Self-Medication for Upper Respiratory Tract Infections (URTIs) Among Clinical Medical Students: A Cross-Sectional Study of Knowledge,Attitudes,and Practices

Abstract

Background

Self-medication, defined as the use of medicines without prior professional consultation, is a widespread public health concern. When practiced inappropriately, particularly through the misuse of antibiotics, it contributes to adverse drug reactions and the growing threat of antimicrobial resistance (AMR). Medical students represent a population of particular interest, as their clinical knowledge may predispose them to self-treat conditions such as upper respiratory tract infections (URTIs), which are predominantly viral and self-limiting. This study aimed to assess the prevalence of self-medication for URTIs and to evaluate the knowledge, attitudes, and practices of clinical-phase medical students toward this behavior.

Methods

A cross-sectional study was conducted among 165 clinical-phase MBBS students, including third-, fourth-, and fifth-year students and interns, selected by simple random sampling. Data were collected using a structured, self-administered questionnaire adapted from World Health Organization guidelines, covering sociodemographic characteristics and knowledge, attitudes, and practices regarding self-medication for URTIs. Statistical analysis was performed using SPSS version 25 and included descriptive statistics, chi-square tests, and correlation analyses, with statistical significance defined as p < 0.05.

Results

The mean age of participants was 23.5 ± 2.25 years, with a nearly equal gender distribution. Three-quarters of students (74.5%) reported having self-medicated for URTIs, with community pharmacies serving as the primary source of medicines (71.5%). Only 21.2% of participants demonstrated good knowledge, while 54.5% showed moderate knowledge. Although 79.4% recognized the link between antibiotic misuse and AMR, 27.9% still believed antibiotics to be effective against viral URTIs, and 21.2% admitted to not completing prescribed antibiotic courses. Despite the majority (77.6%) holding negative attitudes toward self-medication in principle, unsafe practices remained prevalent. The year of study was significantly associated with both knowledge level and self-medication practices (p < 0.05).

Conclusion

Self-medication for URTIs is highly prevalent among clinical-phase medical students, revealing a concerning disconnect between knowledge, attitudes, and actual clinical behavior. Addressing this gap will require reinforcing antimicrobial stewardship within medical curricula, strengthening clinical supervision, and implementing stricter regulation of over-the-counter antibiotic availability, all of which are essential steps toward promoting rational drug use and mitigating the escalation of antimicrobial resistance.

Keywords

self-medication upper respiratory tract infections anti-bacterial agents antimicrobial resistance students medical cross-sectional studies

Background

Self-medication, defined as the use of medicines without consultation with a qualified healthcare professional, is a common global practice.^1,2 When practiced responsibly, it can support self-care and reduce pressure on healthcare systems.² However, inappropriate self-medication may result in delayed diagnosis, incorrect treatment, adverse drug reactions, and increased healthcare costs.^3-6 In some cases, complications arising from delayed or improper treatment may lead to greater economic and clinical burden than timely professional care.⁶

One of the most serious consequences of irrational self-medication is antibiotic misuse. Inappropriate antibiotic use is a major driver of antimicrobial resistance (AMR), a growing global health threat that compromises the effectiveness of standard treatments, increases morbidity and mortality, and increases healthcare expenditure.^7-9 Unsupervised antibiotic use is associated with adverse drug reactions, treatment failure, and prolonged illness.^10,11 These concerns are particularly pronounced in low- and middle-income countries, where enforcement of regulations on prescription-only medicines is often inconsistent.¹²

Upper respiratory tract infections (URTIs) are among the most common illnesses worldwide and frequently prompt self-medication.¹³ Most URTIs are viral and self-limiting, requiring only symptomatic management rather than antibiotic therapy.¹⁴ Nevertheless, antibiotics are commonly used to treat URTI symptoms due to misconceptions regarding their etiology, prior experiences, and easy access to medications without a prescription.^8,15 Such practices contribute significantly to the development of antimicrobial resistance and undermine rational drug use.

