Knowledge, Attitude, and Practice on Antibiotic Use and Resistance Among Undergraduates, Pokhara Metropolitan, Nepal

Background: Antimicrobial resistance (AMR) is a global health problem contributing to increasing rates of morbidity and mortality throughout the world. Inadequate knowledge and misconceptions surrounding antibiotics and their overuse can significantly contribute to the growth and spread of AMR. This study aimed to assess knowledge, attitudes, and practices (KAP) regarding antibiotic use and resistance among undergraduates in Pokhara, Nepal, and examine associations of knowledge and attitudes with demographic factors and specific antibiotic use practices. Methods: A cross-sectional survey was conducted from April to September 2023 among 461 undergraduate students in Pokhara Metropolitan City. Frequency distributions were used to describe participants' KAP regarding antibiotics. Chi-square tests were applied to identify factors significantly associated with knowledge and attitudes toward antibiotics, with a significance level of 5%. Result: Among the total participants, 155 (33.6%, 95% CI: 29.6-38.3) had a lower level of knowledge regarding antibiotics, while a moderate and higher level of knowledge was observed among 208 (45.1%, 95% CI: 40.1-49.5) and 98 (21.3%, 95% CI: 17.5-24.7) students, respectively. Nearly half (53.6%, 95% CI: 48.9-58.2; 50.1%, 95% CI: 45.8-54.4) of the students illustrated positive attitudes and good practices. Factors such as gender, academic discipline, and previous education on antibiotics were associated with students' knowledge regarding antibiotics, at 5% level of significance (p < 0.05). Similarly, a statistically significant relationship existed between students' academic discipline, past courses, and their attitudes toward antibiotics. The knowledge of the participants on the antibiotic use was found to have a statistical relationship with practice-related attributes such as finishing the antibiotic course even after feeling well, giving less preference to antibiotic for cold (p < 0.05). The attitude of the participants toward antibiotics was found to have a statistical relation with practices such as consulting a doctor for antibiotics and finishing the course of antibiotic (p < 0.05). Conclusion:A large proportion of undergraduates have moderate to high knowledge regarding antibiotic use, while only half had a positive attitude and good practice toward antibiotic use, suggesting a large gap existing in awareness of antibiotic resistance and rational use.