Knowledge, attitude, and perception of prescribers about antimicrobial stewardship in a tertiary care hospital


  • Jayesh Pralhad Patil Department of Pharmacology, Government Medical College, Aurangabad, Maharashtra, India
  • Mirza Shiraz Baig Department of Pharmacology, Government Medical College, Aurangabad, Maharashtra, India
  • Vishal Ashok Kulkarni Department of Pharmacology, Government Medical College, Aurangabad, Maharashtra, India



KAP study, Antimicrobial resistance, Rational antibiotic use, Antimicrobial stewardship program


Background: Irrational antimicrobial use has contributed to amplification and spread of antimicrobial resistance (AMR). Antimicrobial stewardship by healthcare personnel can reduce AMR. The World Health Organization (WHO) has established a worldwide action plan to address AMR, including free online availability of open WHO courses. So, our study sought to ascertain knowledge, attitude, and practice (KAP) of healthcare personnel concerning AMS at tertiary care hospital.

Methods: Study was conducted as a KAP survey among practitioners (faculty, senior and junior residents) from several departments of Government Medical College, Aurangabad, Maharashtra. A validated questionnaire with 30 questions was prepared and distributed to 100 participants. The data collected in MS excel was analyzed with descriptive statistics and results expressed as mean and standard deviation, frequencies, and percentages.

Results: Response rate was 16.7% (n=100). Knowledge on AMS was observed among doctors’ with >80% near correct responses in each question. Insignificant knowledge gap was found comparing between faculty members, senior residents, and junior residents (p>0.005) in the knowledge, attitude and practice of antimicrobial use. All participants felt that ASP is a requirement of hospital, and it minimizes healthcare expenditures and negative impacts of inappropriate AM prescribing.

Conclusions: All HCPs have a knowledge gap on ASP, although there is no significant difference in knowledge, attitude, and practice of antimicrobial use between faculty members and senior and junior residents. This demonstrates importance of faculty members taking lead in incorporating more practice and education into ASP.


Bhatia R, Narain JP. The growing challenge of antimicrobial resistance in the South-East Asia Region - Are we losing the battle? Indian J Med Res. 2010;132(5):482-6.

World Health Organization. Antimicrobial resistance. Available at: Accessed on 17 January 2023.

John TJ, Dandona L, Sharma VP, Kakkar M. Continuing challenge of infectious diseases in India. The Lancet. 2011;377(9761):252-69.

Raghavan P. Growing drug resistance: Antibiotic consumption in India has skyrocketed, finds new study. The Economic Times. 2018. Available at: cms?from=mdr. Accessed on 17 January 2023.

World Health Organization. Antimicrobial resistance. Available at: southeastasia/health-topics/antimicrobial-resistance. Accessed on 17 January 2023.

Reygaert WC. An overview of the antimicrobial resistance mechanisms of bacteria. AIMS Microbiol. 2018;4(3):482.

Mauldin PD, Salgado CD, Hansen IS, Durup DT, Bosso JA. Attributable hospital cost and length of stay associated with health care-associated infections caused by antibiotic-resistant gram-negative bacteria. Antimicrob Agents Chemother. 2010;54(1):109-15.

Sango A, McCarter YS, Johnson D, Ferreira J, Guzman N, Jankowski CA. Stewardship approach for optimizing antimicrobial therapy through use of a rapid microarray assay on blood cultures positive for Enterococcus species. J Clin Microbiol. 2013;51(12):4008-11.

Nathwani D, Varghese D, Stephens J, Ansari W, Martin S, Charbonneau C. Value of hospital antimicrobial stewardship programs [ASPs]: a systematic review. Antimicrob Resist Infect Control. 2019;8:35.

World Health Organization. Global Antimicrobial Resistance and Use Surveillance System (GLASS) Report: 2021. Available at: publications-detail-redirect/9789240027336. Accessed on 17 January 2023.

Centers for Disease Control and Prevention (U.S.). Antibiotic resistance threats in the United States, 2019. Centers for Disease Control and Prevention (U.S.). 2019. Available at: view/cdc/82532. Accessed on 17 January 2023.

Ventola CL. The antibiotic resistance crisis: part 1: causes and threats. P T. 2015;40(4):277-83.

Dutescu IA, Hillier SA. Encouraging the Development of New Antibiotics: Are Financial Incentives the Right Way Forward? A Systematic Review and Case Study. Infect Drug Resist. 2021;14:415-34.

World Health Organization. Antimicrobial Stewardship: A competency-based approach. OpenWHO. Available at: courses/AMR-competency. Accessed on 17 January 2023.

World Health Organization. Antimicrobial stewardship programmes in health-care facilities in low- and middle-income countries: a WHO practical toolkit. Available at: handle/10665/329404. Accessed on 17 January 2023.

Nepal A, Hendrie D, Robinson S, Selvey LA. Knowledge, attitudes and practices relating to antibiotic use among community members of the Rupandehi District in Nepal. BMC Public Health. 2019;19(1):1558.

Khajuria K, Kaur S, Sadiq S, Khajuria V. KAP on antibiotic usage and resistance among second professional medical students. Int J Basic Clin Pharmacol. 2019;8(1):68-73.