Medical students represent a distinct population in the context of self-medication. Their partial clinical knowledge, early exposure to pharmacology, academic pressures, and confidence in self-diagnosis may increase their likelihood of self-treating illnesses.^16,17 Although medical students often possess theoretical knowledge regarding the risks of antibiotic misuse and antimicrobial resistance, this knowledge does not always translate into appropriate attitudes or safe practices.¹⁸ Studies conducted in several low- and middle-income countries report a high prevalence of self-medication among medical students, frequently involving inappropriate antibiotic use.^19-21

In Nepal, self-medication is further facilitated by the widespread availability of prescription-only medicines, including antibiotics, in community pharmacies.² Although antibiotics are legally classified as prescription-only medicines under various acts and regulations, including the Drug Act 1978, enforcement remains inconsistent, and dispensing without a prescription is common.² Community pharmacies often serve as the first point of contact for individuals seeking treatment for minor illnesses, reinforcing self-medication behaviors.²² Given that medical students are future prescribers, their knowledge, attitudes, and practices regarding self-medication may influence future prescribing patterns and broader public health outcomes.

Despite increasing concern about antibiotic misuse and antimicrobial resistance, limited research in Nepal has comprehensively examined medical students’ knowledge, attitudes, and practices regarding self-medication, particularly in the context of upper respiratory tract infections. Identifying gaps between knowledge and actual practice is essential for informing targeted educational strategies and strengthening antimicrobial stewardship efforts.

Therefore, this study aims to assess the knowledge, attitudes, and practices regarding self-medication for upper respiratory tract infections among clinical-phase medical students at a tertiary medical college. The findings are expected to inform curriculum development, promote rational drug use, and contribute to national efforts to combat antimicrobial resistance.

Methods

Study Design and Study Site

A cross-sectional study was conducted among clinical-phase medical students at KIST Medical College and Teaching Hospital (KISTMCTH), a tertiary care teaching hospital located in Imadol, Kathmandu Valley, Nepal. The institution serves as a major academic and healthcare center, providing undergraduate medical education and clinical services to a large and diverse patient population. Data collection took place over a three-month period from September 18 to December 18, 2025, following Institutional Review Committee approval.

Study Population

The study population comprised MBBS students enrolled in the clinical phase of their medical education at KISTMCTH, including third-, fourth-, and fifth-year students and interns. Given their formal training in pharmacology and clinical medicine, this group represents a particularly relevant population for examining knowledge, attitudes, and practices related to self-medication.

Inclusion and Exclusion Criteria

Students enrolled in the clinical phase at KISTMCTH who were present during the data collection period and provided written informed consent were eligible for inclusion. Pre-clinical phase students were excluded, as were those who declined to participate or withheld consent.

Sample Size and Sampling Technique

The sample size was calculated using the single population proportion formula for cross-sectional studies: n = Z²p(1 − p)/d², where Z = 1.96 at a 95% confidence level, p = 50% (assumed prevalence of self-medication), and d = 5% margin of error. A prevalence of 50% was used to maximize the sample size in the absence of precise prior estimates. The calculated sample size was further adjusted using finite population correction based on the total number of eligible clinical-phase students, resulting in a final sample size of 165 participants.

Simple random sampling was employed to select participants from the official enrollment list provided by the academic administration. Each eligible student was assigned a unique identification number, and participants were selected using a computer-generated random number table. Proportional allocation was applied to ensure adequate representation from each academic year.

Variables

The independent variables included participants’ sociodemographic and academic characteristics, namely age, gender, and year of study. The dependent variables were knowledge, attitudes, and practices (KAP) related to self-medication for upper respiratory tract infections (URTIs). These domains were selected based on evidence from prior studies and the established understanding that self-medication behavior is shaped by an individual’s knowledge of and attitudes toward medicines and illness management.

Data Collection Tool

Data were collected using a structured, self-administered questionnaire adapted from World Health Organization (WHO) guidelines and previously validated studies,^8,11,17,18 with minor modifications to suit the local context. The questionnaire was prepared in English and consisted of four sections.

