"FROM PRESCRIPTION TO

PERCEPTION: A COMPREHENSIVE
SURVEY AND REVIEW ON AWARENESS
OF MEDICINES, SELF-MEDICATION
PRACTICES, AND SIDE EFFECTS"
Introduction:
1. BACKGROUND OF THE STUDY:
Medications are a mainstay in the prevention of diseases, treatment of the same, as well as in the promotion
of one's health. Still, the effectiveness and safety of a drug are mostly based on the rational use of medicines
(as the right medicine, in the right dose, for the right duration, and at a cost that the patient or community can
afford) Medicine are the pillar of contemporary health care, providing tremendous therapeutic value when
employed logically and under expert guidance. Over the past decade, the abuse and excessive use of readily
accessible medications have become increasingly a worldwide problem. The transition from prescription to
perception—how people comprehend, read, and make use of drugs on their own—opened up the gap between
secure therapy and self-medication practice. In the developing nations like India, this is compounded by ready
availability of over-the-counter (OTC) medicines, inadequate regulation, and a lack of public awareness about
rational use of medicines and possible side effects. Self-medication, or the use of medicines without a
prescription or expert advice, is prevalent among all socioeconomic classes. Self-medication is becoming a more
widespread part of modern health behavior. Across most of modern culture, individuals are increasingly taking
personal responsibility for their own health, frequently dealing with minor diseases without seeking help from a
doctor or pharmacist. Recent research indicate that self-medication is growing prevalent worldwide, especially in
low- and middle-income countries. A 2024 meta-analysis reported that approximately 64% of the Indian
population engages in self-medication for common ailments such as fever, pain, or acidity(1). Among the most
commonly self-medicated drug classes are analgesics/antipyretics (nsaids), antibiotics, and proton pump
inhibitors (ppis). In India, antibiotics and nsaids are frequently used without prescription for symptoms like
fever, headache, and common colds. Non-steroidal anti-inflammatory drugs (nsaids) are among the most
commonly used medications worldwide for the management of pain, inflammation, and fever. They function
primarily by inhibiting the cyclo-oxygenase (COX) enzymes—COX-1 and COX-2—thereby reducing the synthesis
of prostaglandins that mediate inflammation and pain responses(2) There is still a lack of knowledge in
community settings about the proper dosage, duration, and contraindications of nsaids. Pharmacists and pharmacy
students are crucial in helping patients use nsaids safely, identifying warning signs (such dark stools, abdominal
pain, or renal symptoms), and suggesting gastroprotective co-therapy when necessary. Enhancing knowledge and
counseling practices around nsaids is therefore a crucial component in promoting rational self-care and
minimizing preventable adverse drug events (WHO, 2024). Self-medication with antibiotics is defined as
acquiring and taking antibiotics to self-diagnose and medicate infectious diseases without consultation
of a medical practitioner(3).These antibiotics are not prescribed by physicians, but are obtained by
sharing drugs with relatives, using leftover drugs stored at home, or by purchasing medicine(s) using
an old prescription(4). World Health Organization (WHO) warns that a significant proportion of antibiotics
are used for self-medication, raising concerns about antibiotic resistance globally. Antibiotic resistance
arises as bacteria undergo evolutionary changes to shield themselves from the effects of antibiotics. A
recent meta-analysis published in 2023 reported that approximately 19.8% of children and adolescents in India
had practiced antibiotic self-medication, often using leftover medications or advice from relatives(5). Proton
Pump Inhibitors (ppis) are among the most prescribed and self-medicated drugs across the globe. They are
mainly employed for treatment of acid-related disorders like gastroesophageal reflux disease (GERD), peptic
ulcer disease, and dyspepsia through irreversible blockade of the hydrogen/potassium ATPase enzyme system
of parietal cells in the stomach, resulting in inhibition of gastric acid secretion. The most available ppis are
omeprazole, pantoprazole, lansoprazole, and esomeprazole — most of which are readily available over the
counter in India and other developing countries. Long-term unsupervised PPI therapy has been linked to several
adverse effects, including vitamin B12 and magnesium deficiency, bone fractures, renal impairment, and
increased risk of gastrointestinal infections due to altered gut(6).ppis are generally well tolerated,
inappropriate and prolonged use without medical supervision has emerged as a major concern. Studies have
shown that nearly 40–50% of PPI use globally may be unnecessary, often continued beyond the indicated
duration or used for mild, self-limiting symptoms such as heartburn or bloating(7).

