The Battle against Antibiotic Resistance: Exploring Perceptions, Misconceptions, Attitudes, Practices, and Awareness Factors Inuencing Antibiotic Resistance among General and Clinical Populations

Antibiotic resistance is rapidly advancing and becoming a higher risk over time; previously manageable infections have turned untreatable. Objective: To assess the perceptions, misconceptions, attitudes, practices, and awareness factors in�uencing antibiotic resistance among general and clinical populations. Methods: A total of 348 participants from the general public and 523 junior and senior medical practitioners in Peshawar, Pakistan, were included in this comparative observational cross-sectional study. Data were collected using a standardized questionnaire, which was later assessed by Chi-square test through SPSS version 26.0. Results: The results revealed a lack of awareness and knowledge regarding antibiotic resistance among both groups. Only 32% of the general public correctly identi�ed the de�nition of antibiotic resistance, while 76% of medical practitioners demonstrated a basic understanding of the concept. However, a signi�cant number of participants from both groups recognized the problem of bacterial infections resistant to all antibiotics and the contribution of self-medication to antibiotic resistance. In terms of self-medication practices, approximately 60% of the general public reported self-medicating with antibiotics without consulting a healthcare professional. Among medical practitioners, the rate of self-medication was signi�cantly lower, but a small proportion still admitted to prescribing antibiotics without appropriate diagnosis or indications. The majority of participants, however, did not intend to prescribe/suggest unnecessary antibiotics. Conclusions: The �ndings indicated that both groups were cognizant of the issue, yet certain misconceptions persisted within each group.


M E T H O D S
encouraging patients understanding to stick to treatments and refrain from self-medication, young doctors-the eld's future prescribers-can serve as the front-line defenders against antimicrobial resistance [4,7,11].Studies have shown that China, [12] the United States, [13] Europe [14] and Pakistan [15] respectively, recorded 60%, 10%, 45%, and 50% of improper antibiotic use [5].Selfmedication, a lack of diagnostic tools, the marketing of antibiotics without a prescription, patient requests, and clinician likes and dislikes, and a lack of culture and sensitivity are just a few of the causes of antibiotic resistance [3].A lack of proper training during undergraduate studies has been blamed by several authors for the knowledge and practice gaps among health practitioners.Antibiotic resistance and appropriate prescribing should be covered in greater detail during undergraduate medical education for aspiring doctors.Since it is di cult to modify the doctors' deeply ingrained beliefs and actions once they have obtained their credentials [5,7,16].In spite of the abundance of foreign research, little is known about the knowledge and practices of medical practitioners in comparison to the general public [17].This study is designed to assess the perceptions, misconceptions, attitudes, practices, and awareness factors in uencing antibiotic resistance among general and clinical populations among both medical practitioners and the general public leading to antibiotic resistance.

R E S U L T S
General population (348) and the Clinical participants (523) were involved in the study.Among which 47.5% of the general population and 52.4% of the clinical participants were males (Table 1).
Data collection was carried out employing a standardized questionnaire.Ethical approval for the study design was obtained from the medical research board and ethical committee.The questionnaire used for data collection was meticulously designed, drawing upon an extensive review of the existing literature, and underwent validation by domain experts.Using in-person inter views, the questionnaires were distributed.The questionnaire consisted of two sections: Age, gender, institution, and educational level were among the demographic questions in the rst section while perceptions, misconceptions, attitudes, practices, and awareness factors that contribute to antibiotic resistance were covered in the second section.Data analysis was performed utilizing SPSS version 26.0.Descriptive statistics, including means with standard deviation, frequencies, and percentages, were employed to analyze the variables.The relationship between the responses of the general population and medical practitioners was examined using the chi-square test, with a predetermined signi cance level of 0.05.This study employed a comparative observational crosssectional design and was conducted in Peshawar, KPK, Pakistan.The study duration spanned six months, commencing from December 2022 to May 2023.The sample size was determined using the Open Epi Sample Size Calculator, resulting in a calculated size of 664 with a con dence level of 99%.However, to reduce the sampling error, a total of 1000 questionnaires were distributed among the participants, with 871 questionnaires ultimately being completed in their entirety.The sample consisted of 348 participants from the general public and 523 junior and senior medical practitioners collected using non-Probability convenient sampling technique.Prior to e n r o l l m e n t , p a r t i c i p a n t s w e r e p r o v i d e d w i t h comprehensive information regarding the study's objectives and were required to provide verbal consent.The study included individuals aged 18 years and older who willingly participated, gave verbal informed consent, and fully completed the questionnaire.On the other hand, it excluded individuals under 18, those who were not willing to participate, those who couldn't provide informed verbal consent, and those who didn't nish the questionnaire.Among the general public, 64.4% (224/348) and 48.6% (254/348) of the clinical group agreed that there were bacterial infections resistant to all antibiotics, whereas 10.6% (37) and 8% (42) of the general public and clinical groups disagreed with the statement, respectively.Additionally, the participants considered antibiotic resistance to be a national and global public health concern.However, no signi cant difference was present when enquired about restricting the sale of non -prescribed antibiotics (p-value = 0.160) (Table 3).9 (2.6)   20 (3.8)   51 (14.7)   37 (7.1)   104 (29.9)   228 (43.6)   182 (52.9)   238 (45.5)   348 (100)   523 (100)   0 In the general public group, 35.9% agreed, 39.1% completely agreed and in the clinical group 51.2% agreed and 25.4% completely agreed that the use of antibiotics in self-limiting infections contributed to antibiotic resistance.(p-value = 0.000) A statistically signi cant difference was found to be present among the participants believing antibiotics for longer duration (p-value = 0.007), Empirical therapy (p-value = 0.002), and over-the-counter distribution of antibiotics (p-value = 0.009) contributed to antibiotic resistance (Table 4).In contrast to this, there was no statistical difference among participants who believed that antibiotics for a duration shorter than indicated contributed to antibiotic resistance (p-value = 0.172) (Table 4).Among the general public participants, 62/348 and 104/523 of clinical participants considered antibiotics effective for the treatment of viral infections (p-value = 0.094).Also there was a statistical signi cance among the participants who considered antibiotics as rst-line treatment for cough and sore throat (p-value = 0.004) and who taught antibiotics help them recover faster, when they had a fever (p-value = 0.008) (Table 5).Most of the participants of both the general public and clinical participants did not intend to prescribe/suggest unnecessary antibiotics.(P-value = 0.000) also there was a statistical difference among participants contributing to antibiotic resistance research (p-value = 0.000) (Table 6).Majority of the participants have taken steps to avoid antibiotic resistance in themselves (p-value= 0.000) and their family and friends (p-value = 0.000).Also, a statistical difference was found among the general population and clinical participants trying to persuade people not to self-medicate (p-value = 0.046) (Table 7).

