Antibiotic self-medication behaviours and contributing factors among adults in the Southern West Bank, Palestine

Background Antibiotic self-medication (ASM) is a recognized contributor to antimicrobial resistance, particularly in settings characterized by constrained healthcare access and weak regulatory enforcement. Objectives To estimate the prevalence of ASM, examine antibiotic-related knowledge and behavioural patterns, and identify independent sociodemographic predictors of ASM among adults in the southern West Bank, Palestine. Methods A cross-sectional survey was conducted in May 2025 among 301 adults recruited from community pharmacies in Hebron and Bethlehem. Participants completed a validated structured questionnaire assessing antibiotic knowledge, access pathways, and self-medication practices. Associations were evaluated using χ2 tests, and independent predictors were identified via multivariable binary logistic regression. Results ASM was reported by 76.4% of participants within the preceding three months. Among self-medicators, 91.7% obtained antibiotics directly from community pharmacies without prescription. The mean antibiotic knowledge score was 56.7% ± 28.6, with only 25.3% demonstrating high knowledge. Inappropriate antibiotic use patterns were common, including dose or antibiotic modification (58.3%) and symptom-based discontinuation (40.4%). Only 26.1% reported completing a full antibiotic course, while 37.4% reported adverse drug reactions. Multivariable analysis indicated that ASM was independently associated with male sex [adjusted odds ratio (AOR) = 2.1, 95% CI 1.2–3.7], age >30 years (AOR = 1.9, 95% CI 1.1–3.5), lack of health insurance (AOR = 2.6, 95% CI 1.4–4.8), and high antibiotic knowledge (AOR = 2.3, 95% CI 1.1–4.1). Conclusions ASM represents a highly prevalent mode of antibiotic use in the southern West Bank and appears to be driven primarily by structural and economic barriers rather than knowledge deficits alone. Strengthening pharmacy regulation, improving healthcare accessibility, and implementing context-sensitive antimicrobial stewardship strategies are urgently needed.