The first section collected participants’ sociodemographic and academic information. The second section assessed knowledge of self-medication and URTIs using 6 questions. The third section evaluated attitudes toward self-medication using six statements, each measured on a five-point Likert scale from “strongly agree” to “strongly disagree.” The fourth section assessed self-medication practices using six questions.

The questionnaire was reviewed for content validity by subject experts and pre-tested among a small group of students with similar characteristics to ensure clarity, relevance, and ease of understanding. Data from the pre-test were not included in the final analysis.

Process of Data Collection

Eligible students were approached by the investigators and provided with a clear explanation of the study’s objectives and significance. Written informed consent was obtained from all participants prior to enrollment. Participation was entirely voluntary, and students were informed of their right to withdraw at any time without academic consequences. The structured questionnaire was distributed in person, and participants were given adequate time to complete it independently before returning it to the investigators on the same day. No personal identifying information was collected, ensuring participant anonymity. Completed questionnaires were stored securely and remained accessible only to the research team. The instrument’s internal consistency was assessed using Cronbach’s alpha, yielding a coefficient of 0.76, indicating acceptable reliability.

Scoring System

Knowledge scores ranged from 0 to 6 and were categorized as good (5–6), moderate (3–4), or poor (0–2). Attitude scores ranged from 6 to 30 and were classified as positive (25–30), neutral (18–24), or negative (below 18), where a positive attitude reflected awareness of the risks associated with self-medication and support for rational drug use. Practice scores ranged from 0 to 6 and were classified as safe (5–6), moderate (3–4), or unsafe (0–2), based on reported self-medication behaviors.^23-25

Data Management and Analysis

Data were coded, entered, and cleaned before analysis using the Statistical Package for the Social Sciences (SPSS) version 25 (IBM Corp., Armonk, NY, USA). Descriptive statistics, including frequencies, percentages, means, and standard deviations, were used to summarize participants’ sociodemographic characteristics and knowledge, attitude, and practice (KAP) scores. KAP scores were categorized into predefined levels (e.g., good, moderate, poor) according to criteria established prior to analysis. The chi-square test was used to examine associations between categorical independent variables (age group, gender, and year of study) and levels of knowledge, attitudes, and self-medication practices. The correlation between knowledge, attitude, and practice domains was assessed using Pearson’s or Spearman’s correlation coefficient, as appropriate based on data distribution. A p-value of less than 0.05 was considered statistically significant.

Ethical Considerations

Ethical approval was obtained from the Institutional Review Committee of KISTMCTH. All participation was voluntary, and written informed consent was secured from every participant prior to data collection. Data confidentiality was maintained throughout the study, and no personal identifiers were collected at any stage.

Results

Sociodemographic Characteristics of Participants

A total of 165 clinical-phase medical students completed the questionnaire, yielding a 100% response rate. The mean age of participants was 23.5 ± 2.25 years. The majority (74.5%, n = 123) were aged 20-24 years, with the remaining 25.5% (n = 42) aged 25 years or older. Gender distribution was nearly equal, with 81 males (49.1%) and 84 females (50.9%) participants. One participant (0.6%) identified as other and is reflected in the original data. By academic year, fourth-year students comprised the largest group (33.9%, n = 56), followed by interns (29.7%, n = 49), fifth-year students (26.7%, n = 44), and third-year students (9.7%, n = 16) (Table 1).

Table 1.

Sociodemographic Characteristics(n = 165)

Variable	Category	Frequency (n)	Percentage (%)
Age	20–24 years	123	74.5
Age	≥25 years	42	25.5
Gender	Male	81	49.1
Gender	Female	84	50.9
Year of Study	Third year	16	9.7
	Fourth year	56	33.9
	Fifth year	44	26.7
	Internship	49	29.7

