Antibiotic use and antimicrobial resistance: Knowledge, Attitude and Practices survey of medical students to evaluate undergraduate training curriculum

Introduction. A better understanding of knowledge, attitude and practices of undergraduate medical students towards antimicrobial resistance (AMR) is necessary to identify gaps in the current training curriculum. Methods. A 20-point Likert scale-based questionnaire divided into three parts, knowledge, attitude and practices, relating to antibiotic use and resistance was devised. Students attending each year of the undergraduate medical programme were approached to participate in the study over a 1-week period. Knowledge, Attitude and Practices scores of each year were compared through logistic ordinal regression and the Kruskal-Wallis (KW) test. Results. Two hundred and eight students participated in the study. Overall, knowledge of about intended use of antibiotics, fixed drug combinations and awareness about AMR was good (average score of 73.75%). Steady improvement in knowledge scores was observed from the first year (-0.441) to the final year (0.00). The medical students had favourable attitude towards rational antimicrobial use (Likert score ≥4), including the need to spread awareness about AMR amongst students and the public and following doctor's prescriptions. Self-medication was reported by 28.4% of students and hoarding of leftover doses by 49.1%. Attitude score had a direct correlation with the knowledge score on the KW test (χ ²=29.6, P≤0.5) but had no significant correlation with antimicrobial practices (χ ²=3.9, P≥0.5). The gaps identified in students' practices included self-medication, skipping of dosing and hoarding of leftover medication. Conclusion. As improvement in knowledge did not correlate with better personal behaviours regarding antibiotics, the current curriculum needs to include AMR as a focus area to ensure good antibiotic prescribing practices in future practitioners.