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 Table of Contents  
Year : 2019  |  Volume : 7  |  Issue : 1  |  Page : 57-60

Knowledge, attitude, and awareness of antibiotic resistance among medical students

1 Department of Pharmacology, Faculty of Medicine, Lincoln University College, Petaling Jaya, Selangor Darul Ehsan, Malaysia
2 Department of Biochemistry, Faculty of Medicine and Health Sciences, University Sultan Zainal Abidin, Kuala Terengganu, Terengganu, Malaysia
3 Department of Physiology, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
4 Department of Community Medicine, Faculty of Medicine, Lincoln University College, Petaling Jaya, Selangor Darul Ehsan, Malaysia
5 Department of Oral Diagnostics and Surgical Sciences, School of Dentistry, International Medical University, Bukit Jalil, Kuala Lumpur, Malaysia

Date of Web Publication12-Jun-2019

Correspondence Address:
Dr. Sowmya Sham Kanneppady
Department of Pharmacology, Faculty of Medicine, Lincoln University College, No. 2, Jalan Stadium, SS 7/15, Kelana Jaya, 47301 Petaling Jaya, Selangor Darul Ehsan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/amhs.amhs_104_18

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Background: There is a rising trend in antibiotic use and misuse which contributes to antibiotic resistance. Objective: This cross-sectional, questionnaire-based study was to assess the knowledge, attitude, and awareness of antibiotic resistance among medical students. Materials and Methods: The study was conducted on medical students of all years (year 1–5) in a private university of Malaysia coincide with the “Antibiotic Awareness Week” of the World Health Organization. Results: Students in the clinical phase of their training had more awareness than the preclinical phase on the consumption of antibiotics over the counter without prescription (P = 0.008). Students of both the phases responded differently when asked whether the newer antibiotics were more effective in treating infection (P = 0.022). Only 43.5% of year 4 and 42.3% of year 5 students were aware (P = 0.036) about Antibiotic Awareness Week. Conclusion: The study concludes that medical students should have in-depth knowledge about antibiotic resistance and its underlying mechanisms to prevent the misuse of antibiotics.

Keywords: Antibiotic resistance, awareness, knowledge, medical students, microorganisms

How to cite this article:
Kanneppady SS, Oo AM, Lwin OM, Ahmed Al-Abed AAA, Kanneppady SK. Knowledge, attitude, and awareness of antibiotic resistance among medical students. Arch Med Health Sci 2019;7:57-60

How to cite this URL:
Kanneppady SS, Oo AM, Lwin OM, Ahmed Al-Abed AAA, Kanneppady SK. Knowledge, attitude, and awareness of antibiotic resistance among medical students. Arch Med Health Sci [serial online] 2019 [cited 2022 Nov 27];7:57-60. Available from: https://www.amhsjournal.org/text.asp?2019/7/1/57/259997

  Introduction Top

Antibiotics are the drugs which can cure the infective diseases. They were the greatest contribution of the 20th century to therapeutics. Interestingly, antibiotics are the most commonly used and misused drugs of the 20th and current century.[1] Antibiotic resistance has been the greatest threat to modern medicine due to misuses and abuses of antibiotics.[2] Therefore, the World Health Organization (WHO) declared “World Antibiotic Awareness Week” from November 13, to November 17, 2017, with an objective of improving “awareness and understanding of antimicrobial resistance through effective communication, education, and training.” Antibiotic resistance is escalating dangerously in all parts of the world. New resistance mechanisms are developing and spreading worldwide, threatening in the treatment of infectious diseases.[3] A growing list of infectious diseases such as pneumonia, tuberculosis, and sexually transmitted diseases are becoming harder to treat as antibiotics become less effective. Antibiotic resistance results when the microorganisms develop a mechanism to protect itself from antibiotics for its survival, which makes the antibiotic to be useless when used against that microorganism. When microorganisms develop resistance against the antibiotics, there will be a need for use of newer, higher efficacy, and more expensive antibiotics. Therefore, antibiotics are meant to be used wisely and responsive way in order for the prevention and treatment of infectious diseases. Various factors contributing to antibiotic resistance are patient's demand, physician preferences, a longer time for culture and sensitivity testing, pharmacists and healthcare providers giving it as over-the-counter drug (especially in developing countries), lack of quality medicine, subtherapeutic dose of antibiotic usage in animal husbandry, and promotional activities from pharmaceuticals companies.[4] Another important factor is the lack of knowledge and proper awareness among community and healthcare personnel.[5]

