Knowledge, attitudes, and practices toward antibiotic use and resistance among medical students: a cross-sectional study

Authors

  • Narasimha Murthy K. M. Department of Pharmacology, Sri Siddhartha Medical College, Tumkur, Karnataka, India
  • Arun Hebbar J. N. Department of Pharmacology, Sri Siddhartha Medical College, Tumkur, Karnataka, India https://orcid.org/0000-0002-2404-8661
  • Naveen Kumar Department of Pharmacology, Sri Siddhartha Medical College, Tumkur, Karnataka, India

DOI:

https://doi.org/10.18203/2319-2003.ijbcp20252573

Keywords:

Antimicrobial stewardship, Antimicrobial resistance, Attitude, Knowledge, Medical students, Practice

Abstract

Background: Antimicrobial resistance (AMR) is becoming a major global health problem, which is jeopardizing the effectiveness of current antibiotics and causing increasing difficulty in routine clinical care. As future prescribers, medical students must develop strong knowledge, attitudes, and practices (KAP) to ensure effective antimicrobial stewardship (AMS). It explored the knowledge, attitude and practice of Indian undergraduate medical students concerning antibiotics and antimicrobial resistance.

Methods: A cross-sectional survey was conducted among 500 undergraduate medical students at a tertiary care hospital attached to a medical college in India. A validated, structured 30-item questionnaire based on World Health Organization (WHO) guidelines was used to assess KAP. The responses were reported using a 5-point Likert scale. Statistical analyses included t-tests, Mann-Whitney U tests, and Welch’s ANOVA to evaluate the influence of AMR training and academic progression (p<0.05).

Results: Students demonstrated strong theoretical knowledge of AMR, but reported low confidence and limited engagement in AMS activities. Only 47.6% had formal AMR training, and 16.8% participated in AMS programs. Trained students scored significantly higher in knowledge (p=0.006) but not in attitudes or practices. KAP scores improved progressively across academic years, with final-year students and interns scoring the highest.

Conclusions: While Indian medical students show a high awareness of AMR, confidence and practice-oriented engagement are limited. Curricular reforms incorporating experiential learning and early AMS integration are crucial to bridging the knowledge-practice gap.

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References

World Health Organization. Antimicrobial resistance. Geneva: WHO; 2025. Available fat: https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance. Accessed on 25 May 2025.

Laxminarayan R, Duse A, Wattal C, Zaidi AK, Wertheim HF, Sumpradit N, et al. Antibiotic resistance- the need for global solutions. Lancet Infect Dis. 2013;13(12):1057-98. DOI: https://doi.org/10.1016/S1473-3099(13)70318-9

O’Neill J. Tackling drug-resistant infections globally: Final report and recommendations. London: Review on Antimicrobial Resistance; 2016.

Pulcini C, Gyssens IC. How to educate prescribers in antimicrobial stewardship practices. Virulence. 2013;4(2):192-202. DOI: https://doi.org/10.4161/viru.23706

Abbo LM, Cosgrove SE, Pottinger PS, Pereyra M, Sinkowitz-Cochran R, Srinivasan A, et al. Medical students’ perceptions and knowledge about antimicrobial stewardship: how are we educating our future prescribers? Clin Infect Dis. 2013;57(5):631-8. DOI: https://doi.org/10.1093/cid/cit370

Castro-Sánchez E, Drumright LN, Gharbi M, Farrell S, Holmes AH. Mapping antimicrobial stewardship in undergraduate medical, dental, pharmacy, nursing and veterinary education in the United Kingdom. PLoS One. 2016;11(2):e0150056. DOI: https://doi.org/10.1371/journal.pone.0150056

Dyar OJ, Nathwani D, Monnet DL, Gyssens IC, Stålsby Lundborg C, Pulcini C. Do medical students feel prepared to prescribe antibiotics responsibly? Results from a cross-sectional survey in 29 European countries. Eur J Clin Microbiol Infect Dis. 2018;37(5):811-7. DOI: https://doi.org/10.1093/jac/dky150

Minen MT, Duquaine D, Marx MA, Weiss D. A survey of knowledge, attitudes, and beliefs of medical students concerning antimicrobial use and resistance. Microb Drug Resist. 2010;16(4):285-9. DOI: https://doi.org/10.1089/mdr.2010.0009

