Exploring factors contributing to inappropriate use of antibiotics for common childhood illnesses among parents in Nepal: a qualitative study

Background Inappropriate antibiotic use contributes to antimicrobial resistance (AMR) and is particularly concerning in children, who frequently experience common infections. Evidence on how parents use antibiotics for common childhood illnesses in Nepal is limited. This study explored factors contributing the inappropriate antibiotic use by parents in managing common childhood illnesses in Nepal. Methods This qualitative study was embedded within a mixed-methods study conducted between December 2022 and September 2023. Twenty-six parents of children admitted to the inpatient departments for common childhood illnesses - fever, acute respiratory infections, and diarrhea were purposively selected following a quantitative survey. In-depth interviews were conducted in Nepali until saturation was achieved, audio-recorded, transcribed and translated into English. Data were analysed using codebook thematic analysis with deductive and inductive coding. Results The study identified four major themes with varying understandings of antibiotic use and resistance among the parents. Antibiotics were perceived as strong and effective medicines, particularly when other medicines did not improve child’s illness. Parents exhibited a strong inclination towards using antibiotics frequently without medical consultation, reusing previously prescribed medicines, retaining leftover antibiotics and discontinuing treatment following perceived recovery. Pharmacies were preferred for their accessibility, lower costs and perceived effectiveness of medicines, while financial constraints influenced completion of antibiotic treatment. Geographic barriers further shaped health-care seeking among participants from rural settings, including buying antibiotics from grocery stores. Interactions with healthcare providers and previous treatment experiences also informed subsequent antibiotic-use practices. Conclusion Inappropriate antibiotic use was shaped by parents’ understandings and beliefs about antibiotics their prior experiences of antibiotic usage and healthcare-seeking contexts. These findings underscore the need for improving reliable antibiotic information, strengthening between healthcare providers-parents communication, strengthening confidence in formal healthcare services and addressing non-prescription access to antibiotics.