{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T09:27:26Z","timestamp":1774344446794,"version":"3.50.1"},"reference-count":49,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T00:00:00Z","timestamp":1774051200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006472","name":"\u201cGrigore T. Popa\u201d University of Medicine and Pharmacy","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100006472","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>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\u2013rural 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\u2013rural contexts.<\/jats:p>","DOI":"10.3390\/medicina62030594","type":"journal-article","created":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T13:07:06Z","timestamp":1774271226000},"page":"594","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Renal Risk Awareness and Use Patterns of NSAIDs and Antibiotics in Primary Care Patients from North-Eastern Romania"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-1766-8060","authenticated-orcid":false,"given":"Eric Oliviu","family":"Cosovanu","sequence":"first","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"},{"name":"Doctoral School of Medicine and Pharmacy, Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8089-1787","authenticated-orcid":false,"given":"Maria","family":"Bogdan","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, Faculty of Pharmacy, University of Medicine and Pharmacy, 200349 Craiova, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena Adorata","family":"Coman","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cezar Ilie","family":"Foia","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"},{"name":"Doctoral School of Medicine and Pharmacy, Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2343-5782","authenticated-orcid":false,"given":"Cosmin Gabriel","family":"Tartau","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"},{"name":"Doctoral School of Medicine and Pharmacy, Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena Teona","family":"Cosovanu","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1239-8058","authenticated-orcid":false,"given":"Antoneta Dacia","family":"Petroaie","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liliana Lacramioara","family":"Pavel","sequence":"additional","affiliation":[{"name":"Medical Department, Faculty of Medicine and Pharmacy, Dunarea de Jos University, 800010 Galati, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5568-3780","authenticated-orcid":false,"given":"Ana-Maria","family":"Pelin","sequence":"additional","affiliation":[{"name":"Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, \u201cDunarea de Jos\u201d University, 800010 Galati, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7983-3811","authenticated-orcid":false,"given":"Liliana Mititelu","family":"Tartau","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Aljinovi\u0107-Vu\u010di\u0107, V. (2025). Self-medication as a global health concern: Overview of practices and associated factors\u2014A narrative review. Healthcare, 13.","DOI":"10.3390\/healthcare13151872"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2582887","DOI":"10.1080\/09581596.2025.2582887","article-title":"Beyond pain relief: A comprehensive review of analgesic self-medication and its broad implications","volume":"35","author":"Moni","year":"2025","journal-title":"Crit. Public. Health"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Pedrolongo, D.A., Sagioneti, F.T., Weckwerth, G.M., Oliveira, G.M., Santos, C.F., and Calvo, A.M. (2024). Study on the consumption of non-steroidal anti-inflammatory drugs and antibiotics by the Brazilian adult population: A cohort study. Pharmacy, 12.","DOI":"10.3390\/pharmacy12050150"},{"key":"ref_4","first-page":"3","article-title":"Non-steroidal anti-inflammatory drugs: What is the actual risk of chronic kidney disease? A systematic review and meta-analysis","volume":"63","author":"Soliman","year":"2025","journal-title":"Rom. J. Intern. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.33696\/nephrology.5.013","article-title":"NSAID-associated renal Injury: Mechanisms, risks, and safer strategies","volume":"5","author":"Ahsan","year":"2025","journal-title":"Arch. Nephrol. Ren. Stud."