2. CONCEPT OF SELF-MEDICATION AND AWARENESS:

Medicine awareness refers to people's knowledge, perception and understanding of the proper use, dose,
indications, side effects, stability and storage of a drug. It is a core element of safe healthcare practice and
rational use of drugs. Medicine awareness is important in order to prevent misuse, self-medication and adverse
drug reactions, and thus improve therapeutic efficacy and safety. In a rapidly changing healthcare environment,
awareness on the part of patients, students, to health care professionals, is a fundamental step towards rational
pharmacotherapy and reduction of the global burden from medicine-related problems. Patients use a high
percentage of over-the-counter medicines, such as nsaids, ppis and antibiotics, without a prescription or the
necessary counseling. This lack of awareness has multiple causes such as the ready availability of medicines.
Poorly managed regulations, socio-economic stresses and beliefs that over-the-counter medicines are
completely safe for any ailment. The lack of awareness about proper dosage, side effects, and the distinction between
antibiotics and other medicines allows misuse of nsaids, ppis and antibiotics, leading to adverse events and public health
crises. Patients and the public often deal with misinformation. With increasing information available digitally and
online, more curiosity mixed with confusion is created regarding the use of medicines. Confusion often leads to
self-diagnosis and self-medication, which can complicate the situation including antibiotic resistance,
gastrointestinal complications, or chronic renal injury after overdosing on analgesics or ppis. The trends of an
increase in self-medication were accelerated during the COVID-19 pandemic (2020 - 2022) — patients were taking
antibiotics, pain relievers, and antacids without prescriptions due to fears of infection and inability to access healthcare.

➢Why Awareness is Low: Key Driver

• Financial limitations: Many individuals self-medicate to avoid the expenses related to physician visits or travel.
• Time pressures & convenience: Because of a busy lifestyle, delays, or long waits, people self-medicate instead of
seeing a physician.
• Illness perception: People feel symptoms are minor and can handle them without medical assistance.
• Success or past experience: If people previously received medicine and improved, they would use it again without
consulting a physician.
 • Ready availability of pharmacies/OTC drugs: Readily available, and significant oversights of the law by pharmacies,
can be a motivation to self-medicate.
• Inadequate health literacy: Not everyone has adequate health literacy in understanding drug classes, side effects
or rational drug use.

3. FOCUS ON SELECTED DRUG:

❖ NONSTEROIDAL ANTI-INFLAMMATORY DRUGS:
Nsaids (nonsteroidal anti-inflammatory drugs) are medications that reduce inflammation, pain and fever ,by inhibiting the
cyclooxygenase (COX) enzymes (COX-1 and COX-2),
which are involved in prostaglandin synthesis . There are
many different types of nsaids, including
nonprescription and prescription strength, Common
examples include ibuprofen, diclofenac, naproxen, and
aspirin. Healthcare providers use them to treat a wide
range of symptoms, from headaches and dental pain to
arthritis and muscle stiffness. The accessibility and
perceived safety of several nsaids have led to
widespread self-medication practices. While
convenient, this practice carries significant public health
risks, as unsupervised use can lead to serious adverse
effects, including gastrointestinal complications (ulcers,
bleeding), renal impairment, and cardiovascular events,
especially with chronic use or improper dosing.(8)
. Non-steroidal anti-inflammatory drugs (nsaids) have
played a central role in the treatment of pain and
inflammation. Nsaids are the largest single group of
drugs used globally, constituting more than 20 % of all prescriptions (9). Estimates suggest over 73 million NSAID
prescriptions are written annually worldwide, with approximately 30 million individuals taking them daily(10).

❖ Proton pump inhibitors:

Proton pump inhibitors (ppis) are a group of medicines that decrease stomach acid production. They can help relieve
symptoms of chronic acid reflux (GERD) and stomach ulcers. Ppis are available both over the counter and by prescription.
Proton pump inhibitors primarily treat conditions that arise when stomach acid irritates or damages parts of your digestive
system, like your stomach, duodenum or your food tube (esophagus). Ppis are used to treat stomach (peptic) and duodenal
ulcers, H. Pylori infection, Zollinger-Ellison syndrome.

Proton pump inhibitors block an enzyme that produces stomach acid. It’s called the hydrogen-potassium ATPase pump,
or the “proton pump,” for short. Think of it this way: proton pump inhibitors “inhibit” (or prevent) the proton pump from
completing the chemical processes needed to make stomach acid.