Knowledge of Self-Medication and URTIs

Knowledge levels varied considerably among participants. Just over one-fifth (21.2%, n = 35) demonstrated good knowledge, while the majority showed moderate knowledge (54.5%, n = 90), and 24.2% (n = 40) exhibited poor knowledge (Table 2, Figure 1). Regarding the etiology of URTIs, 59.4% (n = 98) correctly identified viruses as the most common causative agents. However, 35.8% incorrectly attributed URTIs to bacterial infection, 1.8% to fungal causes, and 3.0% were uncertain. Regarding antibiotic use, 63.6% (n = 105) correctly recognized that antibiotics are ineffective against viral URTIs, whereas 27.9% (n = 46) held the misconception that antibiotics are effective, and 8.5% were unsure. Awareness of antimicrobial resistance was relatively high, with 79.4% (n = 131) acknowledging that inappropriate antibiotic use drives resistance. More than half of participants (55.8%) correctly identified a range of behaviors, including the use of leftover medicines, purchasing drugs over the counter without a prescription, and using herbal remedies, as forms of self-medication. Despite this, 23.0% believed it was safe to take antibiotics without a physician’s consultation. Regarding drug classification, 70.3% correctly identified paracetamol as a non-prescription drug, while 20.6% mistakenly believed it required one.

Table 2.

Knowledge, Attitude, and Self-Medication Practices Among Participants (n = 165)

Variable	Category	Frequency (n)	Percentage (%)
Knowledge Level	Good	35	21.2
	Moderate	90	54.5
	Poor	40	24.2
Attitude toward Self-Medication	Positive	37	22.4
Attitude toward Self-Medication	Negative	128	77.6
Self-Medication Practice	Practiced self-medication	123	74.5
	Did not self-medicate	42	25.5
	Used the pharmacy as a source	118	71.5
	Did not complete antibiotics	26	21.2

Figure 1.

Knowledge levels regarding self-medication and URTIs

Association Between Knowledge and Sociodemographic Factors

Neither gender (χ² = 0.018, p = 0.991) nor age group (p = 0.295) was significantly associated with knowledge level, although students aged 20–24 years showed marginally higher proportions of good knowledge than older peers. In contrast, the year of study was significantly associated with knowledge level (χ² = 13.924, p = 0.030). Third-year students recorded the highest proportion of good knowledge (37.5%), while interns demonstrated comparatively lower levels (16.3%). Fifth-year students showed the highest proportion of poor knowledge (36.4%) (Table 2).

Attitudes Toward Self-Medication

The majority of participants held negative attitudes toward self-medication, with 77.6% (n = 128) classified as having a negative attitude and 22.4% (n = 37) a positive one (Table 2, Figure 2). More than half (51.5%) disagreed or strongly disagreed that self-medication is a practical way to save time and money, although 31.5% were in agreement. A notable proportion (39.4%) believed they were capable of diagnosing and treating themselves, compared to 24.8% who disagreed. Awareness of potential harm was high: 84.2% agreed or strongly agreed that self-medication can lead to adverse health outcomes, and 81.8% agreed that antibiotics should not be used without a confirmed diagnosis. An equal proportion supported the need for additional education on rational drug use for medical students. However, despite the overall negative orientation, 50.3% considered self-medication acceptable for mild symptoms, suggesting some degree of ambivalence in attitudes.

Figure 2.

Attitude toward self-medication

Association Between Attitudes and Sociodemographic Factors

No statistically significant association was found between attitude and gender (p = 0.071), year of study (p = 0.964), or age group (p = 0.543). Negative attitudes toward self-medication were consistently observed across all demographic subgroups (Table 3).

Table 3.

Association Between Attitude Toward Self-Medication and Sociodemographic Factors (n = 165)

Variable	Attitude (negative) n (%)	Attitude (positive) n (%)	p-value
Gender
Male	63 (77.8)	18 (22.2)	0.071
Female	65 (77.4)	19 (22.6)
Age group
20–24 years	94 (76.4)	29 (23.6)	0.543
≥25 years	34 (81.0)	8 (19.0)
Year of study
Third year	12 (75.0)	4 (25.0)	0.964
Fourth year	43 (76.8)	13 (23.2)
Fifth year	35 (79.5)	9 (20.5)
Internship	38 (77.6)	11 (22.4)

χ² test used; p < 0.05 considered statistically significant.

