Infection is a major health concern in developing low-resource countries that represents a serious leading cause of morbidity and mortality, especially in children. To cope with financial life challenges, parents try to save both money and time by using their knowledge and experience to treat their children. Over-the-counter unrestricted access to antibiotics and the disseminated information about diseases and therapeutic modalities through the Internet encourage self-medication prescription by parents. As a consequence, inappropriate antibiotic use has emerged, contributing to the development of drug resistance. Misusing antibiotics is a multifactorial problem that has a negative impact on medical services and adversely affects clinical outcomes, especially in vulnerable populations such as children. The current study explored the pattern of antibiotic use by parents and the factors affecting this pattern in a sample of the Egyptian population.

The inappropriate use of antibiotics is not a hidden problem. Several studies have analyzed this problem with different results even within the same country. In the Egyptian population, the rate of antibiotic misuse ranged from 13 to 80% [25, 26]. This wide variation reflects the influence of sociodemographic and economic factors on antibiotic use patterns in the population. Previous studies have shown that lack of knowledge and low income were the two main factors contributing to inappropriate antibiotic use in developing countries. The highest rate of antibiotic misuse in the pediatric population was reported in the Middle East (34%), followed by Africa (22%) [27].

Among the studied children’s caregivers, the current study found 37.2% to be antibiotic misusers. Several studies evaluated parents´ antibiotic use in different areas of Egypt. Among Egyptian children, Osman et al. found that about 50% of mothers in Qena Governorate misused antibiotics [21], while Mohammed et al. found that more than two-fifths of parents in Alexandria used antibiotics without an acceptable prescription [22]. Other studies evaluated parents’ antibiotic use in different countries. Mallah et al. reported that 41% of Lebanese participants had at least one misuse behavior [28], and Alanazi et al. revealed that the prevalence of antibiotic misuse was 57.8% among children in Saudi Arabia [29]. Additionally, Mutagonda et al. found a much higher prevalence of misuse in Tanzania, where 82% of participants were inappropriate antibiotic users [17].

This wide range of values for reported misuse between studies could be attributed to differences in parents’ knowledge and attitude towards antibiotics. In our current study, 30.2% of the participants had good knowledge, and 72% had a positive attitude, which was greater than previous studies, where for instance only 10.9% had good knowledge and 16.4% had positive attitudes in the study in Tanzania [17].

The present study results revealed that a good knowledge level was significantly associated with higher education, having work, and having sufficient income. These findings are in accordance with studies in Tanzania and Bosnia [17, 30] but stand in contrast to the findings from Islam et al. who found that secondary education, not being employed, and having a low household income were associated with good knowledge in his study in Bangladesh [31].

Although the study participants had a good level of knowledge about the use and resistance of antibiotics, our research showed that 31% of them had poor knowledge about the side effects of antibiotics, and 54% had neutral attitudes towards the safety and resistance of antibiotics. Underestimation of the hazardous effects of antibiotics may contribute to their misuse by parents considering them as safe medications.

Furthermore, our study showed that 79.6% had positive attitudes towards doctor prescriptions of antibiotics. This positive attitude by the parents can potentially adversely affect physicians’ behaviors. Awad et al. reported that some physicians prescribe antibiotics to satisfy their patients and guarantee their visits in the future despite unnecessary indications for antibiotic use [32].

The current study demonstrated that a higher level of parents’ education and their positive attitude towards antibiotics were protective factors that decreased the proportion of inappropriate antibiotic use. These results corroborated those of earlier studies [22, 30, 33, 34].

In addition, having a higher number of children and an older age of children were associated with greater misuse of antibiotics among our participants. These strong associations reflect the financial burden, as more than half of our included parents relied on their previous experiences (58.5%) or previous prescriptions (76.5%) instead of visiting physicians.

The source of getting correct information about antibiotics is crucial for their appropriate use. In our study, most parents (92%) got their information from physicians, and more than half (58.5%) got their information based on their previous experience. Our findings were consistent with those of Awadh et al. [35] and Siddiqui et al. [36] in other investigations. However, these findings raise concerns that widespread prescriptions of antibiotics by medical staff may encourage parents to do the same the next time their children get ill. Evidence revealed that even among physicians and in hospital settings, there is a high rate of inappropriate use of antimicrobials [37]. Thus, we may be entering into a vicious cycle where inappropriate use of antibiotics leads to the emergence of drug resistance, which in turn leads to further prescription of more antibiotics and vice versa.

This study has some limitations due to the relatively small sample of the population included and the cross-sectional design, which limits our ability to analyze the cause-and-effect relationship. We did not examine the consequences of inappropriate antibiotic use by parents, including overall financial costs, hazardous effects on children, and the emergence of antibiotic-resistant strains.