Determinants and Patterns of Antibiotic Use in Children Under Five in Cambodia: Analysis of Demographic and Health Survey Data 2010–2022

BACKGROUND: Antimicrobial resistance is driven by inappropriate antibiotic use. In Cambodia, young children frequently receive antibiotics despite declining rates of common illnesses. We analyzed nationally representative data to describe trends and determinants of antibiotic use for acute respiratory infection (ARI), fever, and diarrhea among under-five children. MATERIALS AND METHODS: rural residence, household wealth quintile, and maternal education, accounting for sampling weights and clustering. RESULTS: rural residence. In 2010, children in the richest quintile had greater odds of antibiotic use for fever (aOR, 2.10; 95% CI, 0.89-4.97) and diarrhea (aOR, 3.39; 95% CI, 1.61-7.11) compared to those in the poorest quintile; these disparities persisted, though attenuated, in later surveys. CONCLUSION: Despite substantial declines in childhood illness, antibiotic use among Cambodian children under five remains disproportionately high-especially in urban and wealthier households. Antimicrobial stewardship initiatives should focus on reducing overuse in privileged populations while ensuring equitable access in underserved areas.