Self-Medication Practices for URTIs

Nearly three-quarters of participants (74.5%, n = 123) reported practicing self-medication for URTI symptoms, while 25.5% (n = 42) did not (Figure 3). In terms of frequency, 26.7% reported always self-medicating, 35.8% did so often, and 26.7% did so rarely, with only 10.3% reporting never having self-medicated. Community pharmacies were the most frequently cited source of medicines (71.5%), followed by personal knowledge (13.9%), leftover prescriptions (7.3%), and recommendations from family or friends (7.3%). Paracetamol and antihistamines were the most commonly used medications, although antibiotics were also frequently obtained and used without a prescription.

Figure 3.

Prevalence of self-medication for URTIs

Antibiotic-Related Practices

Among participants who reported antibiotic use, 66.7% completed the full course of treatment. However, 21.2% admitted to stopping the course early, and 12.1% indicated that antibiotic use was not applicable to them. Two-thirds of respondents (66.7%) reported reading medication leaflets before use, while 33.3% did not. Year of study was significantly associated with leaflet-reading behavior (χ² = 9.459, p = 0.024), with interns showing the highest compliance (77.6%). Age was also significantly associated with this practice (p = 0.002), with older students demonstrating better habits.

Association Between Self-Medication Practices and Sociodemographic Factors

Gender was not significantly associated with self-medication practice (p = 0.196), nor was age group (p = 0.488). However, year of study was significantly associated with self-medication behavior (χ² = 14.818, p = 0.002). Third-year students reported the highest prevalence of self-medication (93.8%), a finding that warrants particular attention given their relatively limited clinical exposure at that stage of training (Table 3).

Discussion

The focus of this study was to evaluate knowledge, attitude, and practice (KAP) regarding self-medication for upper respiratory tract infections (URTIs) among clinical-phase medical students at KISTMCTH. It was found that there is a very high prevalence of self-medication among the medical students in this study, moderate overall knowledge, and a majority of negative attitudes towards self-medication, as well as concerning practice patterns regarding antibiotics and reliance on OTC pharmacies.

Even though the majority of respondents (59.4%) recognized viral infection as the leading cause of URTI, a significant percentage (35.8%) believed URTIs were caused by bacteria, and many were unsure of the cause altogether. This partially consistent understanding, compared with earlier studies conducted with healthcare students in Serbia²⁶ and Jordan²⁷ showed deficiencies in their knowledge of antibiotics and the etiology of infections. In the study conducted by Alshogran et al, a significant number of students believed that bacteria were responsible for the common cold.^26,27 The majority (79.4%) of respondents in this study recognized that the improper use of antibiotics can lead to antibiotic resistance. This is consistent with findings from Gupta et al, where undergraduate medical students from India displayed a high level of awareness regarding antimicrobial resistance and its effects on patient outcomes.²⁸ Yet, awareness of proper decision-making in antibiotic prescribing is not always indicative of actual practice and behaviour in this regard. In this study, 27.9% of respondents believed antibiotics were still effective for treating viral URTIs, highlighting an ongoing gap between knowledge and practice in this area. Gupta et al documented disparities between theoretical knowledge and the actual use of antibiotics in India.²⁸ Therefore, having a high level of awareness alone does not guarantee that health care providers will rationally prescribe antibiotics in accordance with established guidelines.

In our study, knowledge levels differ according to year of study, with a statistically significant difference (P=0.030). This shows that as students progress through medical school, the time they spend studying and working in a clinical setting increases their ability to understand pharmacology. While interns had a higher percentage of moderate knowledge than other students, it wasn’t consistent that all “senior” students would have improved knowledge levels. This supports previous studies’ findings of an incremental increase in pharmacological knowledge, but a lack of stability, during the course of training.^29,30

