Knowledge, attitude, and practice of clinicians about antimicrobial stewardship and resistance among hospitals of Pakistan: A multicenter cross-sectional study

Abstract Considering that antimicrobial resistance (AMR) is a global challenge, there is a dire need to gauge the knowledge, attitude, and practice (KAP) of clinicians in endemic countries. The aim of the current multicenter, cross-sectional study was to highlight the knowledge, aptitude and practice gaps in antimicrobial (AM) stewardship and AMR among practicing doctors working in public tertiary care teaching hospitals of Lahore, Pakistan. A KAP survey, based on a self-administered questionnaire containing 45 questions, was conducted among 336 clinicians practicing in 6 randomly selected hospitals of Lahore, Pakistan. Overall, 92% of the clinicians considered AMR as a worldwide problem but only 66% disagreed that cold and flu symptoms require antibiotics. Moreover, around 68% doctors felt confident about their practice in AM but still 96% felt need to get more knowledge about AM. Need to establish courses on rational antibiotic use was demanded by 84% of participants. The main contributing factors considered for AMR by the doctors included excessive AM usage in medical profession (87.1%) and multiple antibiotics per prescription (76.4%). Pharmacologically, AM spectrum was accurately chosen by 1.4% (ampicillin), 0.003% (erythromycin) and 0% (levofloxacin). Clinically, a more than 50% of clinicians used miscellaneous AM for empirical therapy of respiratory tract infection and cholecystitis. The data was analyzed using Statistical Package for Social Sciences (SPSS) version 25. The knowledge of clinicians is relatively poor in AM spectrum and drugs of choice for certain infections. However, they know about their short comings with positive approach towards improvement.