BACKGROUND: Antibiotic self-medication (ASM) is when a person takes antibiotics without a prescription or consulting a healthcare professional. These practices contribute to the misuse of medicines and antibiotic resistance which is a growing global health threat that can lead to longer hospital stays, higher healthcare costs, and increased mortality rates. Though various studies have been conducted on ASM in different countries, there has not yet been a systematic review that comprehensively assesses the problem in the entire globe. Hence, this systematic review and meta-analysis aimed to evaluate the global pooled prevalence of antibiotic self-medication and the reasons for its practice. METHOD: A systematic search of electronic registers and databases was conducted on PubMed, Medline, Embase, Scopus, Web of Science, Google Scholar, and gray literature including institutional repositories, and national health databases. It used carefully selected keywords and indexing terms in the past ten years. The Joanna Briggs Institute's critical checklist extracted relevant data after appraisal. Narrative analysis was used for descriptive data while Comprehensive Meta-Analysis (CMA) Software was used to analyze quantitative data. Statistics were used to look for heterogeneity, publication bias, and correlations. Sensitivity tests and sub-group analysis were employed to compare outcomes. A p-value <
0.05 was considered significant in all cases. RESULTS: Seventy-one studies were included in this systematic review and meta-analysis. The total number of participants was 63,251 with sample sizes ranging from 110 to 15,526. In primary outcomes, ASM ranged from 0.65 to 92.2%. The pooled prevalence of ASM globally was 43.0% (95% CI: 38.0, 48.1%). A high degree of heterogeneity across studies was shown with I CONCLUSION: ASM practice was higher among African and student users. The previous successful experience was the most frequent reason reported. Educational level, gender, and age were often mentioned as predictor factors. Hence, designing interventional approaches that consider the different burdens among the target population and tackle the reasons for the practices might benefit averting antimicrobial resistance.