Although self-medication is commonly used by many individuals, over three-quarters of those who participated in this research project (77.6%) exhibited negative attitudes towards self-medication as a whole; this indicates that most are aware that using medications improperly could cause harm to their health. Additionally, the majority of those who completed the survey (over 84%) reported that self medicating with medications (taking them without medical supervision) has the capacity to produce negative changes in health, while over 80% of the respondents (each) stated that they do not support the practice of using antibiotics to treat conditions without having a physician’s documented diagnosis of the condition. Other studies have found similar results; although those students also understood the risks associated with improperly using medications, many continued to use self-medication.^17,29

A high proportion of respondents (81.8%) believe that medical students need additional education regarding the rational use of medications. This suggests that there are gaps in the current educational/training programs for medical professionals. Kumar et al and Brinkman et al reported this same issue; in both studies, medical students indicated a need for more structured, earlier education in pharmacology and antimicrobial stewardship.^17,29

All attitude levels were similar across demographic factors such as gender, age, and year of study, indicating that students, regardless of their demographic background or level of academic achievement, experienced negative attitudes toward self-medication similarly. The similar nature of this finding may differ from other studies worldwide that observed that senior students have a more liberal view of self-medication, possibly due to differences in the local structure of academic programs and the medical prescription culture.^26,27

In this study, self-medication was very common: 74.5% of respondents reported self-medicating for upper respiratory tract infections (URTIs). Globally, SM is also everywhere, with higher frequencies reported from Serbia (79%),²⁶ Jordan (78%),²⁷ and Ethiopia (67–80%).³¹ This shows that medical students globally exhibit self-medication behaviour. The higher prevalence of SM in third year (3Y) medical students than in other years (p = 0.002) indicates that these students have likely experienced greater stress due to academic demands and lower clinical confidence, as they have only just begun their clinical training.

In this study, a high percentage (74.5%) of students were self-medicated with URTI symptoms. The rates are similar to those reported in other studies, including studies conducted in Serbia (79%),²⁶ in Jordan (78%)²⁷ and Ethiopia (67%–80%).³¹ These findings illustrate that self-medication is a common practice among medical students worldwide. Third-year medical students reported significantly higher rates of self-medication than students in other cohort years (p= 0.002), likely due to increased academic demands and lower clinical confidence from early clinical experiences.^11,12,17

A large majority of students obtained their medicines from OTC pharmacies (71.5%), consistent with the lack of prescription requirements for access to medicines in Nepal. In South Asia, there are examples of pharmacies being the primary source of care for minor illnesses,^28,31 demonstrating that a variety of systemic influences support self-medicating rather than the individual consumer’s knowledge alone

According to reports from participants completing the project, about two-thirds reported completing all of their prescribed antibiotics when using self-medication. Over 20% of participants did not complete their antibiotic prescriptions, which increases the risk of antimicrobial resistance. In similar studies performed among medical students in India²⁸ and other developing countries,³² a large percentage also did not complete their antibiotics as instructed. While 66.7% of participants reported reading the medication information provided with the drugs, the proportion of participants who read this information increased as participants progressed through their studies and grew older. Thus, it is possible that increased maturity and experience in the clinical environment will improve medication safety and the safe use of medications by future practitioners.^17,29,33

The results of the current research indicate a substantial relationship between knowledge and practice. Even though subjects were found to demonstrate considerable knowledge about safe use of self-medication, many subjects showed a negative view toward self-medication practices. However, the majority of participants engaged in unsafe self-medication practices. This phenomenon is consistent with findings from previous studies.^17,29,30,34 The association between perceived competency, medication availability, time constraints, and societal expectations is complex, contributing to the identified discrepancies between knowledge and practice.

The results enhance the belief that simply increasing one’s understanding will not solve the problem. Other means must be taken to move beyond mere knowledge into the ability to act. Implementing an organized education program, providing ongoing education on ethical prescribing practices, and strengthening monitoring of the sale of OTC antibiotics will allow for greater translation of knowledge into appropriate action. It may also be beneficial to incorporate antimicrobial stewardship principles earlier in medical training and then to utilize supervised clinical judgment to bridge this gap.