Poor knowledge and lack of training about antibiotic resistance during undergraduate medical studies may lead to a change in behavior among future doctors.[6] Research assessing undergraduate medical students' knowledge about antibiotic resistance is rare in the literature. Thus, the objective of this study was to assess the knowledge, attitude, and awareness of antibiotic resistance among undergraduate medical students.

  Materials and Methods Top

The present research is a cross-sectional, questionnaire-based study conducted at Lincoln University College of Malaysia after getting approval from the institutional research committee. The study period was from November 13, to November 17, 2017, which is chosen to be in conjunction with “WHO Antibiotics Awareness Week.” All the 260 students from year 1 to year 5 Doctor of Medicine (MD) program participated in the study after obtaining informed consent. A total of 10 questions was prepared in Google docs after extensive literature search using PubMed, Google, and other search engines. As shown in [Table 1][6],[7], five questions (number 1, 2, 3, 4, and 9) were designed to assess students' knowledge on antibiotic, three questions (number 5, 6, and 7) were constructed to assess students' attitude on taking antibiotics, and the remaining two questions (8 and 10) assessed students' awareness about antibiotic resistance. The link for the questions was distributed to all participants through “WhatsApp” social media and e-mails. Responses were collected from Google Sheets and the results were analyzed using SPSS version 22 (SPSS Inc., Chicago IL, USA).
Table 1: Percentage of response obtained for questionnaire from participants

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  Results Top

The number of students participating in the study from different years of the MD program is given in [Table 2]. Overall knowledge of students with regard to the questionnaire is shown in [Table 1]. [Table 3] shows a comparison of knowledge of different batches regarding antibiotic resistance. Majority of students of all batches were aware that antibiotics are used against bacterial infections. However, students of clinical phase had a definite understanding on the ineffectiveness of antibiotics for treating viral infections such as common cold or flu than students of preclinical phase (Q2, P = 0.001, and Q3, P = 0.002). Students were aware of the fact that antibiotics become ineffective after repeated usage of the same antibiotics (Q4, P = 0.008). Regarding taking antibiotics over the counter without prescription, clinical year students had more awareness than preclinical year students (Q5, P = 0.008). Majority of the students of all batches, except year 1, were aware and heard about antibiotic resistance (Q8, P = 0.001). Students of all years responded differently for question number 9 which says newer antibiotics are more effective in treating infection (P = 0.022). Majority of the students were unaware of the WHO Antibiotic Awareness Week (P = 0.036).
Table 2: Number of students participated from different years of Doctor of Medicine program

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Table 3: Response rate from different batches

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  Discussion Top

This study aimed at assessing the knowledge of antibiotics among medical students of all years. Our findings showed that medical students in the clinical phase had a greater knowledge of antibiotic usage and antibiotic awareness compared to the preclinical phase. Majority of the students were aware that antibiotics are used for bacterial infection and not for viral infection, except 32.7% of preclinical phase students. A similar result was observed for taking antibiotic over the counter without a prescription. The knowledge of antibiotic resistance of preclinical phase students is less compared to clinical phase students. Even though this topic is taught in the preclinical phase, utilization of the antibiotics through prescription starts in the clinical phase. This could be the reason for better knowledge of antibiotics in clinical phase students.

