What drives rural households to use antibiotics? Findings from a community-based study in rural blocks of Pune, India

Abstract Background While antibiotics are essential, their misuse across human, animal and environmental sectors contributes significantly to antimicrobial resistance (AMR). Antimicrobial stewardship programmes aim to address this, but their reach remains limited in rural settings. As social units, households play a critical role in shaping health behaviours, making their involvement vital in research. The objective of the current study was to identify system-wise use and determinants of antibiotic use in rural households. Methods A cross-sectional survey was conducted in two randomly selected rural blocks: Junnar and Mulshi in Pune district. Of 1993 households screened, 443 with ongoing antibiotic use (verified by prescription or physical availability) were included. Data on illnesses, knowledge, healthcare access and behaviours were collected using a semistructured questionnaire. Statistical analysis included chi-square/Fisher's exact tests and multivariable logistic regression using Stata 12.1. Results Antibiotic purchases were significantly higher in other social groups. Statistically significant determinants of antibiotic use (p0.005) included eye-related complaints and buying without a doctor’s advice in Mulshi (adjusted OR AOR=4.95), use beyond 10 days (AOR=8.65), affordability (AOR=4.15), lack of awareness about incomplete doses (AOR=4.23) and belief that antibiotics are essential for recovery (AOR=4.67). Conclusions Community-driven, context-specific antimicrobial stewardship interventions are crucial to address AMR, focusing on awareness, perceptions and responsible use among rural households.