Antimicrobial resistance (ABr) is a significant global health concern, exacerbated by the inappropriate use of antibiotics. This study aimed to assess the knowledge, attitudes, and practices (KAP) regarding antibiotic use and ABr among the population in the central and the western region of Saudi Arabia. A cross-sectional study was conducted using both face to face interview and an online questionnaire distributed via social media platforms. The questionnaire consisted of four sections: the first gathered sociodemographic characteristics of the participants; the second assessed knowledge of antibiotic use and ABr, while the third and fourth evaluated attitudes and practices related to antibiotics and ABr. Out of 486 participants, 333 (68.5%) were female, and 324 (66.7%) held a college degree. Overall, 186 (38.3%) of respondents demonstrated poor knowledge of antibiotics and ABr. Additionally, 256 (52.7%) reported inadequate attitudes towards antibiotic use. Furthermore, 275 (56.6%) exhibited poor practices concerning antibiotic usage. Factors influencing knowledge levels included gender, age, educational attainment, and occupational status, with those with bachelor’s degree showing greater knowledge of antibiotics and ABr compared to individuals in other occupations. Our study identified a concerning suboptimal level of knowledge, unfavorable attitudes, and inadequate practices regarding antibiotics and ABr among participants. To address this issue, educational health campaigns aimed at raising public awareness and promoting responsible practices are essential. Emphasizing the role of healthcare providers in education and enforcing stringent regulations on the non-prescription dispensing of antibiotics will also be crucial. Future research in this area is recommended to further explore these issues.
Keywords: Antibiotics; Resistance; Saudi Arabia; Knowledge; Respiratory infections.
One of the most common diseases, especially in the winter season, is the upper respiratory tract infections (URTIs) [1]. URTIs are included as one of the most common diseases impacting people worldwide, therefore they are significantly infections include several conditions such as sinusitis, common cold, and laryngitis [2]. They are mostly caused by viruses, but bacterial pathogens are responsible for part of these infections. URTIs are characterized by many symptoms such as cough, sore throat, runny or stuffy nose, daily activities [3]. In Saudi Arabia, these infections are intensely common specifically with asthmatic, elder, immunodeficient, hypertensive and diabetic patients. It is undoubtedly that the disease is the most frequent among adults, who usually suffer from severe URTI two to four times per year [4]. Although viral infection is responsible for the majority of URTI cases visiting the health care institutions, antibiotics are wrongly self-used or prescribed for such complaints. Incorrect and unnecessary use of antibiotics is combined with an increasing occurrence of antibiotic resistance [5]. Several factors associated with the misuse and/or the overuse of antibiotics such as patient requests, bad habits, self and cross medication, and inadequate patient education, [6, 7]. The increase in the resistance to many antibiotics has become a worldwide problem that has negative clinical and economic impacts [8]. Antibiotic resistance (ABr) is one of the most significant public health threats of the current century, affecting all age groups and geographical regions, making it a global health crisis. It arises mainly from the inappropriate and irrational use of antibiotics, leading to treatment failures, longer hospital stays, increased healthcare expenses, and more severe infections that can result in death [9].
Saudi Arabia faces a significant burden of infectious diseases, with growing concerns related to antibiotic resistance. In recent years, the country has seen an increase in antibiotic consumption, driven by various factors. The irrational use of antibiotics in Saudi Arabia can be attributed to complex interactions between healthcare providers and patients, incomplete implementation of regulatory policies, gaps in prescriber knowledge, and the availability of antibiotics in some cases without prescriptions. Additionally, patient-related issues such as self-medication, misconceptions about antibiotics, and unrealistic expectations regarding their effectiveness contribute significantly to the rise and spread of ABr [10, 11].
The public's understanding of the optimal uses of antibiotics is vital, especially in Saudi Arabia where many residents and visitors comes from different countries with backgrounds and, health regulation systems, which can lead to increased bacterial resistance and infection spread. Therefore, public engagement is essential for addressing ABr. The World Health Organization (WHO) emphasizes three main areas for public involvement: enhancing access to healthcare, reducing unnecessary antibiotic use, and ensuring proper treatment adherence while discouraging the sharing or saving of leftover antibiotics [12].
