studies in countries such as India and Egypt revealed that economic barriers to healthcare access often drove individuals to self-medicate with antibiotics, exacerbating the problem ( Auta et al., 2015). In Saudi Arabia, a study conducted by Zowawi et al. (2013) reported that nearly 40% of individuals admitted to obtaining antibiotics without a prescription, highlighting a widespread public health issue.

2016 to Present: More recent studies have delved deeper into the public health implications of antibiotic overuse, with a particular focus on the rising rates of antibiotic resistance. For instance, a 2019 report by the World Health Organization (WHO) underscored the urgent need for global action to combat antibiotic resistance, which has been accelerated by the overuse of antibiotics in both healthcare and agricultural settings ( WHO, 2020). In Saudi Arabia, recent data indicates that antibiotic overuse remains a pervasive issue, with the public often unaware of the long-term consequences of misuse ( Alrashed et al., 2019). The current study seeks to fill this gap by exploring the public health consequences of antibiotic overuse within the context of Saudi Arabia.

Research design: This research employed a cross-sectional, quantitative design to investigate the public health consequences of antibiotic overuse. The study focused on quantifying the impact of antibiotic overuse on health outcomes and healthcare systems, as well as understanding public perceptions and behaviors that contribute to this issue. A quantitative approach was chosen due to its ability to generate statistically significant data that can be generalized to the broader population ( Fatima et al., 2014).

Based on the results summarized in Table 1 : Demographic information, the study participants predominantly identified as female (65.52%, n=344), while males accounted for 34.48% (n=181). The majority of respondents were aged between 18-29 years (63.62%, n=334), with smaller proportions in the age groups 30-39 (16.38%, n=86), 40-49 (11.62%, n=61), and 50 and above (8.38%, n=44). In terms of education, most participants had a bachelor’s degree (55.05%, n=289), followed by those with a high school diploma or below (30.10%, n=158). A smaller percentage had achieved a diploma (7.62%, n=40), a master’s degree (4.38%, n=23), or a doctoral degree (2.86%, n=15).

Table 2 : Awareness and knowledge of antibiotic use shows that 86.10% (n=452) of participants were aware that antibiotic resistance is a problem. Regarding the effectiveness of antibiotics against viral infections, 59.05% (n=310) incorrectly believed that antibiotics are effective against viruses, while 40.95% (n=215) correctly indicated they are not. Additionally, 37.90% (n=199) of participants reported always requesting antibiotics for non-bacterial infections, such as viral infections like colds or flu. Public awareness of antibiotic resistance was considered somewhat serious by 55.05% (n=289), very serious by 33.14% (n=174), and not serious by 11.81% (n=62).

As detailed in Table 3 : Antibiotic prescription and use practices, 37.90% (n=199) of participants reported always prescribing or taking antibiotics. A significant portion (86.10%, n=452) admitted to using antibiotics without a prescription, while 13.90% (n=73) reported they had not. Completion of the full course of antibiotics was reported by 59.05% (n=310) of participants, with 40.95% (n=215) admitting to not completing the course. Additionally, 81.90% (n=430) of respondents had stopped taking antibiotics before completing the prescribed course, while 18.10% (n=95) reported they had not.

According to Table 4 : Perceptions of antibiotic resistance and healthcare costs, 55.05% (n=289) of participants believed antibiotic resistance to be somewhat serious, and 33.14% (n=174) considered it very serious. When asked about the impact of antibiotic overuse on healthcare costs, 68.38% (n=359) agreed it increased costs, while 31.62% (n=166) did not. Moreover, 81.90% (n=430) of respondents agreed that stronger regulations are necessary to combat antibiotic overuse, compared to 18.10% (n=95) who disagreed.

Finally, Table 5 : Public health recommendations highlights that 86.10% (n=452) of respondents believe public health campaigns are effective in reducing unnecessary antibiotic use, with 13.90% (n=73) disagreeing. Regarding support for stricter regulations on over-the-counter antibiotic sales, 85.90% (n=451) were in favor, while 14.10% (n=74) were opposed. For strategies to reduce antibiotic overuse, 83.81% (n=440) supported effective strategies such as increased public awareness, with 16.19% (n=85) not supporting these measures.

The present study offers a comprehensive examination of the factors contributing to antibiotic overuse within the Saudi Arabian population, highlighting the significant roles of demographic variables, awareness levels, and perceptions regarding antibiotic resistance. The findings indicate that younger individuals and those with lower educational attainment are more prone to misuse antibiotics, a trend that aligns with global patterns of self-medication and non-prescribed antibiotic use ( Auta et al., 2015; Gupta et al., 2017). This susceptibility among younger demographics may be influenced by easier access to over-the-counter medications, peer behaviors, and a diminished perception of personal risk associated with antibiotic resistance.