Majority of clinical phase students have shown outstanding knowledge on antibiotic usage and awareness on antibiotic resistance, which explains that theoretical knowledge acquired during lectures has been emphasized during ward rounds and while treating the patients. Clinical phase students are allowed to check the patient prescription and possible discussion by teaching clinicians regarding antibiotics and development of their resistance which emphasizes on practical usage of antibiotics. In a study conducted by Khan et al., it was highlighted that 38% of the participants agreed for the usage of antibiotics for viral infections and 60% agreed that antibiotic should be taken for recovery from the common cold.[6] However, in our study, the students were aware of the usage of antibiotics except for year 1 preclinical phase students. Our study finding was consistent with the study done by Bharath et al., in which 75% of the participants completed the course of antibiotics and 92% obtained antibiotics from the doctor.[8] In our study, 87.6% of the participants were aware of completing the course of antibiotics and 77.6% were aware of taking medications with a prescription. In a similar study conducted by Scaioli et al., 94.8% of the students were aware that it was mandatory to finish the full course of antibiotics even if the symptoms are improving and 16% of them would buy antibiotics without medical prescription, and 36.6% of them started taking antibiotics after a simple phone call with the doctor, without a proper medical examination.[9] Previous study by Azevedo et al. showed >55% of the university students believed that antibiotics need to be prescribed for a simple viral illness; however, in our study, 46% believed the same.[10] In the study conducted by Khan et al., it was shown that >85% of the respondents were aware of the consequences of antibiotic resistance such as ineffective treatment, prolongation of illness, emergence of bacterial resistance, and additional burden of medical cost to the patient.[6] However, we did not include details of the consequences of antibiotic resistance in our questionnaire. In the present study, we could identify that the awareness of preclinical phase students about antibiotics is lesser compared to clinical phase students. Outcome-based education (OBE) is said to be an important tool in which the requirements are explicitly defined in detail, to ensure that the medical graduates are fit for practice. This form of education can be utilized for educating the students about antibiotics, so that they are fit to prescribe antibiotics, maximize its effectiveness and minimize the development of resistance.[11] It may be worth to introduce OBE in antibiotic usage to undergraduate medical students in the preclinical phase itself. Medical students are the future prescribers of antibiotics. The initiative for rational prescribing of antibiotics must start from the root level. It is important to analyze their knowledge at this level[12] so that future educational and training interventions can be taken up effectively according to the need. The students should be made aware of these important facts and a sense of responsibility should be nurtured that as prescribers, they are not only responsible for the benefit and the welfare of their patients but also for the society at large. Apart from teaching about antibiotic prescribing, the principles of the protocol development for antibiotic use in healthcare facilities should form an integral part of the undergraduate teaching.[13] Small group exercises that facilitate the students in practicing patient education skills, such as negotiating with patients about the need for antibiotics and educating them about the proper use of antibiotics, should form an important part of the student's antibiotic curriculum.[14] The medical education strategies should aim not only increase the knowledge but also change the behavior and improve the patient outcomes.[12] They have to be tailored as per the youngsters' development, capabilities, and experience.[10] Antibiotic resistance has been widely discussed and publicized in the press, in the media, and on the online discussion forums, and the general public are becoming knowledgeable about the issue of resistance. Since the media and the internet have become important sources of information, especially among the youth,[15] they have become the medium of gaining knowledge and awareness regarding various public issues.

  Conclusion Top

A comprehensive understanding of antibiotic resistance and also the knowledge of the use and misuse of the same are absolutely inevitable for undergraduate medical students. The medical curriculum should lay stress on the cautious usage of antibiotics in the preclinical phase where students are yet to get exposure to patients and the prescriptions by physicians. Our study provides an important insight into the knowledge and attitudes of undergraduate medical students on antibiotics, and it can be considered to draft an effective undergraduate curriculum. Since the present study involved only undergraduate medical students, further research can be undertaken to assess and compare the knowledge of house officers, postgraduate medical students, medical officers, and general practitioners on antibiotics.