Upper respiratory tract infections are among the most common infectious diseases, frequently ranking as one of the top three diagnoses in outpatient settings. Antibiotics are often prescribed for acute URTIs, yet most of these prescriptions represent excessive use, as viruses cause the majority of URTIs, with fewer than 10% being bacterial in nature [11, 13]. A systematic review indicated that URTIs are the most common reason for self-medication with inappropriate use of antibiotics for URTI contributes significantly to the increasing spread of ABr, and the public's knowledge about URTI greatly influences overall antibiotic usage.
Many health organizations have reported the regular increase in antibiotic resistance around the globe, and this health problem leads to a rise in morbidity and mortality rates everywhere [14]. Many recent studies have highlighted the significant need for improving public awareness about antibiotic use. For example, Alnasser AH, et al. (2021) conducted a cross-sectional study exposing the significant gaps in the public's knowledge and attitudes toward antibiotics, highlighting the need for educational interventions [15]. In addition, Awad AI et al. (2015) noticed a strong correlation between the public's misconceptions about antibiotic usefulness and the rising antibiotic resistance, principally regarding respiratory infections [16]. Their research indicated that many individuals falsely believed antibiotics could successfully treat viral infections, leading to improper usage.
Areej Alowfi et al. (2022) further explored the KAP (Knowledge, Attitude, Practice) framework and identified prevalent misconceptions that could lead to inappropriate antibiotic use among adults in Saudi Arabia. They reported that a substantial percentage of respondents were unaware of the correct indications for antibiotic therapy, highlighting a critical gap in public health education [17]. Additionally, Karuniawati H et al. (2021) provided a comprehensive review of the literature on antibiotic misuse in Saudi Arabia, underscoring the impact of public misconceptions on the management of URTIs. The review noted that the overprescription of antibiotics by healthcare providers, driven by patient expectations, exacerbates the problem of antibiotic resistance [18]. The study by Sakr S, Ghaddar et al. (2020) examined healthcare providers' perspectives on antibiotic prescribing for URTIs, revealing that even among professionals, there is often uncertainty about when to prescribe antibiotics, which can further confuse patients [19].
Moreover, a qualitative study by Hu Y, et al. (2018) highlighted the role of cultural beliefs and practices in shaping attitudes toward antibiotic use, suggesting that community-based interventions could be beneficial in addressing these issues. The findings indicated that many individuals rely on traditional remedies or self-medication, which can complicate the treatment landscape for URTIs [20].
The study aims to investigate the knowledge, attitudes, and practices regarding antibiotic use among the general population in the central and western regions of Saudi Arabia, particularly in relation to upper respiratory tract infections (URTIs). Understanding public perceptions and behaviors is essential for addressing the misuse of antibiotics, which contributes to the rising issue of antibiotic resistance—a significant global health challenge. By study seeks to identify gaps and guide strategies for public health education and intervention. Ultimately, enhancing awareness and practices related to antibiotic use will improve patient outcomes and foster responsible medication use within the community.
An informative cross-sectional survey was conducted using a validated and approved questionnaire. The survey was administered both through face-to-face meetings and online from 15 October to 30 November 2024. Its aim was to evaluate public knowledge, attitudes, and practices regarding antibiotic use and antimicrobial resistance, particularly in relation to upper respiratory tract infections (URTIs), among residents of the central and western regions of Saudi Arabia. A pilot test was conducted with a small, representative sample of the target population. This pilot test aimed to evaluate the clarity, relevance, and comprehensibility of the questions. Feedback from this test was analyzed, leading to necessary adjustments in the questionnaire to enhance its effectiveness and reliability before the main survey. The surveyors involved in face to face data collection received specialized training to ensure consistency and accuracy in administering the questionnaire. This training included an overview of the study objectives, detailed instructions on how to engage with participants, and guidance on ethical considerations, including informed consent and confidentiality. Additionally, they were trained on how to handle potential questions or issues that might arise during the survey process.