Alkhalil S, Alhaj M, Alhaj N, Al Awaida W, Obeidat N, Al-Qudah R, et al. Knowledge, attitudes and perceptions of medical students on antimicrobial stewardship. Antibiotics. 2020;9(11):821. DOI: https://doi.org/10.3390/antibiotics9110821

Yousef N, Al-Bakri AG, Bustanji Y, Wazaify M, Khalil R, Al-Qudah R. Knowledge, attitude, and behavior about antimicrobial use and resistance among medical, nursing and pharmacy students in Jordan: a cross-sectional study. Antibiotics. 2022;11(11):1559. DOI: https://doi.org/10.3390/antibiotics11111559

Alghamdi S, Alshammari F, Alzahrani M, Alghamdi S, Alotaibi B, Alshahrani A, et al. Knowledge, awareness, and perceptions towards antibiotic use, resistance, and antimicrobial stewardship among final-year medical and pharmacy students in Saudi Arabia. Antibiotics. 2024;14(2):116. DOI: https://doi.org/10.3390/antibiotics14020116

Saksena R, Parida A, Jain M, Gaind R. Antibiotic use and antimicrobial resistance: knowledge, attitude and practices survey of medical students to evaluate undergraduate training curriculum. Access Microbiol. 2025;7(1):000638. DOI: https://doi.org/10.1099/acmi.0.000638.v4

Majumder MAA, Rahman S, Cohall D, Haque M, Begum Z, Huq S. Antimicrobial stewardship: fighting antimicrobial resistance in southeast Asia. Bangladesh J Med Sci. 2020;19(3):366-76.

Kotwani A, Joshi J, Lamkang AS, Gandra S. Over-the-counter antibiotic dispensing by pharmacies: a standardized patient study in Udupi district, India. BMJ Glob Health. 2021;6(9):e006801.

World Health Organization. Antimicrobial stewardship programmes in health-care facilities in low- and middle-income countries: a WHO practical toolkit. Geneva: WHO; 2019.

Ajibola O, Omisakin OA, Eze AA, Omoleke SA. Self-medication with antibiotics, attitude and knowledge of antibiotic resistance among community residents and undergraduate students in Northwest Nigeria. Diseases. 2018;6(2):32. DOI: https://doi.org/10.3390/diseases6020032

Haque M, Rahman NAA, McKimm J, Haque SZ, Islam MN, Abdullah S, et al. Knowledge, attitudes, and practice regarding antibiotic use and resistance among medical students in Bangladesh: a cross-sectional study. Antibiotics. 2020;9(8):523. DOI: https://doi.org/10.3390/antibiotics8030154

Thriemer K, Katuala Y, Batoko B, Alworonga JP, Devlieger H, Van Geet C, et al. Antibiotic prescribing in DR Congo: a knowledge, attitude and practice survey among medical doctors and students. PLoS One. 2013;8(2):e55495. DOI: https://doi.org/10.1371/journal.pone.0055495

Dyar OJ, Howard P, Nathwani D, Pulcini C. European medical students: a first multicentre study of knowledge, attitudes and perceptions of antibiotic prescribing and antibiotic resistance. J Antimicrob Chemother. 2014;69(3):842-6. DOI: https://doi.org/10.1093/jac/dkt440

Charani E, Mendelson M, Pallett SJC, Ahmad R, Van den Bergh D, Mpofu K, et al. An analysis of the influence of the local culture and context on antimicrobial stewardship interventions in low- and middle-income countries: a qualitative meta-synthesis. J Antimicrob Chemother. 2023;78(2):281-91.

Singh S, Sharma A, Gupta V. Simulation-based training for antimicrobial stewardship among medical students in India: a pilot study. J Hosp Infect. 2024;142:75-82.

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Published

2025-08-22

How to Cite

Murthy K. M., N., Hebbar J. N., A., & Kumar, N. (2025). Knowledge, attitudes, and practices toward antibiotic use and resistance among medical students: a cross-sectional study. International Journal of Basic & Clinical Pharmacology, 14(5), 760–764. https://doi.org/10.18203/2319-2003.ijbcp20252573

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Original Research Articles