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Ndaki, P.M., Mwanga, J.R., Mushi, M.F., Konje, E.T., Mwita, S.M., and Mshana, S.E. (2025). Drivers of inappropriate use of antibiotics among community members in low- and middle-income countries: A systematic review of qualitative studies. BMC Public Health, 25.","DOI":"10.1186\/s12889-025-21553-6"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Estany-Gestal, A., Salgado-Barreira, A., and Vazquez-Lago, J.M. (2024). Antibiotic use and antimicrobial resistance: A global public health crisis. Antibiotics, 13.","DOI":"10.3390\/antibiotics13090900"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1007\/s40266-025-01180-x","article-title":"Regular use of oral nonsteroidal anti-inflammatory drugs in a population of Polish seniors: Findings from the PolSenior2 cross-sectional survey","volume":"42","author":"Wierzba","year":"2025","journal-title":"Drugs Aging"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2345","DOI":"10.1002\/acr.25157","article-title":"Prevalence of nonsteroidal anti-inflammatory drugs prescribed for osteoarthritis: A systematic review and Meta-Analysis of observational studies","volume":"75","author":"Yang","year":"2023","journal-title":"Arthritis Care Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1007\/s11739-012-0843-4","article-title":"Preventability analysis of adverse drug reactions detected in two internal medicine departments in Romania","volume":"9","author":"Farcas","year":"2014","journal-title":"Intern. Emerg. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2362","DOI":"10.30574\/ijsra.2024.13.2.2377","article-title":"Self-medication with antibiotics: A pervasive risk factor for antibiotic resistance and public health concerns","volume":"13","author":"Sezerano","year":"2024","journal-title":"Int. J. Sci. Res. Arch."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2620","DOI":"10.18203\/2394-6040.ijcmph20173192","article-title":"A systematic review of the literature on survey questionnaires to assess self-medication practices","volume":"4","author":"Limaye","year":"2017","journal-title":"Int. J. Community Med. Public Health"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Chautrakarn, S., Khumros, W., and Phutrakool, P. (2021). Self-medication with over-the-counter medicines among the working age population in metropolitan areas of Thailand. Front. Pharmacol., 12.","DOI":"10.3389\/fphar.2021.726643"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e13665","DOI":"10.1111\/ijcp.13665","article-title":"The prevalence and patterns of self-medication with antibiotics in Jordan: A community-based study","volume":"75","author":"Nusair","year":"2021","journal-title":"Int. J. Clin. Pract."},{"key":"ref_15","first-page":"e51281","article-title":"Patterns and prevalence of self-medication in Saudi Arabia: Insights from a nationwide survey","volume":"15","author":"Alhur","year":"2023","journal-title":"Cureus"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"87","DOI":"10.59890\/ijist.v2i2.1427","article-title":"Investigation of the prevalence of self-medication with antibiotics among students in Afganistan: Insight from Kabul Medical University","volume":"2","author":"Safi","year":"2024","journal-title":"Int. J. Integr. Sci. Technol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Abdu, N., Mosazghi, A., Teweldemedhin, S., Asfaha, L., Teshale, M., Kibreab, M., Anand, I.S., Tesfamariam, E.H., and Russom, M. (2020). Non-steroidal anti-inflammatory drugs (NSAIDs): Usage and co-prescription with other potentially interacting drugs in elderly: A cross-sectional study. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0238868"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Low, J.Y.C., Sivanandy, P., Ingle, P.V., and Manirajan, P. (2025). Assessment of non-steroidal anti-inflammatory drugs use and its complications among pediatric patients at a private tertiary care hospital in Malaysia. BMC Pediatr., 25.","DOI":"10.1186\/s12887-025-06016-6"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"151","DOI":"10.18081\/2333-5106\/2024.12\/151","article-title":"Comprehensive assessment of the global burden of antimicrobial resistance: Trends and insights from 2000 to 2023","volume":"12","author":"Alomari","year":"2024","journal-title":"Am. J. Biomed"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Poudel, A.N., Zhu, S., Cooper, N., Little, P., Tarrant, C., Hickman, M., and Yao, G. (2023). The economic burden of antibiotic resistance: A systematic review and meta-analysis. