PONE-D-25-10954Social Determinants of Self-Medication with Leftover Antibiotics in Lebanese Households: A Cross-Sectional Study.PLOS ONE

Dear Reve Rami Khaddaj,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

==============================Kindly reply to all comments provided by both reviewers.Also note that it is important to have some discussions about the pandemic and post pandemic period in Lebanon and how it affected disease, public awareness and related issues to your work. Relevant work from Lebanon about the COVID19 pandemic include: Khoury 2020, El Deeb 2020 and Abou Hassan 2023.It is essential to provide detailed responses as well as suggested changes to be able to proceed with your manuscript.==============================

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Omar El Deeb

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: No

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The research work is a relevant study which will potentially enhance scientific knowledge on the dynamics of non-prescribed antibiotic use, and provide evidence for antimicrobial stewardship especially in the LMICs where the study was conducted.

However, a revision is required on the manuscript (details have been provided as comments on the manuscript).

Reviewer #2: Comments to the author

The current study is about the social determinants of health influencing utilization of antibiotics leftovers in Lebanese households. The authors have found that socio-economic instability, healthcare access challenges, and experiential factors are critical in use of leftovers antibiotics among their Lebanese population which were studied.

Although the manuscript is mostly well-written in Standard English and it is clear and scientifically sound; but there are major issues according to the study objective, design and method,

1- The study does not provide any new findings or methods, and it can mostly be used as a local guidance,

2- The authors only mentioned Lebanon as their place of study which Lebanon is a country with so many cities and so much variations in their quality of life, so you had to used Cluster Sampling for choosing samples for the distribution of the questionnaire,

3- In addition having access to the internet as a inclusion criteria is a bias by its own specially in a developing country which you have not mention any statistics about internet access i.e. households with internet access. And also the platforms that you have shared the questionnaire as well can lead to limited access and biased sampling. These are the reasons that makes the study weak in representing results, since it can directly influence the knowledge of individuals about the healthcare issues in addition to effect of socio-demographic factors on access to the internet

All the above mentioned reasons question the generalizability of the study.

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Reviewer #1: Yes:  Oluwafemi J. Adewusi

Reviewer #2: No

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Attachments

Attachment

Submitted filename: PONE-D-25-10954_reviewer.pdf

Social Determinants of Self-Medication with Leftover Antibiotics in Lebanese Households: A Cross-Sectional Study.

PONE-D-25-10954R1

Dear Dr.,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Omar El Deeb

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewer #2:

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #2: (No Response)

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #2: Partly

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: No

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #2: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #2: Since I have rejected the manuscript in first place, there was no need to go through the text. My comments aere so basic and there is nothing to make me change my mind

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy .

Reviewer #2: No

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