Objective: to describe the configuration of the processes of social determination that have influenced self-medication by antibiotics in the city of Medellín between the years 2012-2022. Methods: Descriptive interpretive study with an ethnographic approach from the perspective of the social determination of health. Results: structural processes such as the commodification of social security, few public health actions, and de-industrialization and subsequent loss of labor rights were identified as the main destructive processes that affect self-medication by antibiotics and that are reproduced in the private and private domains. singular respectively. The main protective process identified was family and community support. Conclusion: Self-medication by antibiotics is a practice that is determined by the social structure and the prevailing development model by maintaining barriers to health services that transcend the health system through different mechanisms. That is why the interventions that are carried out around this practice must be characterized by intersectorality and the articulation of different institutions and social actors so that they can be effective and have efficiency in the short, medium and long term.