The Sore Throat and Antibiotic Resistance (STAR) Study in Malaysia: Nationwide Survey of Antibiotic Use for Upper Respiratory Tract Infection and Sore Throat
Year: 2026
Type: article
Study design: Observational Study
Abstract: Antimicrobial resistance (AMR) is exacerbated by the ongoing misuse of antibiotics for upper respiratory tract infections (URTIs), and it is vital to try and determine factors associated with antibiotic misuse. The Sore Throat and Antibiotic Resistance (STAR) study aims to evaluate public knowledge, perceptions, and behaviors to antibiotic use for acute URTIs and sore throat in Malaysia. A nationwide online survey was carried out in June 2024 among Malaysian adults who reported having sore throats with other URTI symptoms in the past six months using a random sampling method. A 26-item (plus 5 for screening) self-administered questionnaire, adapted from the Eurobarometer survey on AMR, was shared through the Toluna online panel. The questionnaire included four sections that covered demographic details, URTI symptom patterns, antibiotic use, and self-medication practices for symptomatic relief, as well as knowledge, perceptions, and behaviors about these practices. Among 1031 respondents, sore throat was the most common symptom (62%). It often occurred significantly (p < 0.001) with cough (51.4%) and flu-like symptoms (53.8%). Antibiotic use was high, with 72% using them for respiratory illnesses and 33.4% for sore throat. Self-medication for symptomatic relief occurred mostly for sore throat (62%). While 78% had seen AMR messages and 70% knew about antibiotic risks, many held misconceptions: 66.1% thought antibiotics relieve pain and 72.5% believed they speed recovery. Confidence in non-antibiotic care was low at 42%, and 80% expressed anxiety about not using antibiotics. Unsafe behaviors included keeping leftover antibiotics (34%) and stopping treatment early (45%). This study found a significant gap between perceived knowledge and practice as well as behaviors that contribute to inappropriate antibiotic use. These findings emphasize the need for targeted interventions such as public education, improved communication between healthcare providers and patients, including the benefits of a pro-symptomatic approach to first line management. Antimicrobial resistance (AMR) poses a significant threat to global health. Despite this, antibiotics are still commonly used for conditions like sore throats and flu-like symptoms, which are usually caused by viruses that do not need antibiotics. We carried out an online survey across Malaysia with 1031 people from different demographic backgrounds to understand why this is happening. Sore throat was the most reported symptom (62%), often appearing alongside cough (51.4%) and flu-like symptoms (53.8%), showing strong co-occurrences (p < 0.001). Even with guidelines against antibiotics for viral infections, 72% of those surveyed said they used antibiotics for respiratory problems, with 33.4% specifically for sore throat. Self-medication was common (62%), particularly for sore throat. Most respondents had seen messages about AMR (78%) and recognized the risks of antibiotics (70%), yet misunderstandings were widespread: 66.1% thought antibiotics relieve pain, and 72.5% believed they speed up recovery. Emotional factors also influenced behavior, with 80% feeling anxious about not using antibiotics, and only 42% felt sure they could manage symptoms without them. Unsafe practices were common, such as 34% keeping leftover antibiotics and 45% stopping their treatment early. These results reveal a significant gap between perceived knowledge and actual behavior. A pro-symptomatic approach to first line management of acute URTIs coupled with initiatives which improve public understanding and communication between healthcare providers and their patients are crucial for reducing unnecessary antibiotic use and addressing AMR.
Source: Advances in Therapy
Language: English
Subfield: Applied Microbiology and Biotechnology
Field: Immunology and Microbiology
Domain: Life Sciences
Open Access status: hybrid
Estimated APC paid: $4,790
OpenAlex ID: W7131669092