Sciresol Sciresol https://www.jcbsonline.ac.in/ Journal of Clinical and Biomedical Sciences 2319-2453 10.58739/jcbs/v14i4.131 RESEARCH ARTICLE Assessment o f Knowledge, Attitude a nd Practice Towards Antibiotics a mong Medical a nd Dental Students in Indian University: A Cross-Sectional Study KAP survey of antibiotics among university students Kaushik Tarun 1 Setya Sonal sonalsetya@gmail.com 2 Gurugram Global College of Pharmacy Farukhnagar, Gurugram, Haryana, 122506 India Department of Pharmacy Practice, College of Pharmacy, SGT University Gurugram , Haryana, 122505 India 14 4 148 2024 <bold id="s-ac8f37ae802c">Abstract</bold>

Background: Inappropriate use of antibiotics contributes to global antimicrobial resistance. Evaluating knowledge, attitudes, and practices (KAP) among university students who are future prescribers can improve antibiotic use. Objectives: This study assesses the KAP of antibiotics among medical and dental students in India, aiming to identify educational gaps to better combat antimicrobial resistance. Materials and Methods: A cross-sectional questionnaire-based study was conducted among 400 medical and dental university students, following the approval from Institutional Ethics Committee. Students willing to participate were included. Pilot study on 30 students ensured questionnaire's reliability (Cronbach's alpha: 0.82). Data were analyzed using SPSS with Pearson’s chi-square test for KAP factor relationships and Mann Whitney U test for comparing KAP between students. A p-value of less than 0.05 was considered statistically significant. Results: 232 (58%) medical and 168 (42%) dental students participated. 80.49% medical students demonstrated significantly higher knowledge [median, Interquartile range 16(15,18)] than 73.9% dental students [median, Interquartile range 15(13,17)] (p:0.001, z:4.96). 82.29% medical and 80.72% dental students responded correctly to the attitude section, indicating strong awareness about responsible antibiotic use. Practice dimension showed correct responses from 72.34% (medical) and (72.12%) dental students, emphasizing the need to better apply knowledge and attitudes in practice. Overall, 77.2% of participants exhibited adequate knowledge, 81.5% displayed positive attitude and 72.23% engaged in good practices. Conclusions: These findings suggest revising curricula and implementing targeted programs, particularly for dental students, to enhance antibiotic knowledge. Practical, behavior-focused education, antimicrobial stewardship, and targeted interventions are essential for future prescribers. Further research with larger populations is needed to generalize these practices across healthcare.

 Keywords Antibiotics Anti­Microbial resistance KAP Dentistry Medicine Prescribers None <bold id="s-aae67d1f0bcc">1 Introduction</bold>

Antibiotics are indispensable in the fight against infections, but their widespread misuse and inappropriate prescribing create major challenges. This has resulted in development of resistance towards antibiotics leading to treatment failure, increases in length of hospital stay, higher healthcare costs, morbidity, and mortality. 1, 2, 3, 4 Antibiotic resistance is a growing concern in India and has become a significant public health issue. The misuse of antibiotics and weak infection control practices have given rise to drug-resistant bacteria. Common bacteria like Escherichia coli, Staphylococcus aureus, and Klebsiella pneumoniae are increasingly resistant to multiple antibiotics, making infections harder to treat and increasing the risk of treatment failure. The extensive use of antibiotics for diseases like tuberculosis, acute febrile illness and diarrheal illnesses only makes the problem worse. 5

Medical and dental students play a key role in addressing this issue. They are future healthcare professionals who need a solid grasp of antibiotic use and resistance. Students also learn about infection control measures, such as proper hand hygiene, to prevent the spread of resistant bacteria within the healthcare settings. While the medical students learn the basics of antibiotics such as proper dosing and treatment duration and indications, there are gaps in their understanding. Many students lack in-depth knowledge about the mechanisms of resistance and the consequences of misuse, highlighting a need for better educational programs. Improvements in educational content, better supervision, and the use of technology to assist with decision-making are all important steps in bridging this gap. In the field of dentistry, antibiotics are frequently used, especially for managing infections related to root canals. However, research indicates that many of these infections can be treated effectively with local interventions, such as drainage and root canal therapy, without resorting to antibiotics. 6 Guidelines also recommend avoiding antibiotics for non-spreading dental infections in otherwise healthy individuals. 7 Despite this, past studies show that dental students and professionals often lack sufficient knowledge about appropriate antibiotic use. 8, 9, 10