Educational attainment emerged as a crucial determinant in antibiotic misuse. Individuals with higher education levels demonstrated better adherence to prescribed antibiotic courses, suggesting that enhanced health literacy fosters a greater understanding of medical guidelines and the importance of completing antibiotic regimens ( Alrashed et al., 2019; Ventola, 2015). This correlation underscores the necessity for educational interventions that not only inform but also empower individuals to make informed health decisions. Alhur’s research on vitamin literacy and information-seeking behavior further supports the role of education in promoting informed health practices. Enhancing educational initiatives can bridge knowledge gaps, fostering responsible antibiotic use and adherence to treatment protocols ( Alhur et al., 2024a).

Awareness of antibiotic resistance significantly impacted misuse behaviors. Participants who lacked sufficient knowledge about antibiotic resistance were more likely to misuse antibiotics, either by using them without a prescription or by not completing the prescribed course. This gap in awareness highlights the critical need for public health education campaigns aimed at increasing understanding of antibiotic resistance and its serious implications for both individual and public health ( Gupta et al., 2017; World Health Organization, 2020). Additionally, Alhur’s study on drug-herbal interactions in Hail, Saudi Arabia, underscores the complexity of medication practices in the region. The concurrent use of antibiotics and herbal remedies without adequate knowledge can exacerbate the risks associated with antibiotic overuse, including adverse drug-herbal interactions and complications in managing antibiotic resistance ( Alhur, 2024b).

Interestingly, gender did not emerge as a significant predictor of antibiotic misuse in this study, suggesting that antibiotic overuse is a pervasive issue affecting both males and females equally in the Saudi Arabian context. This finding contrasts with some studies in other regions where gender differences in health behaviors have been observed ( Zhao et al., 2013). Alhur’s investigation into public perspectives on digital innovations in pharmacy indicates that factors such as ease of use and data security are more influential than gender in determining the acceptance of digital health tools ( Alhur et al., 2024c). This implies that interventions aimed at reducing antibiotic misuse should focus on enhancing digital literacy and addressing concerns related to data privacy, rather than targeting specific genders.

The integration of digital health technologies presents both opportunities and challenges in addressing antibiotic misuse. Alhur’s research on public perspectives of digital innovations in pharmacy reveals a moderate level of optimism towards digital tools, alongside significant concerns about data privacy and usability ( Alhur et al., 2024d). Leveraging digital platforms for educational campaigns could enhance the reach and effectiveness of interventions aimed at reducing antibiotic overuse. However, it is imperative to address public concerns regarding data privacy and ensure the usability of digital health tools to foster trust and facilitate their adoption in promoting responsible antibiotic use.

Moreover, the high prevalence of herbal remedy use in Hail, Saudi Arabia, as reported by Alhur, indicates a need for integrated public health strategies that address both pharmaceutical and herbal medication practices. Public health education should encompass safe practices for the use of all types of medications, emphasizing the potential risks of drug-herbal interactions and promoting informed decision-making ( Alhur, 2024d). This holistic approach can mitigate the compounded risks associated with the simultaneous use of antibiotics and herbal remedies, thereby enhancing overall public health safety.

This study explains the multiple factors contributing to antibiotic overuse in Saudi Arabia, emphasizing the important roles of age, education level, awareness, and perceptions of antibiotic resistance. Younger individuals and those with lower educational attainment are more prone to antibiotic misuse, especially when there is insufficient awareness and understanding of the seriousness of antibiotic resistance. These findings highlight the urgent need for comprehensive public health interventions that include targeted education, extensive awareness campaigns, regulatory enforcement, and active involvement of healthcare professionals.

Addressing antibiotic overuse is essential to reduce the growing threat of antibiotic resistance, which puts individual patient outcomes and the effectiveness of healthcare systems at risk globally. By implementing tailored educational programs, increasing public awareness, and strengthening regulations, Saudi Arabia can make significant progress in promoting responsible antibiotic use. Furthermore, using digital health technologies and addressing cultural factors related to medication practices can improve the effectiveness of these interventions. Collaborative efforts among policymakers, healthcare providers, educators, and the community are crucial to combat antibiotic resistance and protect public health.

This study was reviewed and approved by the Research Ethics Committee (REC) at the University of Hail, Saudi Arabia. The approval reference number is H-2024-473, and the date of approval is May 13, 2024. The research protocol adhered to the ethical principles governing research involving human participants, as outlined in the Declaration of Helsinki. For reference, the full document outlining the principles of the Declaration of Helsinki is available on the World Medical Association’s official website.

All participants received a Participant Information Sheet that explained the study’s objectives, voluntary participation, and assurances of confidentiality and anonymity. Informed consent was obtained electronically from each participant before they began the survey. Participants were informed of their right to withdraw from the study at any time without consequences.

To protect participants’ privacy, no personally identifiable information was collected. All data were stored securely in encrypted, password-protected systems, with access restricted to authorized research team members.

All participants provided informed consent electronically before beginning the questionnaire. The consent form clearly explained the study’s objectives, the voluntary nature of participation, and assurances of confidentiality and anonymity. Participants were informed that they could withdraw from the study at any time without any repercussions.

Data collection was designed to maintain participant anonymity and confidentiality. No personally identifiable information was collected, and all data were securely stored in encrypted and password-protected systems accessible only to the research team.

This ethical approval and adherence to recognized research principles ensure the study’s compliance with institutional and international standards for human research.