Irrational and inappropriate use of antibiotics has become the mainstay of antibiotic resistance. In developing countries, antibiotic resistance is considered as emerging global problem due to the misuse of antibiotics. 1 COVID-19 and various other factors had led to a higher antimicrobial resistance with the pandemic impacting antibiotic stewardship and pushing back years of work to control it. Antibiotic overuse can lead to resistance and along with that it leads to adverse reactions and economic burden on the patient as well as the healthcare system. 2

Many strategies have been implemented for rational and appropriate use of antibiotics like antibiotic stewardship, prescription audit, integrated approach, hospital formulary. 1 Antimicrobial stewardship is an integrated approach to promote the rational and appropriate use of antibiotics by preferred route and for suitable duration of therapy. 3, 4 It is aimed to reduce the antimicrobial resistance and also to select the appropriate antimicrobial drugs to treat the infection. Raising awareness about the seriousness and the impact of antimicrobial resistance is now considered a crucial step to stop the spread. For this, various campaigns such as educating the health care workers, pharmacists, and general public about antibiotic stewardship should be implemented.

Many studies have been conducted about the antimicrobial resistance and stewardship, but these studies differ as they are conducted in different setup with different physician, prescription pattern, antibiotic policy, formulary, patient load etc. The present study delineates the knowledge, attitude, and perception of resident doctors about antimicrobial stewardship so that loopholes can be stitched in time. Understanding the KAP of our resident doctors will facilitate better and more effective antimicrobial use for them.

This study can help us to understand the knowledge of our resident doctors and helps us to bridge the gap of lacunae. Also, to know the scope of improvement, better education can be given to them which can help to improve the appropriate antimicrobial treatment pattern for patients and decrease the antibiotic resistance, misuse/overuse of antibiotics and adverse drug reactions.

This was the questionnaire based prospective observational study conducted among the final year junior resident doctors at a tertiary care teaching centre in Maharashtra. After obtaining permission from Institutional Ethics Committee Letter No.215/2019 dated 10/10/2019, the pretested and validated questionnaire were given to the resident doctors of various departments.

The questionnaire was divided into 3 sections, first section was knowledge consisting of 5 questions. It was about the rational AM prescribing pattern. The second section was about the attitude of the resident doctors regarding the AM stewardship program. This section has the answers such as agree, don’t know and disagree. Also, some questions were negatively framed in this section. Third section was about the perception of resident doctors as to how they can rate their skills of prescribing AM. The questionnaire was given to the resident doctors via google form online as well as the printouts to make it feasible for all the resident doctors to fill it without any reference materials or assistance. The collected data was analysed using MS Excel and SPSS software. Total KAP scores were calculated at the end and were analysed by statistical tests for the significance.

A total of 55 resident doctors participated and completed the questionnaire study. Resident doctors working in various departments of a tertiary care teaching hospital were included in the study. Participant’s knowledge, attitude and perception were evaluated in this study.

The knowledge of resident doctors about prescribing antibiotics in the given clinical scenario is shown in Table 1. Almost 72% of participants prescribed AM for viral infection too. As AM resistance is the emerging trend, 78% of participants are of the opinion that efficacy will be better if the antibiotic is newer. Other questions of knowledge apart from these were fairly answered by the participants.

The attitude of the resident doctors towards AM use is shown in Table 2. 89% of resident doctors are of the opinion that AM pharmacology should be integrated with the clinical case scenario for better understanding of the rational use. Also, almost 71% are of the attitude that educating the nurses and pharmacists can play a pivotal role in shaping the AM stewardship. Rational use of antibiotics should be established at the institute level according to 94% of participants.

The good perception of resident doctors towards the AM use is shown in Table 3. Almost 71% of resident doctors were competent enough to select the best antimicrobial for the given clinical case scenario.

There are many studies which had assessed the attitude and perception of medical students. 5, 6 The present study is unique in its way to assesses the knowledge, attitude, and perception of resident doctors from a tertiary care teaching hospital. This study will also help us to provide the insight of resident doctors regarding the current knowledge of antimicrobials to be used in the specific case. The respondent’s scored average in their knowledge about specific AMs. Among the resident doctors participated in the study, 72.72 % prescribed antimicrobials for viral infection.

Prefabricated clinical case scenario was given to the respondent and only 70.9% resident doctors had average and basic knowledge regarding the case. These findings differ from another study where 39% of the respondents scored above average for the clinical scenario based questions. 7

A study was done by the pharmacology department amongst the health care workers which emphasized on the importance of clinical case scenario learning. 4 Integration of teaching pharmacology with clinical scenario for rational AM has some time constraint. 6 So when these medical students enter into their general practice or specialized practice, they find it very difficult as to which appropriate AM to prescribe. If we train the resident doctors regarding the antimicrobial stewardship programme, they can more efficiently contribute towards appropriate and rational us of AM in future. 8, 9

About 81.8% of respondents in our study are of the attitude that AM stewardship education must be given. A study done by Huang et al highlighted that 74% of medical students favoured starting the AM stewardship education in china. 10 Majority 89% of the resident doctors are of the opinion that AM pharmacology should be integrated with other clinical subjects so as to have an idea about the rational use of AM and to avoid its misuse/overuse. A similar study was conducted by Vasundara et al 11 which also has shown the similar results. Respondents are of the opinion that the new AM should be developed in near future which is said to be one of the solutions for combating the AM resistance.

As many antibiotics can be purchased Over the Counter (OTC) without prescription, even the high-end antibiotics can be purchased OTC without any prescription. 12 A study was done which had shown high rates of self medication amongst 35% medical students which can lead to irrational use of antibiotics and can further land up into AM resistance. 13

Our results regarding the attitude and perception supports the study done by Davey et al. which focussed onto training the resident doctors or prescribers about the appropriate and rational AM use. 14 Many initiatives of integrating teaching pharmacology about AM use and the therapy of choice with the clinical case scenario should be undertaken in all the medical and its allied branches. Also, perception of our respondents about the AM education is similar to the findings of the survey done by Abbo et al. 5 Further the prescriber should have also have the thorough knowledge about the AM choice based on patient, investigation which will help him to come to a diagnosis.

Our present study brings about the need for integrating clinical based scenario with AM prescribing for resident doctors as well as undergraduate students to avoid the irrational prescribing practices in future. Innovative teaching methods should also be implemented so as to simplify the AM pattern and to give AM of choice for the particular condition.

The strength of our present study was that the participation was voluntary, and the participants were not allowed to take any kind of help for filling the given questionnaire, so it can help us to get the actual KAP collected. The limitation of our study was that all the participants were from single Medical College, and it was conducted in resident doctors only.

The attitude of the resident doctors towards antimicrobial education is good but the deficiencies in the knowledge and perception need to be improved further. So, there is a need for new intervention to address these lacunae.