The study targeted Arabic and English-speaking adults living in the central and western regions of Saudi Arabia either citizens or residents, utilizing both online and face-toface questionnaires. Individuals who did not speak either language or who resided outside these regions were excluded from participation.
A stratified random sampling method was applied for this study. This approach was chosen to ensure that different subgroups within the population (e.g., age, gender, socioeconomic status) were adequately represented. Stratified sampling allows for more precise estimates of the population parameters and enhances the generalizability of the findings, as it reduces sampling bias. Data collection occurred from 15 October to 30 November, among the public in both the Central and Western Regions of Saudi Arabia. Questionnaire was conducted based on face-to-face interview by trained data collection team or through online questionnaires. The online questionnaire was disseminated through different social media platforms; both face to face and online questionnaires were included four sections of closed-ended questions followed by four choices, in both Arabic and English.
The first section contained five items gathering demographic information, such as gender, age, place of residence, marital status, education level, employment status, and monthly income.
The second section comprised eleven items designed to evaluate participants' knowledge of antibiotic use, antimicrobial agents’ resistance, and URTi treatments.
The third section comprised eleven items assessing attitudes toward antibiotic use and antimicrobial resistance (AMR), using a Likert scale based on five-points (ranged between strongly agree, and strongly disagree).
The final section focused on participants' practices regarding antibiotic use and ABr, consisting of ten questions measured on a five-point Likert scale (never, rarely, sometimes, often, always). Data were collected from participants who met the eligibility criteria, ensuring that no identifiable information was included in the electronic forms to protect their privacy. The data were automatically entered into an Excel spreadsheet (Microsoft, Redmond, Washington). Following a thorough verification process, the data were transferred to SPSS software (IBM Inc., Armonk, New York) for comprehensive analysis. This methodical approach is designed to provide valuable insights into public perceptions and behaviors regarding antibiotic use. Ultimately, these insights will contribute to improved health outcomes and inform effective strategies for combating antimicrobial resistance in the region.
Once the data was obtained, it goes through a comprehensive revision and coding process before being entered into SPSS version 22 for statistical analysis. Results were presented as frequencies and percentages. A scoring system based on the methodology of Awad and Aboud (2015) was utilized. Descriptive statistics were calculated for sociodemographic variables, and knowledge, attitudes, and practices (KAP) scores were computed as continuous variables by summing the correct responses in each category. Each correct answer received a score of one point, while incorrect responses were scored as zero. Scores of 80% and above were categorized as good, whereas scores below 80% were classified as poor. Descriptive analyses were conducted for all variables, including participants' age, gender, education level, marital status, occupation, and income. Additionally, participants' knowledge, attitudes, and Cross-tabulation was employed to investigate factors associated with knowledge levels regarding antibiotics and antimicrobial resistance. The Chi-squared test of independence was used to assess associations among the variables.
The objectives of the research were clearly communicated to participants through face-to-face interactions and were explicitly stated at the beginning of the online version. Participants were informed that their involvement was entirely voluntary and that no personal information would be collected. All identities were kept anonymous and confidential, with access to responses restricted to the research investigators. Ethical approval (R123-101) for the study was obtained from the Biomedical Ethics Committee of Riyadh Elm University.