We acknowledge the undergraduate students, Lincoln University, Malaysia, for their participation in this study.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

McCartney M. Margaret McCartney: Blaming doctors won't reduce antibiotic overuse. Br Med J 2015;351:4697.  Back to cited text no. 1
Davies J, Davies D. Origins and evolution of antibiotic resistance. Microbiol Mol Biol Rev 2010;74:417-33.  Back to cited text no. 2
Ortiz-Martínez Y, Galindo-Regino C, Valdes-Villegas F, Mendoza-Borja K, González-Hurtado MR, Chávez-Verbel V, et al. World antibiotic awareness week 2017 and its influence on digital information seeking on antibiotic resistance: A Google trends study. J Hosp Infect 2018;100:276-7.  Back to cited text no. 3
Om C, Daily F, Vlieghe E, McLaughlin JC, McLaws ML. “If it's a broad spectrum, it can shoot better”: Inappropriate antibiotic prescribing in Cambodia. Antimicrob Resist Infect Control 2016;5:58.  Back to cited text no. 4
Jamshed SQ, Elkalmi R, Rajiah K, Al-Shami AK, Shamsudin SH, Siddiqui MJ, et al. Understanding of antibiotic use and resistance among final-year pharmacy and medical students: A pilot study. J Infect Dev Ctries 2014;8:780-5.  Back to cited text no. 5
Khan AK, Banu G, Reshma K. Antibiotic resistance and usage – A survey on the knowledge, attitude, perceptions and practices among the medical students of a Southern Indian teaching hospital. J Clin Diagn Res 2013;7:1613-6.  Back to cited text no. 6
Huang Y, Gu J, Zhang M, Ren Z, Yang W, Chen Y, et al. Knowledge, attitude and practice of antibiotics: A questionnaire study among 2500 Chinese students. BMC Med Educ 2013;13:163.  Back to cited text no. 7
Bharath Kumar VD, Monika N, Kalpana L, Veena RM, Sathish Chandra MR. Assessment of awareness about antibiotic resistance among first-year medical undergraduates in a medical college. Int J Clin Pharmacol Res 2015;5:239-42.  Back to cited text no. 8
Scaioli G, Gualano MR, Gili R, Masucci S, Bert F, Siliquini R. Antibiotic use: A cross-sectional survey assessing the knowledge, attitudes and practices amongst students of a school of medicine in Italy. PLoS One 2015;10:e0122476.  Back to cited text no. 9
Azevedo MM, Pinheiro C, Yaphe J, Baltazar F. Portuguese students' knowledge of antibiotics: A cross-sectional study of secondary school and university students in Braga. BMC Public Health 2009;9:359.  Back to cited text no. 10
Davenport LA, Davey PG, Ker JS. BSAC Undergraduate Education Working Party. An outcome-based approach for teaching prudent antimicrobial prescribing to undergraduate medical students: Report of a working party of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother 2005;56:196-203.  Back to cited text no. 11
Davey P, Garner S; Professional Education Subgroup of SACAR. Professional education on antimicrobial prescribing: A report from the specialist advisory committee on antimicrobial resistance (SACAR) professional education subgroup. J Antimicrob Chemother 2007;60 Suppl 1:i27-32.  Back to cited text no. 12
Nathwani D, Davey P. Antibiotic prescribing-are their lessons for physicians? J Med 1999;92:287-92.  Back to cited text no. 13
Steiner E, Saddler LC, Fagnan LJ. Promoting appropriate antibiotic use: Teaching doctors, teaching patients. Calif J Health Promot 2004;2:22-30.  Back to cited text no. 14
Zafar SN, Syed R, Waqar S, Zubairi AJ, Vaqar T, Shaikh M, et al. Self-medication amongst university students of Karachi: Prevalence, knowledge and attitudes. J Pak Med Assoc 2008;58:214-7.  Back to cited text no. 15


  [Table 1], [Table 2], [Table 3]

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