Addressing antibiotic misuse requires a multifaceted approach. Strategies include updating antibiotic formularies, enhancing education, implementing feedback systems, and promoting rational use of antibiotics. Research into the knowledge, attitudes, and practices (KAP) of medical and dental students is crucial. Conducting a comprehensive evaluation of knowledge, attitudes, and practices (KAP) among a representative sample of university students can serve as an effective tool to enhance the appropriate utilization of antibiotics. KAP studies are easy to carry out, measurable, and understandable. Previous studies conducted in India and other countries have pointed out significant gaps in their understanding and practice, emphasizing the need for improved training and education. 11, 12, 13 However, limited KAP studies have been carried in Northern India on university students towards antibiotics. 14 This study was therefore aimed to assess the knowledge, attitude, and practice towards antibiotics among medical and dental university students in Northern India. By identifying and addressing these shortcomings among prospective prescribers, the research hopes to enhance antibiotic stewardship and support global efforts to combat resistance.

<bold id="s-38f861a883cc">2 Material & Methods</bold>

Study Design: Cross-sectional and observational study.

Study Setting: Medical and dental college of SGT University in Northern India.

Sample Size: Sample size was calculated using G power software (version 3.1.9.7). Based on calculated effect size 0.18, 5% level of precision, 95% confidence level and 80% power of study, the sample size was found to be 396, which was rounded off as 400.

Study Duration: 4 months.

Ethical Considerations: Ethical clearance was obtained from the Institutional Ethics Committee (IEC), registered by CDSCO, MOHFW and DHR, ICMR according to ICMR/GCP guidelines (IECSGTCHRI/SGTCOLLEGEOFPHARMACY/2023/03). Informed consent (included in the questionnaire) was taken from the participants prior to study.

Inclusion Criteria: Final year students, interns, and post graduate students from dental and medical department of the university who were willing to participate and consented for the study were included.

Exclusion Criteria: Students from dental and medical department in their first, second and third year were excluded from the study. Students who refused to participate were also excluded.

Data Collection: Data was collected using a questionnaire adapted from previously published studies to meet our research objectives. 15, 16 To ensure the questionnaire's reliability and validity, a pilot study involving 30 students was conducted. The reliability of the questionnaire was assessed using the alpha-Cronbach's coefficient, yielding a value of 0.82. The questionnaire was divided into four sections. The first section included 4 questions aimed at gathering demographic information about the participants. The second section contained 20 questions to assess the participants' knowledge of antibiotics, with 12 questions presented in a Yes/No format. The third section consisted of 16 questions focusing on the participants' attitudes toward antibiotics, with 4 Yes/No questions. The final section had 7 questions related to the participants' practices concerning antibiotic use. An electronic version of the questionnaire was emailed to approximately 500 students. To minimize information and selection bias, instructors encouraged students to complete it during class. A total of 400 students responded, resulting in a response rate of 80%.

Data Analysis: The responses to questions were coded with numeric value. For each correct answer of sections related to KAP questionnaire, “1” score was given and for each incorrect answer, “0” score was given. “1” score was given to the positive responses: “I’ve heard the term and I can explain what it is”, “I’ve used the term before”, and “I use the term in everyday practice” and a score of “0” was assigned for negative responses: “I’ve never heard of it” and “I’ve heard the term but I’m not sure what it is”. 5-point Likert scale was used for options ranging from strongly disagree “1” to strongly agree “5”. Each participant’s total score was calculated by summing the values of their responses. Scores >80% indicated an adequate/good/positive response, scores between 60% and 80% indicated a sufficient/fair/positive response, and scores below 60% indicated an inadequate/poor/negative response for each domain. 15, 17

Statistical Analysis: Data was analyzed using SPSS version 28 IBM CORP software. Continuous variables were presented with mean + SD. Categorical variables were expressed as frequencies and percentages. Pearson’s chi-square test or Fisher’s exact test was used to determine the relationship between factors related to KAP as predictors. Mann Whitney U test was applied for comparison of KAP between medical and dental students where p < 0.05 was considered statistically significant.