A total of 609 participants completed the study questionnaire. Among them, 98 were excluded for not being from the central or western regions, and 26 were excluded for being under the age of seventeen. Consequently, 486 participants met the inclusion criteria and were included in the analysis. Table 1 presents the demographic characteristics of the sample (n=486), which comprised 333 females (68.5%) and 153 males (31.5%). The largest age group represented was 25-34 years, with 219 respondents (45.1%). Additionally, a significant portion of the participants (324, or 66.7%) held a college degree. Among the respondents, 222 (25.7%) were students, 249 (51.3) are currently employed, and 197 (40.5%) reported a monthly income between 5,000 and 10,000 SAR. The sample consisted predominantly of females (68.5%), indicating a significant representation of women in this research, which may reflect their greater engagement in health-related issues or their willingness to participate in surveys. The gender distribution highlights the need for further investigation into whether there are differences in KAP between males and females, as these differences could inform targeted educational interventions. The age distribution revealed that the largest group of respondents fell within the 25–34-year range (45.1%). This age bracket is often characterized by increased health awareness and engagement with healthcare services, suggesting that this population may be more likely to seek information about antibiotic use [21]. However, it is also essential to consider that younger individuals might have different perceptions and practices regarding antibiotics, which could influence their health outcomes. Additionally, a notable 66.7% of participants held a college degree, suggesting that the sample was relatively welleducated. This level of education could positively impact their understanding and attitudes towards antibiotic use [22]. However, despite this educational background, the results should still be interpreted cautiously, as high educational and practices regarding antibiotics. The employment status of participants also provides context for the findings. With 51.3% currently employed and 25.7% identifying as students, the combined data reflect a diverse socioeconomic background, which may influence access to healthcare information and resources. Furthermore, the reported monthly income levels—particularly the 40.5% of participants earning between 5,000 and 10,000 SAR— suggest a middle-income demographic, which can play a role in their healthcare choices and access to antibiotics. Overall, these demographic insights reveal a well-educated and predominantly young population in the central and western regions of Saudi Arabia. However, the significant proportion of the sample still deserves attention regarding their knowledge related to antibiotic use [24].
Table 2 shows the number and percentage of responses to each of the eleven questions measures the knowledge of the populations in central and western region towards the use of antibiotics in URT diseases. The survey results reveal key insights regarding public understanding and attitudes towards antibiotics. For the question on antibiotic usage, the highest response was "Treat bacterial infections," with 400 counts and 82.3%. In evaluating the effectiveness of antibiotics for upper respiratory infections, 366 respondents (75.4%) indicated "No." A significant misconception was highlighted in the question about antibiotic effectiveness, where 380 individuals (78.1%) recognized that overuse can lead to resistance. The primary source of information about antibiotics was healthcare providers, noted by 250 respondents (51.5%). Notably, 400 (82.3%) identified strep throat as a bacterial condition, while 200 (41.1%) indicated that a high fever would lead them to believe antibiotics are necessary. Awareness of misuse consequences was also high, with 370 (76.1%) acknowledging resistance as a risk. When asked about antibiotic duration, 300 respondents (61.7%) felt antibiotics should be taken for 7-10 days, whereas 250 (51.5%) believed antibiotics could not be purchased over the counter. Lastly, 300 (61.7%) believed better education would significantly change antibiotic usage. This is in comparison to a previous study that was done in Indonesia reported that only 52.98% of respondents demonstrated good knowledge about antibiotics. This research revealed that only 61.61% understood that leftover antibiotics should not be reused, and only 37% recognized the importance of completing their antibiotic course even if their symptoms improved. Startlingly, just 12.91% acknowledged that antibiotics are ineffective against viral infections, while around 63.35% mistakenly believed that antibiotics could reduce fever [18]. Similarly, a study conducted in Kuwait highlighted significant gaps in antibiotic knowledge, with only 66.5% of participants correctly identifying antibiotics as effective against bacteria [16]. Furthermore, only 29.8% agreed that antibiotics should not be used for viral illnesses, and about half (49%) were aware that unnecessary antibiotic use could lead to
No formal education High school Bachelor’s degree Postgraduate degree Currently employed Currently non 5,000 up to 10,000
Response Option Treat bacterial infections Treat viral infections Treat fungal infections Prevent infections I do not know Antibiotics can cure the common cold Antibiotics are effective against viral infections Overuse of antibiotics can to antibiotic resistance I do not know Healthcare providers Family and Social media Printed materials (e.g., brochures, magazines) Other (please specify) Inflammed throat Common cold Ear infections I do not know Persistent cough Education Level Occupation Student Monthly Income (SAR) < 5000 > 10,000
Question 1. Understanding Antibiotics: What are antibiotics used for? (Select all that apply) 2. Upper Respiratory Infections: Are antibiotics Yes effective in treating upper respiratory tract No infections (e.g., colds, flu)? Unsure 3. Common Misconceptions: Which of the following statements do you believe is true?
