Challenges to antibiotic stewardship: A cross-sectional study on self-reuse and disposal practices of leftover antibiotics

Background: Antimicrobial resistance (AMR) is a growing global health threat, primarily driven by the inappropriate use of antibiotics and unsafe disposal practices. In developing countries like Pakistan, the misuse of leftover antibiotics through self-medication and improper disposal remains a poorly addressed public health concern. Objectives: This study aimed to describe the prevalence, patterns and associated factors of self-reuse and disposal practices of leftover antibiotics among residents of Karachi, Pakistan and to identify gaps affecting antibiotic stewardship. Methods: A descriptive, cross-sectional study was conducted using a validated online questionnaire targeting adults (?18 years) residing in Karachi. A total of 385 responses were collected via non-probability sampling. The study was conducted from 10/02/2025 to 03/06/2025. Descriptive statistics and chi-square tests were applied using SPSS version 26 to evaluate associations between sociodemographic factors and antibiotic-related behaviours. Results: Approximately 24% of participants did not complete their prescribed antibiotic course, predominantly because of symptom resolution. Over half (56%) reported retaining leftover antibiotics and 43% admitted to reusing them without professional consultation, largely due to previous successful outcomes. A significant association was observed between educational level and perceptions of the safety of antibiotic reuse (p < 0.001). Disposal practices were suboptimal, with 70% discarding expired antibiotics in household trash and only 8% utilizing pharmacy take-back services. Counselling on proper disposal varied significantly by socioeconomic status (SES) (p = 0.009), with the highest rate reported among low SES participants (37.5%), but overall awareness of disposal programs remained low. Conclusion: The findings highlight concerning patterns in antibiotics storage, self-use and disposal practices in Karachi. These patterns suggest a need for public educational, pharmacist-led interventions and improved access to medication take-back programs to promote safer practices and reduce AMR risk.