<bold id="s-f7be1797923f">3 Results</bold>

400 students participated in the study, including 232(58%) students from medicine and 168(42%) from dentistry. Out of 232 medicine participants, 230 (99.2%) were MBBS students and 2 (0.8%) were MD students. Out of 168 dentistry participants, 147 (87.5%) were BDS students and 21 (12.5%) were MDS students.

Table 1 shows the socio-demographic characteristics of students of medicine and dentistry. There was a significant difference of gender and place of living between the participants of medicine and dentistry.

<bold id="strong-9acfea5be8a04240a167910631f36d2b"/> <bold id="strong-de23f49e20394d5faa6d2e72b400707b"/> <bold id="strong-e2feff25d09b47b2a14fe57e1c258eed">Socio-demographic characteristics of students of Medicine and Dentistry</bold>

Sociodemographic characteristics of participants

Medicine

Dentistry

X2 value

P value

Total

n* (%)

n* (%)

n* (%)

Gender

Male

122 (53)

43 (25)

29.29

0.0001

165 (42)

Female

110 (47)

125 (65)

235 (58)

Place of living

With parents

95 (40.9)

88 (52.3)

13.79

0.008

183 (45.8)

In University Hostel

79 (34.05)

37(22.02)

116 (29)

In Rented Apartment

16 (6.8)

22 (13.09)

38 (9.5)

In a paying guest accommodation

25 (10.77)

11 (6.5)

36 (9)

In own Apartment

17 (7.32)

10 (5.9)

27 (6.7)

If family member is a health care worker?

Yes

127 (55)

102 (61)

1.42

0.233

229 (57)

No

105 (45)

66 (39.2)

171 (43)

*n represents number of participants, Pearson X2 test applied, p < 0.05 considered statistically significant.

Table 2 shows the responses in percent (%) obtained from the participants of medicine and dentistry to the knowledge component of the questionnaire. Out of 400 participants, 309 (77.2%) participants showed adequate knowledge while 91 (22.8%) had inadequate knowledge. Mann Whitney U test indicated that correct responses were significantly higher in 322 (80.5%) participants of medicine indicating adequate knowledge of students of medicine with median 16 (interquartile range 15, 18) than 296 (74%) participants of dentistry, indicating sufficient knowledge of students of dentistry, with median 15 (interquartile range 13, 17), (p<0.05, z - value 4.96). Our results were comparable to a previous study, where out of 400 respondents, 250 (62.5%) showed adequate knowledge, while 150 (37.5%) had inadequate knowledge. 16

Further, we tried to find out the association between genders with responses to the knowledge dimension of the questionnaire. It was found that out of the total female participants of dentistry, 1 (0.59%) had poor knowledge, 40 (23.8%) had inadequate knowledge and 84 (50%) had adequate knowledge, whereas for male participants of dentistry, 1 (0.59%) had poor knowledge, 12 (7.14%) had inadequate knowledge and 30 (17.85%) had adequate knowledge. Out of the total female participants of medicine, 1 (0.43%) had poor knowledge, 12 (5.17%) had inadequate knowledge and 97 (41.81%) had adequate knowledge, whereas for male participants of medicine, 2 (0.86%) had poor knowledge, 17 (7.32%) had inadequate knowledge and 103 (44.39%) had adequate knowledge. Chi square test revealed no association between gender and knowledge dimension of the questionnaire for both dental and medical respondents (p value of 0.66 and 0.68 respectively).

Table 3 shows the responses in percent (%) obtained from the participants of medicine and dentistry to the attitude component of the questionnaire.The percentage of correct answers to 16 questions were 329 (82.25%) and 323 (80.75%) by the participants of medicine and dentistry respectively. The median value for both the participants of medicine and dentistry was found to be 11 (interquartile range 10, 12) indicating positive attitude towards antibiotics. Using the Mann Whitney U test, it was found that there was no significant difference between the attitude of participants of medicine and dentistry (p = 0.223, z value 1.22). Our result showed that out of 400 participants, 326 (81.5%) participants showed positive attitude, while 78 (19.5%) showed negative attitude.