Because it was a cross-sectional study conducted at a single site using self-reported data, it is not possible to draw causal conclusions, nor can we determine whether social desirability influenced respondents’ answers. However, the information from this study provides insight into what future physicians in Nepal believe about self-medication. Furthermore, the findings stress the importance of revising the medical curriculum and creating institutional policies that promote reasonable self-care and rational drug use.

Limitations

This study has several limitations that should be considered when interpreting the findings. First, the study was conducted at a single tertiary medical college in Kathmandu, which may limit the generalizability of the results to medical students in other institutions or regions of Nepal. Patterns of self-medication may differ across rural settings and institutions with different academic environments. Second, the cross-sectional design of the study restricts the ability to establish causal relationships between knowledge, attitudes, and practices related to self-medication. The findings, therefore, reflect associations at a single point in time rather than changes over time. Third, the study relied on self-reported data, which may be subject to recall bias or social desirability bias. Some participants may have underreported unsafe practices or provided responses they perceived as more acceptable than their actual behaviors. Additionally, the study focused primarily on KAP-related factors; other potential influences, such as cultural beliefs, peer influence, academic stress, and institutional prescribing culture, were not explored. Future studies incorporating qualitative methods or multicenter designs may provide a more comprehensive understanding of self-medication behaviors among medical students.

Recommendations

Based on the findings of this study, several recommendations can be proposed. There is a clear need for targeted educational interventions aimed at strengthening rational drug use among medical students, particularly with regard to antibiotic stewardship and self-medication for common illnesses such as URTIs. Integrating antimicrobial stewardship principles early into the medical curriculum, with repeated reinforcement during clinical training, may help bridge the gap between knowledge and practice. Regular workshops, seminars, and problem-based learning sessions focusing on rational prescribing, consequences of antimicrobial resistance, and safe self-care practices should be implemented. Additionally, supervised clinical exposure that emphasizes appropriate prescribing behavior may help students translate theoretical knowledge into practice. At the policy level, stricter regulation and monitoring of over-the-counter antibiotic sales are essential to reduce easy access to prescription-only medicines. Collaboration between academic institutions, regulatory authorities, and community pharmacies could further promote responsible self-medication practices. Future research should also examine behavioral, cultural, and systemic factors that influence self-medication to inform more comprehensive interventions.

Conclusion

Self-medication for URTIs is highly prevalent among clinical-phase medical students, with a pronounced gap between knowledge, attitudes, and actual practice. Although most students demonstrated awareness of antimicrobial resistance and expressed negative attitudes toward self-medication, this awareness and attitude did not consistently translate into rational behavior, and inappropriate antibiotic use remained common. The predominant reliance on community pharmacies highlights the role of ready access to over-the-counter medicines as a key systemic driver. These findings underscore that knowledge alone is insufficient to change behavior. A coordinated response is needed, encompassing antimicrobial stewardship education within the medical curriculum, strengthened clinical supervision, and tighter regulation of antibiotic sales, to foster rational drug use among future physicians and contribute to national efforts to combat antimicrobial resistance.

Footnotes

Acknowledgements

The authors would like to express their sincere gratitude to the Department of Community Medicine and the academic administration of KIST Medical College and Teaching Hospital for providing the necessary support and facilities to conduct this study. The authors are grateful to all the medical students who volunteered for the study and provided valuable information. The authors also acknowledge the contributions of faculty members who provided guidance during questionnaire development and statistical analysis.

ORCID iDs

Abishesh Shakya

Sunil Shrestha

Ethical Considerations

Ethical approval for this study was obtained from the Institutional Review Committee of KIST Medical College and Teaching Hospital, Imadol, Kathmandu, Nepal. The study was conducted in accordance with institutional ethical standards and the principles of the Declaration of Helsinki. Participant confidentiality was strictly maintained, and no personal identifiers were collected.

Consent to Participate

Written informed consent was obtained from all participants prior to their participation in the study. Participation was voluntary, and respondents were informed about the objectives of the study and their right to withdraw at any stage without consequences.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.*

Trial Registration

Not applicable, as this study was a cross-sectional observational study and did not involve a clinical trial.

Appendix

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