Factors influencing rational antibiotic use behaviours of early childhood caregivers in three tertiary care hospitals, Bangkok metropolitan: a cross-sectional descriptive study.

Background: The increasing prevalence of antimicrobial resistance (AMR) is a global health issue, and one of the key contributing factors is the inappropriate and excessive use of antibiotics. This problem is particularly relevant to early childhood, where antibiotic administration relies heavily on caregivers. Despite its critical importance, research on the factors influencing rational antibiotic use behaviours among early childhood caregivers remains limited in Thailand. This study, therefore, aims to explore caregivers' behaviours in administering antibiotics to children, as well as personal and health literacy factors that may influence these behaviours. Method: This cross-sectional descriptive study was conducted in 2024 among 183 caregivers of children under 6 years of age who visited the pediatric outpatient clinics at three tertiary hospitals in Bangkok Metropolitan. Rational antibiotic use was measured using a questionnaire with a 5-point Likert scale. Descriptive statistics (including percentage, mean, and standard deviation) and multiple linear regression analyses were used to explore the relationship between caregivers' characteristics, antibiotic literacy, and rational antibiotic use behaviour. Results: The overall rational antibiotic use behaviour among caregivers was at a moderate level (mean 3.08, S.D.  0.56). However, inappropriate behaviours were also observed, with 18.6% of caregivers reporting immediate antibiotic administration for fever and 12.6% saving leftover antibiotics. Multiple linear regression analysis revealed that caregivers' household income, knowledge, self-management, and decision-making abilities collectively predicted rational antibiotic use behaviour, accounting for 13.4% of the variance (p < .001). Conclusions: This study concludes that caregivers' rational antibiotic use needs to be improved. Household income, knowledge, and self-management skills, including decision-making, are key factors influencing this behaviour. The findings have practical implications and can be applied to develop educational programmes and policies that enhance caregivers' antibiotic literacy and promote safe, rational antibiotic use.