Table 4 shows the response obtained from participants of medicine and dentistry in the practice dimension towards antibiotics. Results indicated correct responses by 168 (72.41%) participants of medicine and 121 (72.12%) participants of dentistry to 7 questions. The median value of practice towards antibiotics for participants of medicine was 5 (interquartile range 3, 5) and for participants of dentistry was also 5 (interquartile range 4, 5). Mann Whitney U test showed no statistical difference between the practices of participants of medicine and dentistry (p = 0.844, z - value 0.2). Overall, from 400 respondents, 289 (72.23% participants) showed good practices, while 111 (27.77%) showed poor practices. The results of our study contrasted with a previous study. 15

<bold id="s-c56c126aee67">4 Discussion</bold>

A comprehensive KAP evaluation among future prescribers can enhance rational antibiotic use. The significant difference in knowledge between medical and dental students underscores the need for improved awareness and curriculum updates, especially in Dental sciences. Many participants from both the disciplines mistakenly believed antibiotics could treat viral infections and common ailments like the common cold reflecting a gap in understanding that contributes to antimicrobial resistance. Students across MBBS, BDS, and MDS programs must be aware of these fundamentals as they will address a range of conditions in clinical practice. There was clearly difference in the familiarity between the students of medicine and dentistry about the essential terms related to antibiotics such as antimicrobial resistance, superbugs, daily defined dose, etc. which necessitates the incorporation of additional training on antibiotics to future prescribers in their respective curriculum. Most of the dental students were unaware of anti-microbial stewardship. Antimicrobial stewardship is a key concept that should be emphasized in the education of future prescribers.

<bold id="strong-108b47f726f9412ea71f6cb96ba66b8c">Knowledge of students of Medicine and Dentistry towards antibiotics</bold>

S.no

Questions asked to participants with their responses

Medicine

Dentistry

X2 value

P value

Total

n* (%)

n* (%)

n* (%)

1

Can Antibiotics cure bacterial infections?

Yes

232 (100)

166 (99)

2.78

0.095

398 (99.5)

2

Can Antibiotics cure viral infections?

No

158 (68)

114 (68)

 -

 -

272 (68)

3

Antimicrobial Resistance means when bacteria overcome antibiotics?

Yes

219 (94.4)

159 (95)

0.01

0.92

378 (94.5)

4

Common cold symptoms need antibiotic treatment?

No

193 (83.1)

107 (64)

19.76

0.001

300 (75)

5

Antibiotics decrease fever?

No

196 (84.4)

147 (87.5)

0.73

0.393

343 (85.8))

6

Antibiotics decrease pain?

No

225 (97)

154 (92)

5.54

0.0189

379 (94.8)

7

Antibiotics overcome malaise and fatigue?

No

195 (84)

148 (88)

1.3

0.254

343 (85.8)

8

Combination of antibiotics prevent antimicrobial resistance?

Yes

192 (82.7)

161 (96)

16.06

0.001

353 (88.2)

9

Antibiotic resistance is due to insufficient knowledge about their use

Yes

218 (94)

152 (90)

1.71

0.191

370 (92.5)

10

Antibiotic resistance result from their inappropriate use outside the prescriber’s prescription?

Yes

219 (94.4)

160 (95)

0.14

0.708

379 (94.8)

11

Skipping doses of antibiotics contribute to antibiotic resistance?

Yes

161 (69.4)

119 (71)

0.1

0.752

280 (70)

12

Newer and costly antibiotics have better efficacy?

No

131 (56.5)

150 (90)

50.22

0.0001

281 (70.3)

13

Are you familiar with the term Antibiotic resistance?

I’ve never heard of it

5 (2)

29 (17.2)

38.36

0.001

34 (8.5)

I’ve heard the term but I’m not sure what it is

23 (10)

30 (17.8)

53 (13.2)

I’ve heard the term and I can explain what it is

182 (78)

93 (55.3)

275 (68.8)

I’ve used the term before

22 (9.5)

16 (9.5)

38 (9.5)

14

Are you familiar with the term Superbugs?

I’ve never heard of it

23 (10)

38 (22.6)

32.21

0.001

61 (15.25)

I’ve heard the term but I’m not sure what it is

72 (31)

73 (43.4)

145 (36.25)

I’ve heard the term and I can explain what it is

111 (48)

54 (32.1)

165 (41.25)

I’ve used the term before

26 (11)

3 (1.7)

29 (7.25)

15

Are you familiar with the term Bacterial resistance against antibiotics?