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0285170"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1007\/s40273-023-01337-9","article-title":"Estimating the treatment and prophylactic economic value of new antimicrobials in managing antibiotic resistance and serious infections for common pathogens in the USA: A population modelling study","volume":"42","author":"Gordon","year":"2024","journal-title":"Pharmacoeconomics"},{"key":"ref_22","first-page":"608","article-title":"Self-medication-a public health problem in Romania nowadays. The first quests","volume":"121","author":"Manole","year":"2017","journal-title":"Med.-Surg. J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"465","DOI":"10.3390\/antibiotics2040465","article-title":"Public beliefs about antibiotics, infection and resistance: A qualitative study","volume":"2","author":"Norris","year":"2013","journal-title":"Antibiotics"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Rusu, R.N., Ababei, D.C., Bild, W., Stoian, I., Macadan, I., Stanciu, G.D., Ciobica, A., and Bild, V. (2022). Self-medication in rural northeastern Romania: Patients\u2019 attitudes and habits. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph192214949"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Tarciuc, P., Stanescu, A.M.A., Diaconu, C.C., Paduraru, L., Duduciuc, A., and Diaconescu, S. (2020). Patterns and factors associated with self-medication among the pediatric population in Romania. Medicina, 56.","DOI":"10.3390\/medicina56060312"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e3803","DOI":"10.7717\/peerj.3803","article-title":"Awareness about antibiotic resistance in a self-medication user group from Eastern Romania: A pilot study","volume":"5","author":"Topor","year":"2017","journal-title":"PeerJ"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Buda, V., Prelipcean, A., Cristescu, C., Roja, A., Dalleur, O., Andor, M., Danciu, C., Ledeti, A., Dehelean, C.A., and Cretu, O. (2021). Prescription Habits Related to Chronic Pathologies of Elderly People in Primary Care in the Western Part of Romania: Current Practices, International Recommendations, and Future Perspectives Regarding the Overuse and Misuse of Medicines. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18137043"},{"key":"ref_28","first-page":"585","article-title":"Global, WHO Regional, and Continental prevalence of self-medication from 2000 to 2018: A systematic review and meta-analysis","volume":"1","author":"Ghasemyani","year":"2022","journal-title":"Ann. Public Health"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"70","DOI":"10.30574\/wjbphs.2024.20.1.0720","article-title":"Determinants and patterns of self-medication: A comprehensive literature review","volume":"20","author":"Pillai","year":"2024","journal-title":"World J. Biol. Pharm. Health Sci."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"5","DOI":"10.2478\/jbcr-2023-0001","article-title":"Prevalence of Self-Medication with Antibiotics in Europe: A Scoping Review","volume":"16","author":"Lebanova","year":"2023","journal-title":"J. Biomed. Clin. Res."},{"key":"ref_31","unstructured":"(2026, January 10). EasyMedStat Statistical Software, Available online: https:\/\/www.easymedstat.com."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"930","DOI":"10.31925\/farmacia.2018.6.2","article-title":"Biostatistic, legislativ and ethical problems of comparative clinical studies. I. Generic and biosimilar drugs case","volume":"66","author":"Mircioiu","year":"2018","journal-title":"Farmacia"},{"key":"ref_33","unstructured":"(2026, January 10). Available online: https:\/\/www.wma.net\/policies-post\/wma-declaration-of-helsinki\/."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"811","DOI":"10.31925\/farmacia.2018.5.10","article-title":"Study regarding the parents\u2019 use of self\u2014medication among children under 12 years old","volume":"66","author":"Cristescu","year":"2018","journal-title":"Farmacia"},{"key":"ref_35","first-page":"1164","article-title":"The impact of self-medication with nsaids\/analgesics in a north-eastern region of romania","volume":"62","author":"Alexa","year":"2014","journal-title":"Farmacia"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"3385","DOI":"10.2147\/IDR.S214574","article-title":"Knowledge, Attitudes And Practices Regarding The Use Of Antibiotics. Study On The General Population Of Mure\u015f County, Romania","volume":"12","author":"Moldovan","year":"2019","journal-title":"Infect. Drug Resist."