The Sore Throat and Antibiotic Resistance (STAR) Study in Malaysia: Nationwide Survey of Antibiotic Use for Upper Respiratory Tract Infection and Sore Throat

Introduction 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. Methods 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. Results 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%). Conclusions 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. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-026-03515-5.