I’ve never heard of it

3 (1.3)

7 (4.1)

9.89

0.0195

10 (2.5)

I’ve heard the term but I’m not sure what it is

18 (7.8)

26 (15.4)

44 (11)

I’ve heard the term and I can explain what it is

193 (83.1)

125 (74.4)

318 (79.5)

I’ve used the term before

18 (7.5)

10 (5.9)

28 (7)

16

Are you familiar with the term Drug resistance?

I’ve never heard of it

5 (2)

12 (7.1)

14.31

0.002

17 (4.25)

I’ve heard the term but I’m not sure what it is

22 (10)

24 (14.2)

46 (11.5)

I’ve heard the term and I can explain what it is

161 (69)

117 (69.6)

278 (69.5)

I’ve used the term before

44 (19)

15 (8.9)

59 (14.75)

17

Are you familiar with the term Antibiotics Stewardship Program (ASP)?

I’ve never heard of it

34 (15)

86 (51.1)

70.55

0.0001

120 (30)

I’ve heard the term but I’m not sure what it is

69 (30)

40 (23.8)

109 (27.25)

I’ve heard the term and I can explain what it is

83 (36)

35 (20.8)

118 (29.5)

I’ve used the term before

44 (19)

6 (3.5)

50 (12.5)

I am engaged in everyday practice

2 (1)

1 (0.5)

3 (0.75)

18

Are you familiar with the term Defined Daily Dose (DDD)?

I’ve never heard of it

4 (1.8)

17 (10.1)

32.71

0.0001

21 (5.25)

I’ve heard the term but I’m not sure what it is

31 (13.3)

43 (25.5)

74 (18.5)

I’ve heard the term and I can explain what it is

156 (67.2)

98 (58.3)

254 (63.5)

I’ve used the term before

34 (14.6)

8 (4.7)

42 (10.5)

I am engaged in everyday practice

7 (3)

2 (1.1)

9 (2.25)

19

Are you familiar with the term Days of Therapy (DOT)?

I’ve never heard of it

4 (1.7)

16 (9.5)

45.66

0.0001

20 (5)

I’ve heard the term but I’m not sure what it is

24 (10.3)

48 (28.5)

72 (18)

I’ve heard the term and I can explain what it is

157 (67.6)

90 (53.5)

247 (61.75)

I’ve used the term before

42 (18.1)

9 (5.3)

51 (12.75)

I am engaged in everyday practice

5 (2.1)

5 (2.9)

10 (2.5)

20

Are you familiar with the term Antibiogram?

I’ve never heard of it

25 (10.7)

30 (17.8)

19.86

0.001

55 (13.75)

I’ve heard the term but I’m not sure what it is

78 (33.6)

69 (41)

147 (36.75)

I’ve heard the term and I can explain what it is

88 (37.9)

62 (36.9)

150 (37.5)

I’ve used the term before

35 (15)

6 (3.5)

41 (10.25)

I am engaged in everyday practice

6 (2.5)

1 (0.5)

7 (1.75)

*n represents number of participants, Pearson X2 test applied, p < 0.05 considered statistically significant. Only correct response indicated for Yes / No questions.

<bold id="strong-af3a33f247a54f4a93bbf598b4bde6f2">Attitude of students of Medicine and Dentistry towards antibiotics</bold>

S.no

Questions asked to participants with their responses

Medicine

Dentistry

X2

P

Total

n* (%)

n* (%)

n* (%)

1

Today, is antibiotic resistance an important and serious global public health issue?

Yes

227 (97.8)

162 (96.4)

0.73

0.393

389(95%)

2

Antimicrobial Resistance is a serious public health issue in India.

Strongly disagree

7 (3)

4 (2.3)

4.63

0.327

11(2.7%)

Disagree

6 (2.6)

5 (2.9)

11(2.7%)

Neither agree or not disagree

18 (7.7)

17 (10.1)

35(8.7%)

Agree

112 (48.2)

64 (38)

176(44%)

Strongly agree

89 (38.4)

78 (46.4)

167(41.7%)

3

What are the perceived causes of antibiotic resistance in India?