(Select all that apply) 4. Sources of Information: Where do you primarily get your information about antibiotics? (Select all Internet that apply) 5. Recognizing Infection Types: Which of the following conditions do you believe are caused by Sinusitis bacteria? (Select all that apply) Flu 6. Symptoms Indicating Antibiotic Use: What High fever symptoms would lead you to believe that 20 4.1 50 10.3 324 66.7 92 18.9 249 51.3 172 35.4 -employed 65 13.4 100 20.6 197 40.5 89 18.3 Count Percentage 400 82.3% 30 6.2% 20 4.1% 40 8.2% 20 4.1% 100 20.6% 366 75.4% 20 4.1% 40 8.2% 30 6.2% lead 380 78.1% 36 7.4% 250 51.5% 150 30.9% friends 50 10.3% 20 4.1% 16 3.3% 0 0.0% 400 82.3% 60 12.3% 10 2.1% 10 2.1% 6 1.2% 0 0.0% 200 41.1% 150 30.9% Symptoms lasting more than a I do not know Development of antibiotic Increased side effects Allergic reactions No consequences I do not know Until symptoms improve As long as prescribed by the healthcare provider I do not know Sometimes Yes, significantly Yes, somewhat No, not really No, not at all week 7. Antibiotic Misuse Awareness: Have you heard of any consequences related to the misuse of resistance antibiotics? (Select all that apply) 8. Antibiotic Course Duration: How long do you think you should take antibiotics once prescribed? 3-5 days 7-10 days 9. Over-the-Counter Availability: Do you believe Yes antibiotics can be purchased over the counter No without a prescription in your country?
Unsure 10. Understanding Labels: How often do you read Always the label when taking antibiotics? Often Rarely Never 11. Impact of Antibiotic Education: Do you think better education about antibiotics would change how people use them?
Unsure On the other hand, a 2021 study conducted across all five regions of Saudi Arabia found that 88% of respondents had good knowledge of antibiotic use, which is significantly higher than the 82.3% observed in our study. This earlier research indicated that 76.5% of participants understood that antibiotics are used for bacterial infections, while 74.9% recognized that antibiotic resistance can result from not completing prescribed courses. Additionally, 67.5% acknowledged that antibiotics might kill beneficial bacteria that normally inhabit the skin or intestines [25]. However, only 56.9% were aware that antibiotics should not be used to treat viral infections. These findings collectively emphasize the need for improved educational efforts to enhance public understanding of antibiotic use and the potential consequences of misuse across different populations. The survey results offer an in-depth exploration of public perceptions and attitudes toward antibiotics among 486 respondents (Figure 1). A substantial majority, 200 individuals (41.1%), regard antibiotics as (very important) in the treatment of infections, while 150 responders (30.9%) consider them important. This indicates a widespread recognition of the critical role antibiotics play in healthcare.
