# Renal Risk Awareness and Use Patterns of NSAIDs and Antibiotics in Primary Care Patients from North-Eastern Romania

## TL;DR

This study explores how patients in rural and urban areas of Romania use NSAIDs and antibiotics, highlighting differences in self-medication and awareness of kidney risks.

## Contribution

The study identifies urban–rural differences in medication use patterns and renal risk perception among Romanian primary care patients.

## Key findings

- NSAID use was nearly universal, with frequent use linked to non-professional recommendations.
- Rural participants showed higher antibiotic misuse driven by informal acquisition.
- Urban participants engaged in frequent, convenience-driven self-medication.

## Abstract

Background and Objectives: Self-medication and inappropriate use of non-steroidal anti-inflammatory drugs (NSAIDs) and antibiotics are major public health concerns, particularly in settings with variable access to healthcare. Understanding patterns of medication use and renal risk perception can inform targeted interventions. This study examined NSAID and antibiotic use, self-medication behaviors, and renal risk awareness among Romanian primary care patients, with attention to urban–rural differences. Materials and Methods: A cross-sectional survey was conducted among 201 primary care patients (101 rural, 100 urban). Data on NSAID and antibiotic use, self-medication practices, sources of recommendation, and renal risk perception were collected using a study-specific questionnaire. Multivariable logistic regression was applied to identify predictors of frequent NSAID use, inappropriate antibiotic use, self-medication frequency, and high perceived renal risk. Results: NSAID use was nearly universal (95%), with frequent use strongly associated with non-professional recommendations. Antibiotic misuse was more common in rural participants and largely driven by informal acquisition. Self-medication patterns differed by residence: rural participants reported system- or access-related reasons and reliance on non-professional sources, while urban participants engaged in frequent, convenience-driven self-medication. Although most participants were aware of potential renal harm, this did not consistently lead to safer behaviors. Higher educational level and trust in healthcare professionals predicted increased perceived renal risk, whereas rural residence was associated with lower risk perception. Conclusions: Medication misuse is influenced more by recommendation sources, access barriers, and trusted information pathways than by knowledge alone. Interventions should focus on improving professional guidance, addressing informal recommendation networks, and tailoring strategies to urban–rural contexts.