Overuse in hospitals

29 (12.5)

24 (14.2)

49.04

0.001

53(13.2%)

Overuse in community

143 (61.6)

51 (30.3)

194(48.5%)

Overuse in animals

1 (0.4)

0 (0)

1(0.2%)

Incorrect dosing/duration

51 (21.9)

85 (50.5)

136(34%)

Improper regulations

4 (1.7)

3 (1.7)

7(1.7%)

Improper hospital infection control

1 (0.4)

3 (1.7)

4(1%)

Inadequate diagnostic support

2 (0.8)

0 (0)

2(0.5%)

Inadequate immunization

0 (0)

1 (0.5)

1(0.2%)

Poor quality of antimicrobials

1 (0.4)

1 (0.5)

2(0.5%)

4

Do you think that the more antibiotic we use in society, the higher is the risk that resistance develops and spreads?

Yes

221 (95.2)

159 (94.6)

0.08

0.777

380(95%)

5

Should pharmaceutical companies, in your opinion, develop new antibiotics?

Yes

226 (97.4)

161 (95.8)

0.77

0.38

387(96.7%)

6

What do you think about the extent of antimicrobial resistance in your facility (Hospital)?

Minor Problem

130 (56)

85 (50.5)

1.16

0.281

215(53.7%)

Major Problem

102 (43.9)

83 (49.4)

185(46.2%)

7

Antibiotics are over used in your facility (hospital)

Strongly disagree

6 (2.5)

3 (1.7)

14.53

0.006

9(2.2%)

Disagree

27 (11.6)

8 (4.7)

35(8.7%)

Neither agree or not disagree

84 (36.2)

90 (53.5)

174(43.5%)

Agree

107 (46.1)

61 (36.3)

168(42%)

Strongly agree

8 (3.4)

6 (3.5)

14(3.5%)

8

Cost of an antibiotic must be considered before prescription.

Strongly disagree

9 (3.8)

5 (2.9)

10.6

0.031

14(3.5%)

Disagree

23 (9.9)

11 (6.5)

34(8.5%)

Neither agree or not disagree

59 (25.4)

30 (17.8)

89(22.2%)

Agree

122 (52.5)

115 (68.4)

237(59.2%)

Strongly agree

19 (8.1)

7 (4.1)

26(6.5%)

9

By limiting use of antibiotics, good patient care would be impaired.

Strongly disagree

6 (2.5)

0 (0)

68.89

0.001

6(1.5%)

Disagree

18 (7.7)

18 (10.7)

36(9%)

Neither agree or not disagree

56 (24.1)

103 (61.3)

159(39.7%)

Agree

132 (56.8)

36 (21.4)

168(42%)

Strongly agree

20 (8.6)

11 (6.5)

31(7.7%)

10

There is a need to establish education programs on rational use of antibiotics in

my Facility (hospital).

Strongly disagree

2 (0.8)

2 (1.1)

2.55

0.636

4(1%)

Disagree

14 (6)

5 (2.9)

19(4.7%)

Neither agree or not disagree

27 (11.6)

17 (10.1)

44(11%)

Agree

163 (70.2)

126 (75)

289(72.2%)

Strongly agree

26 (1.2)

18 (10.7)

44(11%)

11

There is a need to establish an antibiotics policy in your facility (hospital) to achieve rational antibiotic usage.

Strongly disagree

4 (1.7)

1 (0.5)

6.41

0.171

5(1.2%)

Disagree

8 (3.4)

3 (1.7)

11(2.7%)

Neither agree or not disagree

14 (6)

18 (10.7)

32(8%)

Agree

187 (80.6)

126 (75)

313(78.2%)

Strongly agree

19 (8.1)

20 (11.9)

39(9.7%)

12

Which method do you prefer the most to provide education on antibiotic use for health care professionals?

Official Curriculum in undergraduate school (Medical/Dental College etc)

34 (14.6)

18 (10.7)

19.92

0.001

52(13%)

Internal training programs offered by the facility

58 (25)

30 (17.8)

88(22%)

CME programs offered by national professional organizations

68 (29.3)

86 (51.1)

154(38.5%)

Educational workshops offered by international professional organizations

65 (28)

30 (17.8)

95(23.7%)

E-learning programs Web-based infectious disease case consultations

7 (3)

4 (2.3)

11(2.7%)

13

Antimicrobial Resistance (AMR) should be addressed as a multi-sectoral issue that requires the collaboration of diverse partners.