D I S C U S S I O N
This study emphasizes the urgent need for focused e d u c a t i o n a l p r o g r a m s a n d e v i d e n c e -b a s e d recommendations to address these problems and encourage safe antibiotic use by synthesizing the data [18,19].In the current study among the general public, 64.4% and 48.6% of the clinical group agreed that there are bacterial infections resistant to all antibiotics.A study conducted on the general population in Italy concluded that 94% of their participants were well aware of antibiotic resistance [20].A study enrolling junior doctors in Sweden concluded that only 31% and 26% of the doctors knew the correct prevalence of antibiotic misuse and resistance [21].Another study by Konde et al., concluded that doctors should prescribe antibiotics according to the guidelines to control antibiotic resistance [22].The analysis reveals a sizable knowledge gap about antibiotics and their proper usage among the general public as well as healthcare professionals.There are still misconceptions, such as the notion that antibiotics are bene cial against viral illnesses or that it is appropriate to cease taking antibiotics once symptoms subside, which can also be seen in this study among 55.7% and 10.6% of the general population and medical practitioners respectively [23,24].These misconceptions aid in improper intake behaviors, such as self-medication, disregard for recommended regimens, and sharing of antibiotics.Furthermore, the situation is made worse by the sharing of antibiotics, which is frequently done without the correct knowledge or direction.Due to the selection and spread of drug-resistant strains resulting from these practices, antibiotics are less e cient at treating illnesses.This study also showed that 16.6% of the general population and 13.1% of the medical population were of the view to always suggest or prescribe medication whenever someone requires them [25].The surprising nding, however, is that the healthcare workers Alarming in this regard is the knowledge gap noted even among the medical professionals aside from general public which further points towards the dire need of identifying the knowledge gaps and working towards a solution.As can be seen in this study conducted in Peshawar, Pakistan.The requirement for thorough healthcare professional education and training programs is equally crucial.The most recent evidence-based recommendations and recommended practices for prescribing antibiotics can be kept up to date for medical professionals through ongoing professional development.Patients can be empowered to take an active role in the ght against antibiotic resistance through improved patient communication and education regarding the proper use of antibiotics, particularly the signi cance of following prescribed regimens.Also, future prescribers in the industry should also be properly taught and educated, as discussed in a study held in Rwanda [30].The study has several limitations that should be acknowledged.First, the study was conducted in a speci c geographical location (Peshawar, KPK, Pakistan) and may not be representative of other regions or countries.Second, the study employed a non-random convenient sampling technique, which may introduce selection bias.Third, the study relied on self-reported data, which is subject to recall and response biases.Finally, the study focused on knowledge and practices related to antibiotic resistance and did not assess actual prescribing behavior or patient outcomes.While both groups acknowledge the role of inappropriate antibiotic use in resistance, beliefs vary on speci c practices.Participants express an intention to avoid unnecessary antibiotic prescriptions, but translating this intention into action is crucial.
Comprehensive education on antibiotic resistance and prescribing practices should be integrated into medical education.Targeted initiatives and stricter regulation of antibiotic sales and prescriptions are necessary to combat resistance effectively.Increasing awareness and restricting inappropriate antibiotic use is vital for reducing antibiotic-resistant infections and safeguarding public health.Addressing the knowledge gap, promoting responsible prescribing, and implementing targeted education and regulations are crucial steps in tackling antibiotic resistance.
The study reveals that a signi cant portion of both the general public and clinical group recognize antibiotic resistance as a public health concern.There's strong agreement that antibiotics are effective against bacterial infections, but signi cant variations in beliefs about what contributes to antibiotic resistance.Most participants are committed to avoiding unnecessary antibiotics and e d u c a t i n g o t h e r s , e m p h a s i z i n g t h e n e e d fo r comprehensive awareness campaigns and education in this regard.

Table 1 :
Gender-based distribution among the study participants

Table 2 :
Age-based distribution among the study participants

Table 3 :
Perception of antibiotics resistance among the general population and clinical participants

Table 4 :
Factors Contributing to Antibiotic Resistance According to the Study Participants 2 X -

Table 5 :
Misconceptions about antibiotic use among the study participants

are the rst-line treatment for coughs and sore throats.
The Battle against Antibiotic Resistance PJHS VOL. 4 Issue.10October 2023Copyright © 2023.PJHS, by International Publishers

Table 6 :
Participants Attitude contributing to Antibiotic Resistance

Table 7 :
Practices followed by study participants to reduce antibiotics resistance 2 X -ValueI've taken steps to avoid antibiotic resistance.