Ppis don’t stop the production of all stomach acid. You’ll still have enough to digest food. If you were to take a PPI daily
for about five days, the drugs would reduce about 65% of your stomach acid. You’d still have the remaining 35% for your
stomach to break down food. Ppis only available with an Rx Dexlansoprazole Pantoprazole Rabeprazole.

Although ppis are generally considered safe, researchers have identified potential risks associated with them, especially
when using them long-term.

➢ PPIS MAY INCREASE YOUR RISK OF:

 • A CLOSTRIDIOIDES DIFFICILE (C. Diff) infection. Ppis may change the balance of bacteria in your gut, increasing
your risk of an infection.
• A FRACTURE. Ppis may make it more difficult for your body to absorb enough calcium, a mineral that keeps your
bones strong. The FDA warns that ppis may increase your risk of breaking your hip, wrist or spine.
• Kidney disease. They may increase your chances of developing chronic kidney disease (CKD) or cause the disease
to progress.
• A nutritional deficiency. Ppis may prevent your small intestine from absorbing enough magnesium or B12.
Magnesium helps your muscles and nerves work effectively. Vitamin B12 helps keep your nervous system and red
blood cells healthy.(11)

PPI are the world's most prescribed and highest-selling drug

the search identified data from 28 million PPI users in 23
countries from 65 articles. This review indicated that nearly
one-quarter of adults use a PPI. Of those using ppis, 63% were
less than 65years. 56% of PPI users were female, and “White”
ethnicities accounted for 75% of users. Nearly two-thirds of
users were on high doses (≥ defined daily dose (DDD)), 25%
of users continued ppis for > 1year, and 28% of these
continued for > 3years(12). The usage of ppis is exceptionally
high. Studies in tertiary care hospitals in India have frequently
reported that a staggering 89% to 95% of inpatients are
prescribed ppis, often without a documented, appropriate
indication for their use. A2024 study published in the Journal
of Clinical Endocrinology & Metabolism, has added to the
growing body of evidence regarding the risks of chronic PPI
use. This research found that the chronic use of ppis in men
is linked to lower trabecular bone quality, specifically
manifesting as a reduced lumbar spine Trabecular Bone
Score (TBS) and lower Bone Mineral Density (BMD) T-scores
in the hip and femoral neck.(13)

❖ ANTIBIOTICS:
An antibiotic is a drug that suppresses bacterial growth. antibiotics could be totally made from natural materials or they
can include man-made (made in a laboratory) substances. . antibiotics work by killing bacteria by destroying essential
components they require for survival, such as their cell walls or DNA. Antibiotics may inhibit bacteria growth by inhibiting
them from producing specific proteins they require to reproduce. Antibiotics are considered as wondered drug(14).The
public mostly does not have adequate knowledge about how and when to use antibiotics properly, and due to a lack of
professional healthcare supervision—by bypassing diagnostic and consultative healthcare services—they generally misuse
prescription antibiotics . This inappropriate utilization of antibiotics may lead to
several undesirable effects, such as the decreased effectiveness of these drugs, the
emergence of difficult-to-treat infections, treatment failure and worsening clinical
conditions (15) .Self-medication with antibiotics (SMA) is a common practice, Self-
medication with antibiotics is the purchase and self-administration of antibiotics
for the treatment of a suspected infection, and their frequent or prolonged use in
chronic or recurrent illnesses without the guidance of a qualified health
professional. Globally, over half of overall antibiotics sold are bought by consumers
without prescription. Likewise, over two-thirds of antibiotics being used in low- and
middle-income countries are for self-medication. Self-medication of antibiotics is an
emerging global issue since the irrational use of antibiotics is the reason behind
adverse effects such as emergence of resistant
microorganisms, treatment failure, rise in treatment cost,
increase in hospitalization stay and increase in morbidity. Self-
medication is frequent among healthcare workers and
students, such as medical students, dental students and
nursing students. Healthcare students are more likely to use
self-medication of antibiotics owing to their study of
pharmacology of antibiotics in their early years of education.
Therefore, this research was done to evaluate the self-
medication with antibiotics practice among medical students.
Antibiotics may be of narrow or broad spectrum of activity.
Narrow-spectrum antibiotics are more selective and will only act on specific groups or strains of bacteria. Broad-spectrum
antibiotics on the other hand suppress a broader spectrum of bacteria. Narrow-spectrum antibiotics are usually preferred
because the action on other non-disease-causing bacteria is minimal. Regrettably, broad-spectrum antibiotics tend to be
utilized as it might be challenging for physicians to identify the causative agent of the infection because of limited training
and/or resources at hand. Total antibiotic consumption for countries with available data (n = 67) increased by 16.3%
between 2016 and 2023, from 29.5 to 34.3 billion defined daily doses (DDDs), and the antibiotic consumption rate across
these countries increased 10.6% from 13.7 to 15.2 DDDs per 1,000 inhabitants per day. (16). India is widely recognized as
one of the world's largest consumers of antibiotics.