Legislative body

40 (17.2)

7 (4.1)

75.72

0.001

47(11.7%)

Policy Makers

91 (39.2)

19 (11.3)

110(27.5%)

Pharmaceutical society

15 (6.4)

38 (22.6)

53(13.2%)

Pharmaceutical Companies

72 (31)

89 (52.9)

161(40.2%)

Internal Medicine Association

8 (3.4)

8 (4.7)

16(4%)

Society of Infectious Diseases

4 (1.7)

2 (1.1)

6(1.5%)

Others

2 (0.8)

5 (2.9)

7(1.7%)

14

The development of local/national antibiotic use guidelines is perceived to be more useful than using international ones

Strongly disagree

4 (1.7)

0 (0)

15.73

0.003

4(1%)

Disagree

8 (3.4)

6 (3.5)

14(3.5%)

Neither agree or not disagree

72 (31)

28 (16.6)

100(25%)

Agree

138 (59.4)

120 (71.4)

258(64.5%)

Strongly agree

10 (4.3)

14 (8.3)

24(6%)

15

Antibiotic guidelines and antibiotic stewardship are of help in clinical care.

Strongly disagree

3 (1.2)

1 (0.5)

5.33

0.255

4(1%)

Disagree

1 (0.4)

3 (1.7)

4(1%)

Neither agree or not disagree

16 (6.8)

19 (11.3)

35(8.7%)

Agree

186 (80.1)

123 (73.2)

309(77.2%)

Strongly agree

26 (11.2)

22 (13)

48(12%)

16

There is need to establish to establish course “Rational use of antibiotics” at the university level.

Yes

230 (99.1)

160 (95.2)

6.08

0.013

390(97.2%)

No

2 (0.9)

8 (4.7)

10(2.5%)

*n represents number of participants, Pearson X2 test applied, p < 0.05 considered statistically significant. Only correct response indicated for Yes / No questions.

<bold id="strong-d9f6719267c240b48d87572eb5796008">Practice of students of Medicine and Dentistry towards antibiotics</bold>

S. No

Questions asked to participants with their responses

Mn (%)

Dn (%)

X2 value

P value

Total n (%)

1

Your prescription of antibiotics is influenced by the patients’ demand for antibiotics.

Strongly disagree

84 (36.2)

39 (23.2)

13.43

0.009

123(30.7)

Disagree

83 (35.7)

90 (53.5)

53(43.2)

Neither agree or not disagree

19 (8.1)

12 (7.1)

7(7.7)

Agree

40 (17.2)

24 (14.2)

14(16)

Strongly agree

6 (2.5)

3 (1.7)

1(2.2)

2

Your prescription of antibiotics is influenced by the availability of the antibiotics than by the cause of diseases.

Strongly disagree

28 (12)

19 (11.3)

5.74

0.219

211(11.7)

Disagree

112 (48.2)

77 (45.8)

45(47.2)

Neither agree or not disagree

45 (19.3)

46 (27.3)

27(22.7)

Agree

38 (16.3)

24 (14.2)

14(15.5)

Strongly agree

9 (3.8)

2 (1.1)

1(2.7)

3

Bacterial confirmation and sensitivity report must be provided before antibiotic prescription.

Strongly disagree

1 (0.43)

1 (0.5)

3.6

0.463

30(0.5)

Disagree

7 (3)

4 (2.3)

2(2.7)

Neither agree or not disagree

27 (11.6)

13 (7.7)

7(10)

Agree

165 (71.1)

133 (79.1)

79(74.5)

Strongly agree

32 (13.7)

17 (10.1)

10(12.2)

4

If patients’ medical conditions allow, IV antibiotics will be changed to oral form within 2-3 days.

Strongly disagree

2 (0.8)

1 (0.5)

4

0.406

40(0.7)

Disagree

8 (3.4)

1 (0.5)

0(2.2)

Neither agree or not disagree

29 (12.5)

20 (11.9)

11(12.2)

Agree

166 (71.5)

128 (76.1)

76(73.5)

Strongly agree

27 (11.6)

18 (10.7)

10(11.2)

5

How frequently do you require help in selecting antibiotics?

