THERE is a familiar drawer or medication bag in many Malaysian homes. A shallow plastic container filled with old blister packs, half-finished antibiotics and loose tablets whose names nobody remembers. People keep them because they want to be prepared. I once spoke to a mother in the district of Kiulu who kept leftover Amoxicillin because her son often had sore throats. “Duktur bagi baini dulu,” she said. “Kalau sakit balik, ada stok sudah.” These habits feel ordinary. They are part of how many households manage illness, and we hardly think twice about them.
It often begins with good intention. The last time you had a sore throat, the clinic prescribed Penicillin or Amoxicillin. When that same scratchy pain returns months later, it feels practical to take whatever is left in the drawer. Some stop halfway once the fever settles, thinking the rest of the course is unnecessary. Others share extra tablets with a family member “supaya cepat bagus.” It feels harmless and even thrifty. The trouble is that the infection today may not be the same as the one from before, and sometimes the illness is viral. Antibiotics do not kill viruses. They do, however, act on the helpful bacteria in your body. When unnecessary or incomplete courses are taken, the weaker bacteria die first while the stronger ones survive and adapt. That is how resistance begins. Quietly and invisibly, in the middle of what feels like responsible self-care.
Unfinished antibiotics kept at home may seem harmless, but they quietly fuel antimicrobial resistance.
Malaysia’s own data shows how common these habits are. A nationwide Computer-Assisted Telephone Interviewing (CATI) survey in 2021 involving 864 Malaysian adults found that a substantial number had obtained antibiotics without a prescription, usually bought directly from pharmacies. Nearly one in five kept leftover antibiotics for future use, and many admitted sharing these tablets among family members. Awareness of terms like “antibiotic resistance” or “superbugs” was low despite previous antibiotic exposure. Another Malaysian study highlighted that many still believe antibiotics help with colds, flu and simple sore throats even though these are almost always viral.
People are not careless. They simply do not realise that taking antibiotics when they are not needed, or stopping before completing the course, trains bacteria to become harder to kill. Under the Poisons Act 1952 (Act 366), antibiotics fall under Group B poisons and cannot legally be sold over the counter. Despite this, national surveys show that many Malaysians continue to obtain antibiotics without prescription.
The consequences often appear only later. In our hospitals, resistant infections are not theoretical. They shape lives in ways statistics rarely capture. Ministry of Health Malaysia data shows that patients with antimicrobial-resistant (AMR) infections stay in the ward far longer than those with non-resistant infections, averaging between 21.7 and 36.4 days. The median cost of treating a single resistant infection ranges from RM12,476 to RM19,295 and across government hospitals, the total annual cost of managing AMR rose from RM3.7 million in 2017 to RM9.7 million in 2019.
In Sabah, a recent study at Hospital Queen Elizabeth II reported rising use of broad-spectrum antibiotics and increase in multidrug-resistant organisms between 2018 to 2019. Behind those numbers are families juggling unpaid leave, transport costs and the daily anxiety of watching a loved one depend on an antibiotic that may or may not work.
One patient’s experience from 2019 never left my mind. He came from Taman Ketiau, Putatan, where I was serving at Klinik Komuniti Taman Ketiau before it closed. He assumed his painful throat was just his usual tonsillitis. He took leftover Amoxicillin at home and waited for it to settle, but it didn’t. The fever worsened and when he arrived at the clinic, I referred him to the Putatan Health Clinic, and he was later referred to Queen Elizabeth Hospital. What he believed was a simple infection turned into a resistant one that kept him in the ward for nearly three weeks. His mother slept on a plastic chair for days because she refused to leave his bedside. His father travelled back and forth from work, trying to balance income with worry. The cost was not only medical. It was emotional, financial and deeply exhausting. He told me later that he regretted ever taking leftover antibiotics.
Stories like his are happening quietly in many parts of Malaysia, especially among Sabahans living in rural areas where access to clinics remains a challenge. They mirror the global picture. A landmark analysis published in The Lancet estimated that 1.27 million deaths worldwide in 2019 were directly caused by bacterial antimicrobial resistance, with 4.95 million deaths associated with resistant infections. For Malaysia, the Institute for Health Metrics and Evaluation estimated more than 3,000 deaths each year linked to AMR. These are not projections. They are the lives we have already lost.
The bacteria themselves are evolving. National surveillance reports show that resistance in Klebsiella pneumoniae to meropenem increased from 2.3 % in 2018 to 5.0 % in 2022. A recent Malaysian study estimates that there were about 2,500 carbapenem resistant Enterobacterales cases in hospitals in 2022, with an in-hospital mortality rate of roughly 34 %. These infections often force physicians to use last-line treatments such as polymyxins, medicines that are more toxic, more expensive and less likely to be available in smaller district facilities. When first-line antibiotics no longer work, the safety net for many patients becomes dangerously thin.
The problem stretches beyond homes and hospitals. Throwing leftover antibiotics into household rubbish or flushing them down toilets allows these medicines to enter wastewater and soil. Bacteria in the environment are then exposed to the drugs in small, repeated doses. These bacteria can learn and adapt. This is why the Ministry of Health Malaysia introduced the Return Your Medicines programme in 2010. Improper disposal is no longer a minor issue. It is now recognised as a contributor to resistance at the environmental level. Yet many Malaysians still do not realise that unused or expired antibiotics should be returned to health facilities for safe disposal.
Awareness sits at the centre of all of this. Many people do not know that antibiotics target bacteria specifically, not fever or pain. Many do not realise that symptoms improving does not mean the bacteria are gone. Many do not understand how stopping early strengthens the surviving bacteria. And many do not see how reusing or sharing leftover antibiotics in the household can build resistance that returns later in a far more dangerous form.
In conjunction with World Antimicrobial Resistance Awareness Week (18–24 November 2025), which carries a theme that speaks clearly to Malaysia’s current reality, Act Now. Protect Our Present, Secure Our Future, the message is simple. Every decision made at home, especially the choice to take or not take a leftover antibiotic, influences the future of these medicines. Finishing the full course, even when you feel better, protects your body and prevents bacteria from gaining strength. Not keeping leftovers removes the temptation to self-treat later, and not sharing antibiotics protects the people you care about. Trusting your doctor when they say “no need antibiotic” is not neglect. It is evidence-based care. Returning unused medicines supports environmental safety and helps prevent resistant bacteria from forming outside our homes.
Antibiotics are one of medicine’s greatest achievements. They have saved millions of lives. They are also one of our most fragile resources. Treating them like Panadol or something to be kept for the next sore throat slowly erodes their potency. That little drawer of leftover tablets is not a sign of readiness. It is a warning we can no longer ignore.
Act now. Protect these medicines while they still work, because once resistance takes over, no amount of leftover antibiotics will save us.
Melvin Ebin Bondi is a PhD candidate in Public Health at Universiti Malaysia Sabah. He writes a weekly public health column for The Borneo Post.