Gupta MK, Vohra C, Raghav P. Assessment of knowledge, attitudes, and practices about antibiotic resistance among medical students in India. J Family Med Prim Care. 2019;8(9):2864-9.

Pulcini C, Williams F, Molinari N, Davey P, Nathwani D. Junior doctors’ knowledge and perceptions of antibiotic resistance and prescribing: a survey in France and Scotland. Clin Microbiol Infect. 2011;17(1):80-7.

Fernández González F, Detrés J, Torrellas P, Balleste CR. Comparison of the appropriate use of antibiotics based on clinical guidelines between physicians in-training versus practicing physicians. Bol Asoc Med P R. 2013;105(3):21-4.

Mincey BA, Parkulo MA. Antibiotic prescribing practices in a teaching clinic: comparison of resident and staff physicians. South Med J. 2001;94(4):365-9.

Ghosh A, Deb T, Ghosh S. Knowledge, attitudes and practice survey about antimicrobial resistance and prescribing among physicians in a tertiary care teaching hospital in Eastern India. Int J Basic Clin Pharmacol. 2016;5(1):180-7.

Labi AK, Obeng-Nkrumah N, Bjerrum S, Aryee NAA, Ofori-Adjei YA, Yawson AE, et al. Physicians’ knowledge, attitudes, and perceptions concerning antibiotic resistance: a survey in a Ghanaian tertiary care hospital. BMC Health Serv Res. 2018;18(1):126.

Tadesse TY, Molla M, Yimer YS, Tarekegn BS, Kefale B. Evaluation of antibiotic prescribing patterns among inpatients using World Health Organization indicators: A cross-sectional study. SAGE Open Med. 2022;10:20503121221096610.

Chandan NG, Nagabushan H. Assessment of knowledge, attitude and practice of interns towards antibiotic resistance and its prescription in a teaching hospital: a cross sectional study. Int J Basic Clin Pharmacol. 2016;5(2):442-6.

Cotta MO, Robertson MS, Tacey M, Marshall C, Thursky KA, Liew D, et al. Attitudes towards antimicrobial stewardship: results from a large private hospital in Australia. Healthcare Infection. 2014;19(3):89-94.

García C, Llamocca LP, García K, Jiménez A, Samalvides F, Gotuzzo E, et al. Knowledge, attitudes and practice survey about antimicrobial resistance and prescribing among physicians in a hospital setting in Lima, Peru. BMC Clin Pharmacol. 2011;11:18.

Levy SB. The challenge of antibiotic resistance. Sci Am. 1998;278(3):46-53.

Okeke IN, Laxminarayan R, Bhutta ZA, Duse AG, Jenkins P, O'Brien TF, Pablos-Mendez A, Klugman KP. Antimicrobial resistance in developing countries. Part I: recent trends and current status. Lancet Infect Dis. 2005;5(8):481-93.

Kaur S, Sethi P, Panda PK. Knowledge-Practice Gaps of Practicing Doctors on Antimicrobial Stewardship-A Single Center Experience. Am J Infect Dis. 2022;18(1):9-20.

Firouzabadi D, Mahmoudi L. Knowledge, attitude, and practice of health care workers towards antibiotic resistance and antimicrobial stewardship programmes: A cross-sectional study. J Eval Clin Pract. 2020;26(1):190-6.

Venugopalan V, Trustman N, Manning N, Hashem N, Berkowitz L, Hidayat L. Administration of a survey to evaluate the attitudes of house staff physicians towards antimicrobial resistance and the antimicrobial stewardship programme at a community teaching hospital. J Glob Antimicrob Resist. 2016;4:21-7.

Abbo L, Sinkowitz-Cochran R, Smith L, Ariza-Heredia E, Gómez-Marín O, Srinivasan A, Hooton TM. Faculty and resident physicians' attitudes, perceptions, and knowledge about antimicrobial use and resistance. Infect Control Hosp Epidemiol. 2011;32(7):714-8.

Chaves NJ, Cheng AC, Runnegar N, Kirschner J, Lee T, Buising K. Analysis of knowledge and attitude surveys to identify barriers and enablers of appropriate antimicrobial prescribing in three Australian tertiary hospitals. Intern Med J. 2014;44(6):568-74.

Dyar OJ, Pulcini C, Howard P, Nathwani D, ESGAP (ESCMID Study Group for Antibiotic Policies). European medical students: a first multicentre study of knowledge, attitudes and perceptions of antibiotic prescribing and antibiotic resistance. J Antimicrob Chemother. 2014;69(3):842-6.

Hermsen ED, Smith Shull S, Puumala SE, Rupp ME. Improvement in prescribing habits and economic outcomes associated with the introduction of a standardized approach for surgical antimicrobial prophylaxis. Infect Control Hosp Epidemiol. 2008;29(5):457-61.




How to Cite

Patil, J. P., Baig, M. S., & Kulkarni , V. A. (2023). Knowledge, attitude, and perception of prescribers about antimicrobial stewardship in a tertiary care hospital. International Journal of Research in Medical Sciences, 11(9), 3357–3364.



Original Research Articles