[Link] PROBLEMS /RATIONALS

The increasing problem of self-medication and low health literacy about the use of medicine has emerged as a major
worldwide public health issue. Although medicines are supposed to relieve pain and promote health, their irrational and
uninformed utilization can cause serious harmful consequences. In India and most developing nations, easy access to
drugs without a prescription, combined with poor patient education, has been contributing to the development of
improper medicine practices. the low level of awareness and high proportion of self-medication with NSAIDs, PPIs, and
Antibiotics are a complex issue rooted in socio-economic, regulatory, and educational gap. The consequent health risks—
along the spectrum from drug side effects to antimicrobial resistance—demand , evidence-based interventions.. Improved
public health education, strict implementation of prescription rules, and strengthening the role of pharmacists can
significantly cut irrational use of drugs, enhancing health benefits and safety in India as well as globally.

➢ THE MAJOR PROBLEMS ARISE DUE TO SELF-MEDICATION:

• Adverse Drug Reactions & Misuse: Without professional guidance, people may take incorrect dosage, use
wrong drug for symptom, combine medicines dangerously, or continue beyond safe durations.
• Antimicrobial Resistance (AMR): One of the gravest outcomes of irrational medicine use—especially
antibiotics—is Antimicrobial Resistance (AMR). Overuse and misuse of antibiotics cause bacteria to evolve
resistance, making infections harder to treat.
• Misdiagnosis / Delayed Treatment: Self-medication often results in masking of symptoms and delayed
professional diagnosis. For instance, taking NSAIDs for chronic pain or fever may hide underlying diseases such as
infections or autoimmune disorders. Similarly, frequent PPI use can conceal signs of gastrointestinal malignancies.
• Economic & Public Health Cost: According to WHO estimates, AMR alone could reduce global GDP by up to
3.8% by 2050, with low- and middle-income countries like India facing the most severe financial impact. he
expenses of treating complications of NSAID bleeding or antibiotic resistance both burden on healthcare systems
as well as families. In India, self-medication prevalence rates ranging between 45–70% (depending on region)
indicate significant resource wastage due to ineffective or harmful treatment outcomes.
• Lack of Awareness & Regulatory Gaps: Awareness of correct dosage, side effects, drug interactions, and
treatment duration remains inadequate, especially in rural and semi-urban populations. Many individuals obtain
information from non-professional sources such as family, friends, or the internet instead of consulting healthcare
 providers. This results in partial knowledge and a high risk of misuse. Pharmacies often dispense these medicines
without valid prescriptions due to weak enforcement and consumer pressure

5. SIGNIFICANCE OF STUDY:
• This study investigates the complex relationship between self-medication practices and levels of medicine
awareness within the community. The irrational consumption and self-medication practices involving NSAIDs,
PPIs, and antibiotics reflect a serious knowledge gap among individuals, especially in developing countries like
India. This research aims to bridge that gap by exploring people’s perceptions, attitudes, and awareness levels
regarding the safe and responsible use of medicines. It also provides a framework for corrective action through
education, policy strengthening, and healthcare collaboration.
• At the community level, this study highlights the urgent need for medicine literacy among the general population.
Self-medication without adequate knowledge increases the risk of adverse drug reactions, treatment failure, and
antimicrobial resistance (AMR)—a growing global health threat
• For pharmacy and healthcare professionals, this study emphasizes the importance of pharmacist-led counseling,
patient education, and prescription monitoring. Understanding public behavior towards NSAIDs, PPIs, and
antibiotics can help pharmacists and clinicians develop targeted communication strategies to prevent misuse.
Moreover, it supports the integration of patient awareness modules into community pharmacy practice and
hospital settings, ensuring that individuals receive accurate and ethical drug information before use.
• this study, therefore, underlines the economic advantage of promoting rational medicine use — as awareness
and education can significantly reduce preventable drug-related complications, thereby minimizing healthcare
expenditure at both individual and national levels.
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