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1186\/s12939-015-0261-0","article-title":"Inequalities in medicine use in Central Eastern Europe: An empirical investigation of socioeconomic determinants in eight countries","volume":"14","author":"Vogler","year":"2015","journal-title":"Int. J. Equity Health"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"3","DOI":"10.12680\/balneo.2019.230","article-title":"Renal damage induced by non-steroidal anti-inflammatory drug treatment","volume":"10","author":"Para","year":"2019","journal-title":"Balneo Res. J."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e00817","DOI":"10.1002\/prp2.817","article-title":"Kidney damage from nonsteroidal anti-inflammatory drugs\u2014Myth or truth? Review of selected literature","volume":"9","author":"Lechowicz","year":"2021","journal-title":"Pharmacol. Res. Perspect."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Clav\u00e9, S., Rousset-Rouvi\u00e8re, C., Daniel, L., and Tsimaratos, M. (2019). The Invisible Threat of Non-steroidal Anti-inflammatory Drugs for Kidneys. Front. Pediatr., 7.","DOI":"10.3389\/fped.2019.00520"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2211","DOI":"10.1016\/j.ekir.2023.08.031","article-title":"Overview of Antibiotic-Induced Nephrotoxicity","volume":"8","author":"Campbell","year":"2023","journal-title":"Kidney Int. Rep."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"33","DOI":"10.5455\/msm.2023.35.33-41","article-title":"Behavioral and Knowledge Patterns Regarding the Use of Antibiotics Among Urban and Rural Population in Bosnia and Herzegovina-a Cross-sectional Study","volume":"35","author":"Maglica","year":"2023","journal-title":"Mater. Sociomed."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Pogurschi, E.N., Petcu, C.D., Mizeranschi, A.E., Zugravu, C.A., Cirnatu, D., Pet, I., and Ghimpe\u021beanu, O.M. (2022). Knowledge, Attitudes and Practices Regarding Antibiotic Use and Antibiotic Resistance: A Latent Class Analysis of a Romanian Population. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19127263"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1007\/s40620-016-0352-z","article-title":"Nonsteroidal anti-inflammatory drug use in patients with chronic kidney disease","volume":"30","author":"Heleniak","year":"2017","journal-title":"J. Nephrol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s42506-018-0005-2","article-title":"Non-steroidal anti-inflammatory drugs among chronic kidney disease patients: An epidemiological study","volume":"94","author":"Hegazy","year":"2019","journal-title":"J. Egypt. Public Health Assoc."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1007\/s11096-018-0598-8","article-title":"Kidney function and use of nonsteroidal anti-inflammatory drugs among elderly people: A cross-sectional study on potential hazards for an at risk population","volume":"40","author":"Modig","year":"2018","journal-title":"Int. J. Clin. Pharm."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Zaidi, S.F., Alotaibi, R., Nagro, A., Alsalmi, M., Almansouri, H., Khan, M.A., Khan, A., and Memon, I. (2020). Knowledge and attitude towards antibiotic usage: A questionnaire-based survey among pre-professional students at King Saud bin Abdulaziz University for Health Sciences on Jeddah Campus, Saudi Arabia. Pharmacy, 8.","DOI":"10.3390\/pharmacy8010005"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Huang, Y., Gu, J., Zhang, M., Ren, Z., Yang, W., Chen, Y., Fu, Y., Chen, X., Cals, J.W., and Zhang, F. (2013). Knowledge, attitude and practice of antibiotics: A questionnaire study among 2500 Chinese students. BMC Med. Educ., 13.","DOI":"10.1186\/1472-6920-13-163"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"49","DOI":"10.3892\/mi.2025.248","article-title":"Awareness of the use of non-steroidal anti-inflammatory drugs: A cross-sectional study","volume":"5","author":"Chkhikvadze","year":"2025","journal-title":"Med. Int."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/3\/594\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T05:55:38Z","timestamp":1774331738000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/3\/594"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,21]]},"references-count":49,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["medicina62030594"],"URL":"https:\/\/doi.org\/10.3390\/medicina62030594","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,21]]}}}