Association of antibiotic knowledge and beliefs with non prescription antibiotic acquisition among Indonesian adults using national health survey data

Antimicrobial Resistance (AMR) is a critical global crisis projected to cause 10 million annual deaths by 2050. Self-medication with antibiotics (SMA) is a primary accelerant of this crisis, as it bypasses medical safeguards. This study aims to examine the association between antibiotic knowledge and beliefs and non-prescription antibiotic acquisition among Indonesian adults, in order to explore the know–do gap in antibiotic use behavior. This quantitative cross-sectional study utilized secondary micro-data from the 2023 Indonesia Health Survey ( N = 101,482) involving residents aged ≥ 15 years. Complex samples logistic regression was used to estimate adjusted odds ratios (AORs) for prescription-based antibiotic acquisition, accounting for sampling weights, stratification, and clustering, with adjustment for age, sex, education, and occupation as potential confounders. Non-prescription acquisition was 48.1%. While general awareness was low, only 32.2% understood that improper use leads to resistance. Respondents who believed antibiotics must be finished (AOR: 0.364) or taken on schedule (AOR: 0.487) were significantly less likely to obtain antibiotics without prescription. Conversely, permissive beliefs, such as the acceptability of purchasing without a prescription (AOR: 2.331) or reusing leftovers (AOR: 1.371), significantly increased the likelihood of non-prescription acquisition. Non-prescription antibiotics acquisition remains a substantial issue in Indonesia, driven by critical gaps in translating awareness into practice. Procedural, actionable knowledge exerts a stronger influence on behavior than abstract awareness. Stewardship interventions should prioritize dismantling permissive social norms and reinforcing practical dosing skills to mitigate the accelerating threat of AMR.