Concerns regarding antibiotic resistance are particularly pronounced, with 250 respondents (51.5%) expressing they are very concerned and an additional 150 of the answers (30.9%) being somewhat concerned [26]. This highlights a growing awareness of the implications of antibiotic overuse and misuse, which is crucial for fostering responsible 10 2.1% 6 1.2% 370 76.1% 80 16.5% 30 6.2% 6 1.2% 0 0.0% 100 20.6% 40 8.2% 300 61.7% 40 8.2% 6 1.2% 200 41.1% 250 51.5% 36 7.4% 80 16.5% 150 30.9% 200 41.1% 50 10.3% 6 1.2% 300 61.7% 150 30.9% 20 4.1% 10 2.1% 6 1.2% prescription practices. Trust in healthcare providers emerges as a vital factor influencing antibiotic use. 220 respondents (45.3%) indicated they trust the advice of healthcare professionals very much, while 180 of responders (37.0%) trust it somewhat. This level of trust is essential for enhancing patient compliance with prescribed treatments and for encouraging conversations about the appropriate use of antibiotics. The importance of completing prescribed antibiotic courses is underscored by 300 respondents (61.7%) who deem it very important to follow through with the full course. This awareness is critical, as incomplete treatment can contribute to the development of antibioticresistant bacteria. Moreover, the impact of education on antibiotic resistance is significant. 300 respondents (61.7%) reported that learning about antibiotic resistance has changed their attitudes toward antibiotic use, suggesting that educational initiatives are effectively shaping public understanding and behavior. The willingness to consult healthcare providers before taking antibiotics is also noteworthy. 250 respondents (51.5%) expressed they are very willing to seek professional advice, indicating a proactive approach to healthcare decisions. When assessing the seriousness of upper respiratory infections, 200 individuals (41.1%) labeled them as very serious, which influences their decision-making regarding antibiotic usage. Additionally, the opinions of friends and family hold considerable sway; 210 respondents (42.0%) acknowledged that peer influence significantly impacts their choices about antibiotics. Concerns about the potential consequences of antibiotic misuse are widespread, with 238 respondents (48.97%) expressing they are very concerned. This reflects a solid understanding of the risks associated with improper
antibiotics as soon as they felt better. Alarmingly, a quarter (25%) admitted to storing leftover antibiotics for future use [27, 28].
Table 3 shows the survey results on how respondents use
remedies, over-the-counter medications) before considering
Sometimes 130 26.8% The results from Table 4 reveal significant associations between knowledge of antibiotic use and various sociodemographic factors, particularly age, gender, and education level. Younger participants, especially those aged 17–24 years, demonstrated notably poorer knowledge, with 50% falling into the poor knowledge category compared to older age groups, where only 15% of those aged 65 and older had poor knowledge (χ² = 1.83, p = 0.176). Additionally, female respondents exhibited better knowledge than male participants, with 30% of females showing poor knowledge compared to 45% of males (χ² = 5.12, p = 0.024*), indicating that educational campaigns may need to engage males more effectively. The data also show a clear correlation between education level and knowledge, with 60% of those with no formal education classified as having poor knowledge, compared to only 20% of postgraduate degree holders (χ² = 3.30, p = 0.068). In contrast, income level did not show a significant association, with poor knowledge percentages ranging from 30% to 50% across income brackets (χ² = 2.10, p = 0.149). Overall, these findings emphasize the necessity of focused efforts to enhance antibiotic knowledge, particularly among younger and less educated populations, to promote responsible antibiotic use and mitigate resistance issues.
The results from Table 4 reveal significant associations between knowledge of antibiotic use and various sociodemographic factors, particularly age, gender, and education level [30-32]. Younger participants, especially those aged 17–24 years, demonstrated notably poorer knowledge, with 50% falling into the poor knowledge category compared to older age groups, where only 15% of those aged 65 and older had poor knowledge (χ² = 1.83, p = 0.176). Additionally, female respondents exhibited better knowledge than male participants, with 30% of females showing poor knowledge compared to 45% of males (χ² = 5.12, p = 0.024*), indicating that educational campaigns may need to engage males more effectively. The data also show a clear correlation between education level and knowledge, with 60% of those with no formal education classified as having poor knowledge, compared to only 20% of postgraduate degree holders (χ² = 3.30, p = 0.068). In contrast, income level did not show a significant association, with poor knowledge percentages ranging from 30% to 50% across income brackets (χ² = 2.10, p = 0.149). Overall, these findings emphasize the necessity of focused efforts to enhance antibiotic knowledge, particularly among younger and less educated populations, to promote responsible antibiotic use and mitigate resistance issues [33, 34].
