Overview
Upper respiratory tract infections (URTIs) are among the most common pediatric infections worldwide and a frequent trigger for antibiotic prescriptions. In Khartoum, Sudan, a hospital-based study explored how parents understand, think about, and actually use antibiotics for their children’s URTIs. The findings shed light on knowledge gaps, attitudes toward treatment, and real-world practices that influence antibiotic use and antimicrobial resistance (AMR) in the community.
Key findings: knowledge gaps
Most parents recognized that antibiotics should not be used for every fever, with 63.5% acknowledging this. However, only 39.3% were aware that URTIs are primarily viral and do not require antibiotics. A striking 60% believed that antibiotics speed symptom relief, and 70.6% were unaware that inappropriate use contributes to bacterial resistance. Importantly, more than half could identify some antibiotics (e.g., amoxicillin/clavulanic acid and azithromycin) as antibiotics, yet misclassification persisted, with a sizable portion confusing cough syrups and analgesics for antibiotics.
Attitudes toward URTIs and antibiotics
When faced with URTI symptoms, parents tended to seek professional advice promptly, with more than 87% consulting a pediatrician within three days. Yet, a large portion expected antibiotics as a possible treatment option (73.0%). About 65% favored antibiotic use for a child with a cold or nasal drainage, suggesting patient pressure on clinicians even when clinical guidelines discourage antibiotics for viral URTIs. A notable 31.8% admitted they did not consult a doctor before using antibiotics. Half of the participants believed URTIs could be managed without antibiotics, indicating mixed beliefs about necessity and safety.
Practices: antibiotic use and consultation behavior
Over-the-counter antibiotic use was common, with pharmacist recommendations driving about 56.9% of independent antibiotic purchases. A majority stated they would follow their pediatrician’s advice, yet 23% reported doctors explained antibiotic use less than often, and 22.7% believed prescriptions were influenced by parental requests. Half of the parents had good practice regarding antibiotic use for URTIs, while the rest demonstrated less optimal patterns. Younger parents under 35 years tended to have better practice, suggesting shifting knowledge and behaviors with life stage.
Implications for public health and policy
The study highlights a critical need for targeted education to align parental knowledge with evidence-based URTI management. Interventions should emphasize the viral nature of most URTIs in children, the self-limiting course of many infections, and the risks of antibiotic resistance from misuse. Healthcare providers—especially pediatricians and pharmacists—play a pivotal role as trusted sources of information, underscoring the importance of effective communication, shared decision-making, and stewardship messaging at the point of care. Policies that support continuing education for clinicians, community awareness campaigns, and prudent antibiotic dispensing can help reduce unnecessary antibiotic exposure in Sudan’s pediatric population.
Context: Sudan and AMR
Sudan faces a high burden of AMR and rising multidrug-resistant bacteria. Widespread self-medication, variable adherence to guidelines, and social factors shape antibiotic use. Given that over a third of Sudan’s population is under 15, optimizing antibiotic practices for URTIs is essential to protect child health and curb resistance on a national scale.
Concluding thoughts
Educational initiatives must translate into practical tools for parents, clarifying when antibiotics are warranted and how to use them safely. By strengthening doctor–parent communication and promoting responsible antibiotic use, Sudan can advance toward lower AMR risks and healthier outcomes for children with URTIs.