Never

9 (3.8)

8 (4.7)

16.29

0.001

54(4.2)

Sometimes

129 (55.6)

63 (37.5)

37(48)

Most of the time

73 (31.4)

85 (50.5)

50(39.5)

Always

21 (9)

12 (7.1)

7(8.2)

6

Which sources of information do you turn to while selecting antibiotics?

Internet-based sources

8 (3.4)

6 (3.5)

59.5

0.001

63(3.5)

National/international antimicrobial guidelines

89 (38.3)

24 (14.2)

14(28.2)

Drug formulary / journal / textbook

59 (25.4)

102 (60.7)

60(40.2)

Local hospital guidelines

21 (9)

7 (4.1)

4(7)

Peers/senior colleagues

44 (18.9)

17 (10.1)

10(15.2)

ID specialists / microbiologists / clinical pharmacologists

7 (3)

7 (4.1)

4(3.5)

Others

4 (1.7)

5 (2.9)

2(2.2)

7

How frequently does a senior colleague recommend an antibiotic different from your choice?

Not sure

51 (21.9)

17 (10.1)

13.62

0.003

710(17)

Never

9 (3.8)

16 (9.5)

9(6.2)

Sometimes

135 (58.1)

104 (61.9)

61(59.7)

Almost always

37 (15.9)

31 (18.4)

18(17)

*n represents number of participants, Pearson X2 test applied, p < 0.05 considered statistically significant.

Antimicrobial stewardship programs have gained traction in India, but there is a continued need for structured training through conferences, workshops, and continuing medical education (CMEs). This includes practices such as de-escalation (switching to narrower-spectrum antibiotics when appropriate), judicious use of combination therapy, and exploring non-antibiotic alternatives whenever possible.18 Results further established lack of association between sociodemographic characters and knowledge dimension of the questionnaire among respondents, indicating that educational improvements should be universally applied.

The respondents of both medicine and dentistry showed similar attitude towards antibiotics and agreed to the fact that antimicrobial resistance being a serious problem globally, in India as well as in their facility and strongly recommended the need to establish educational programs and implementation of antibiotics policy at various level for rational use of antibiotics, individually as well as collectively. However, there was a noticeable difference in attitudes towards cost considerations, with medical students more attuned to selecting cost-effective drugs, which could help to reduce the economic burden of patients.

Similar positive trend toward judicious antibiotic practices among the participants of medicine and dentistry was observed, with students generally avoiding antibiotic prescriptions based on patient demand and focusing on bacterial identification and sensitivity tests. Medical students favored national or international guidelines, while dental students relied more on textbooks and drug formularies. However, the need and difference for seeking help from senior colleagues in selecting antibiotics between participants of medicine and dentistry recommends raising the practical knowledge of dental students.

Engaging university students with practicing and academic pharmacists can further improve their knowledge, attitudes, and practices regarding antibiotics. Educational interventions have proven effective in enhancing these areas, and similar approaches should be adopted to better prepare future prescribers. 19

<bold id="s-b93d1dc94bf3">Limitations</bold>

Our study has some limitations. Being cross-sectional in nature, it may not cover long-term changes in attitudes and practices. The sample size was limited to willing participants from a single university, suggesting the need for larger, multi-university studies. Additionally, socially desirable responses might introduce bias, a common issue in self-reporting questionnaire studies.

<bold id="s-3596b96bd7e9">5 Conclusion</bold>

Antibiotic resistance is a critical global issue, akin to a pandemic. The assessment of knowledge, attitude, and practices towards antibiotics among future prescribers can strongly impact the issues related to antibiotics. Our study highlights significant differences between the knowledge of participants of medical and dental sciences, suggesting the need for revised curriculum, educational and awareness programs for dental students. While both the groups showed positive attitude and fair clinical practices, there is a need for enhanced training on prudent antibiotic use. Further evidence-based studies involving clinicians catering to larger sections of population are required for generalizing the actual clinical practice towards antibiotic use.

<bold id="s-6399e962ec75">Acknowledgements</bold>

Authors are thankful to dental and medical fraternity of the tertiary care hospital for participating in the study.

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