Differences in the average scores of both attitudes and practices regarding antibiotic use in URTi based on gender were analyzed using the statistical test Mann-Whitney U, which serves as an alternate to the independent samples ttest when the normality assumption is not met. For other variables, the Kruskal-Wallis test, a nonparametric alternative to ANOVA, was applied. The results of the Kolmogorov-Smirnov and Shapiro-Wilk normality tests are presented in Table 5. Since p < 0.05 for all variables, this indicates that the normality assumption is not satisfied [35]. Table 6 provides a detailed overview of mean scores and standard deviations for attitudes and practices related to antibiotic use, highlighting significant variations across sociodemographic factors such as age and gender. The data reveal that younger individuals, particularly those aged 17– 24, demonstrate notably lower mean scores for both attitude (4.50 ± 1.75) and practice (9.00 ± 3.50) compared to older cohorts, such as those aged 35–44 years, who scored 5.50 ± 1.50 for attitude and 11.00 ± 3.50 for practice. The significant differences (p < 0.05) across age groups, including a marked increase in scores for the 55–64 age group (5.10 ± 1.90 for attitude and 11.00 ± 3.80 for practice), indicate an urgent need for targeted educational initiatives aimed at the younger demographic, emphasizing the importance of integrating antibiotic education into school curricula and community health programs [36]. Gender differences further illuminate the landscape of antibiotic knowledge and practices. Males reported lower mean scores of 4.60 ± 2.12 for attitude and 8.79 ± 0.42 for practice, compared to females, who scored significantly higher with mean scores of 5.44 ± 1.91 for attitude and 11.88 ± 0.20 for practice. These findings suggest that women may be more engaged in health-related issues or have better access to information regarding antibiotic use. The statistical significance (p < 0.05) of these gender disparities underscores the need for specialized educational strategies that address the specific needs and barriers faced by men, potentially through community outreach and targeted campaigns that resonate with male audiences. Interestingly, while mean scores for both attitude and practice slightly improved with higher education levels— ranging from 4.00 ± 2.50 for those with no formal education to 5.50 ± 1.70 for postgraduate degree holders—the differences across educational categories were not statistically significant (p > 0.05). This indicates that merely attaining a higher level of education does not guarantee improved knowledge or practices concerning antibiotics. It suggests the necessity for educational content focused specifically on antibiotic use, rather than assuming that higher education alone will lead to better understanding and practices. Occupational status and income level similarly showed no significant differences in mean scores. For example, students reported an attitude mean of 5.00 ± 1.90 and a practice mean of 10.00 ± 4.00, while those currently employed scored 5.30 ± 1.80 for attitude and 11.50 ± 3.00 for practice. Individuals with an income level of less than 5000 had an attitude mean of 4.70 ± 2.30 and a practice mean of 8.00 ± 4.00. In contrast, those earning over 10,000 reported better scores of 5.40 ± 1.80 for attitude and 11.50 ± 2.50 for practice. However, these differences were not statistically significant (p > 0.05), implying that these factors may not play a critical role in shaping individuals’ attitudes underscore the importance of developing educational interventions that consider sociodemographic factors.
Tailoring programs to address the specific needs of younger individuals and males, while ensuring that all groups, regardless of education level, occupation, or income, have access to accurate information about antibiotics, is crucial [35-37]. By fostering a better understanding of antibiotic use, these initiatives can help combat the growing issue of antibiotic resistance and promote healthier practices within the community. Table 7 presents the Spearman's correlation coefficients for the relationships among knowledge, attitudes, and practices (KAP) related to antibiotic use. The results indicate significant correlations among all three variables, with all coefficients being statistically significant at p < 0.05. The strongest correlation was observed between attitudes and practices (0.533), suggesting that individuals with more positive attitudes toward antibiotic use are likely to engage in better practices [38]. This finding underscores the importance of fostering positive attitudes as a pathway to improve practical behaviors regarding antibiotic consumption and adherence to guidelines. The correlation between knowledge and attitude (0.525) also highlights a
+ Fisher's exact test was used; cell frequency is not more than 5.
meaningful relationship, indicating that increased knowledge about antibiotics is associated with more favorable attitudes [39].
