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In 89% of countries, antibiotics can only be prescribed by a doctor and supplied by a pharmacy.<ref>{{cite web |title=Global Database for Tracking Antimicrobial Resistance (AMR) Country Self- Assessment Survey (TrACSS) |url=http://amrcountryprogress.org/ |access-date=2023-03-28 |website=amrcountryprogress.org |language=en |archive-date=28 March 2023 |archive-url=https://web.archive.org/web/20230328115257/http://amrcountryprogress.org/ |url-status=live }}</ref> [[Self-medication]] by consumers is defined as "the taking of medicines on one's own initiative or on another person's suggestion, who is not a certified medical professional", and it has been identified as one of the primary reasons for the evolution of antimicrobial resistance.<ref name=":2">{{cite journal | vauthors = Rather IA, Kim BC, Bajpai VK, Park YH | title = Self-medication and antibiotic resistance: Crisis, current challenges, and prevention | journal = Saudi Journal of Biological Sciences | volume = 24 | issue = 4 | pages = 808–812 | date = May 2017 | pmid = 28490950 | pmc = 5415144 | doi = 10.1016/j.sjbs.2017.01.004 }}</ref> Self-medication with antibiotics is an unsuitable way of using them but a common practice in resource-constrained countries. The practice exposes individuals to the risk of bacteria that have developed antimicrobial resistance.<ref name=nft1>{{cite journal | vauthors = Torres NF, Chibi B, Middleton LE, Solomon VP, Mashamba-Thompson TP | title = Evidence of factors influencing self-medication with antibiotics in low and middle-income countries: a systematic scoping review | journal = Public Health | volume = 168 | pages = 92–101 | date = March 2019 | pmid = 30716570 | doi = 10.1016/j.puhe.2018.11.018 | s2cid = 73434085 }}</ref> Many people resort to this out of necessity, when access to a physician is unavailable due to lockdowns and GP surgery closures, or when the patients have a limited amount of time or money to see a prescribing doctor.<ref>{{cite journal | vauthors = Ayukekbong JA, Ntemgwa M, Atabe AN | title = The threat of antimicrobial resistance in developing countries: causes and control strategies | journal = Antimicrobial Resistance and Infection Control | volume = 6 | issue = 1 | pages = 47 | date = 2017-05-15 | pmid = 28515903 | pmc = 5433038 | doi = 10.1186/s13756-017-0208-x | doi-access = free }}</ref> This increased access makes it extremely easy to obtain antimicrobials and an example is India, where in the state of [[Punjab]] 73% of the population resorted to treating their minor health issues and chronic illnesses through self-medication.<ref name=":2" />
Self-medication is higher outside the hospital environment, and this is linked to higher use of antibiotics, with the majority of antibiotics being used in the community rather than hospitals. The prevalence of self-medication in [[Developing country|low- and middle-income countries]] (LMICs) ranges from 8.1% to very high at 93%. Accessibility, affordability, and conditions of health facilities, as well as the health-seeking behavior, are factors that influence self-medication in low- and middle-income countries (LMICs).<ref name=nft1 /> Two significant issues with self-medication are the lack of knowledge of the public on, firstly, the dangerous effects of certain antimicrobials (for example [[ciprofloxacin]] which can cause [[Tendinopathy|tendonitis]], [[tendon rupture]] and [[aortic dissection]])<ref>{{cite journal | vauthors = Chen C, Patterson B, Simpson R, Li Y, Chen Z, Lv Q, Guo D, Li X, Fu W, Guo B | display-authors = 6 | title = Do fluoroquinolones increase aortic aneurysm or dissection incidence and mortality? A systematic review and meta-analysis | journal = Frontiers in Cardiovascular Medicine | volume = 9 | pages = 949538 | date = 2022-08-09 | pmid = 36017083 | pmc = 9396038 | doi = 10.3389/fcvm.2022.949538 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Shu Y, Zhang Q, He X, Liu Y, Wu P, Chen L | title = Fluoroquinolone-associated suspected tendonitis and tendon rupture: A pharmacovigilance analysis from 2016 to 2021 based on the FAERS database | journal = Frontiers in Pharmacology | volume = 13 | pages = 990241 | date = 2022-09-06 | pmid = 36147351 | pmc = 9486157 | doi = 10.3389/fphar.2022.990241 | doi-access = free }}</ref> and, secondly, broad microbial resistance and when to seek medical care if the infection is not clearing. In order to determine the public's knowledge and preconceived notions on antibiotic resistance, a screening of 3,537 articles published in Europe, Asia, and North America was done. Of the 55,225 total people surveyed in the articles, 70% had heard of antibiotic resistance previously, but 88% of those people thought it referred to some type of physical change in the human body.<ref name=":2" /> Another study conducted in Bangladesh, where antibiotics can be bought without a prescription, found drug-resistant bacteria to be the third highest reason for death with 4.95 million deaths as of 2019<ref>{{cite journal |last1=Raihan |first1=Md Abu |last2=Islam |first2=Md Saiful |last3=Islam |first3=Shariful |last4=Islam |first4=A. F. M. Mahmudul |last5=Ahmed |first5=Khandaker Tanveer |last6=Ahmed |first6=Tania |last7=Islam |first7=Md Nahidul |last8=Ahmed |first8=Shamsunnahar |last9=Chowdhury |first9=Mysha Samiha |last10=Sarker |first10=Dipto Kumar |last11=Lamisa |first11=Anika Bushra |title=Knowledge, attitudes, and practices regarding antibiotic use in Bangladesh: Findings from a cross-sectional study |journal=PLOS ONE |date=12 February 2024 |volume=19 |issue=2 |pages=e0297653 |doi=http://dx.doi.org/10.1371/journal.pone.0297653}}</ref>. The ability to self-medicate whenever and however led to the increase in drug-resistant bacteria within Bangladesh and sadly left, and continues to leave, a damaging mark on the country. With so many people around the world with the ability to self-medicate using antibiotics, and a vast majority unaware of what antimicrobial resistance is, it makes the increase of antimicrobial resistance and its global negative impact much more likely.{{citation needed|date=April 2023}}
=== Clinical misuse ===
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