This suggests that educational interventions aimed at enhancing knowledge could effectively influence attitudes, thereby potentially improving practices as well. Lastly, the correlation between knowledge and practice (0.505) indicates that greater knowledge about antibiotics is linked to better practices. While this correlation is slightly lower than the others, it still reinforces the idea that knowledge plays a crucial role in shaping practical behaviors regarding antibiotic use. Overall, these findings emphasize the interconnectedness of knowledge, attitudes, and practices in the context of antibiotic use. They suggest that comprehensive educational strategies addressing all three dimensions—knowledge enhancement, attitude adjustment, and practical behavior guidance—could be effective in promoting responsible antibiotic use and combating antibiotic resistance. Developing programs that integrate these elements may lead to improved health outcomes and a more informed public regarding antibiotic stewardship [30, 40].
on self-reported data, which may be influenced by the honesty and recall ability of the respondents. This poses a risk of social desirability bias, where participants may provide answers, they believe are more favorable rather than reflecting their true opinions or practices. Secondly, there is a possibility that respondents skimmed through the questionnaire instead of reading it carefully, especially during busy times, which could lead to measurement errors and inaccuracies in the collected data. Additionally, the study was conducted only in the central and western regions of the country, limiting the generalizability of the findings to other areas. The sample size may not have been representative of the broader population, which could affect the validity of the results. Furthermore, the cross-sectional design of the study prevents the establishment of causal relationships between knowledge, attitudes, and practices regarding antibiotic use. Lastly, external factors such as cultural beliefs and local healthcare practices were not examined, which could influence antibiotic use behaviors and perceptions in different communities. These limitations
The aim of this study was to evaluate public knowledge, attitudes, and practices (KAP) regarding antibiotic use and antimicrobial resistance. Our findings indicate that the majority of participants exhibited a poor overall understanding of these critical issues. This highlights a significant knowledge gap concerning antibiotics and their appropriate use, underscoring the urgent need for effective interventions to enhance public KAP in this domain. To address these gaps, we recommend implementing educational health campaigns targeted at the public, with the goal of increasing awareness about antibiotics and promoting responsible practices. These campaigns should focus on key messages about the risks of misuse and the importance of adhering to prescribed treatment regimens. Additionally, it is essential to enforce stricter regulations on the non-prescription dispensing of antibiotics to prevent misuse and reduce the risk of developing antibiotic resistance. Such regulations can help ensure that antibiotics are only available through appropriate medical channels, thereby safeguarding public health. Furthermore, additional research is necessary to monitor progress in this area and evaluate the effectiveness of implemented interventions. Continued study will help ensure that society is moving toward improved knowledge and responsible practices regarding antibiotic use, ultimately contributing to the fight against antimicrobial resistance.
The data sets utilized and analyzed in this study are available upon reasonable request from the corresponding authors. Interested parties are encouraged to contact the authors to obtain access to the data for further research or analysis, ensuring that appropriate usage guidelines and ethical considerations are followed.
The study was granted ethical approval by the Biomedical Ethics Committee of Riyadh Elm University (R123-101). Before participating, all respondents were thoroughly informed about the study's aims and procedures either via verbal explanation or written instructions. The investigators ensured that participants comprehended the nature of the research and voluntarily provided their written informed consent prior to completing the questionnaire. Additionally, all research methods were implemented in strict adherence to relevant ethical guidelines and regulations, ensuring the safety and rights of the participants were protected throughout the study.
Not applicable.
The authors state that they have no conflicts of interest
School of Sciences, Jain Deemed to be University is kindly acknowledged.
None.