Risk perception and antibiotic resistance: bridging knowledge and action

Antibiotic resistance is one of the greatest health threats of our time. As microbes increasingly evade the effects of the drugs designed to combat them, we risk losing the ability to effectively treat even common infections. While the urgency of this problem is clear, tackling it requires innovative and targeted approaches, especially in education.

When we recently conducted a cross-sectional study on the knowledge, attitudes, and practices (KAP) of pharmacy students in seven Middle Eastern countries, I was struck by both the promise and the challenges that arose.

The study, conducted between March 2021 and January 2022, surveyed 4,265 pharmacy students from Egypt, Jordan, Saudi Arabia, Lebanon, UAE, Qatar and Kuwait. It provided a comprehensive snapshot of how future pharmacists perceive antibiotic resistance – a critical concern for global health – and revealed crucial insights into their potential role in mitigating this crisis. The findings are published in the news Medicine.

A promising knowledge base

One of the striking findings was the average knowledge score of the students: 5 out of 7, or 71.4%. This figure is encouraging, especially given the importance of equipping future pharmacists with a sound knowledge of antimicrobial resistance (AMR). In particular, students in their fourth and fifth years of study and students enrolled in the Bachelor of Pharmacy programs demonstrated higher levels of knowledge compared to their peers. These advances underscore the transformative impact of formal education, hands-on training, and years of immersion in the subject.

Pharmacists are at the frontline of healthcare. They play a crucial role in antibiotic stewardship by educating patients, preventing misuse and ensuring rational use of medications. The fundamental knowledge demonstrated by the students in this study is crucial for effectively addressing AMR in their future careers. However, as the findings suggest, there remains significant room for improvement, especially in translating this knowledge into everyday practice.

Risk perception and attitudes

In addition to knowledge, the students' attitude towards AMR was predominantly proactive. An encouraging 89.2% recognized the growing threat of antibiotic resistance, while more than 93% highlighted the need for greater awareness and education about antibiotic use. Many also agreed on the importance of stricter regulation, especially regarding the use of antibiotics in sectors such as poultry and dairy. These findings demonstrate a commendable understanding of the broader context of AMR and the systemic changes required to address it.

However, their reported practices revealed gaps that cannot be ignored. While 73% of respondents said they only use antibiotics with a doctor's prescription, more than half (51.7%) admitted to using antibiotics to control fever – an approach that is often unnecessary and can worsen resistance. This gap between knowledge and behavior points to the need for targeted interventions that go beyond theoretical understanding and focus instead on shaping practical decision-making and habits.

Understanding the role of risk perception in the fight against antibiotic resistance is crucial. In the context of the study, pharmacy students' knowledge and attitudes reflect different levels of awareness about the risks associated with inappropriate antibiotic use. Although many students saw antibiotic resistance as a significant and growing threat, their practices – such as using antibiotics for fever or other non-specific conditions – indicate a possible underestimation of personal risk.

Risk perception plays a crucial role in shaping behavior. Students who view themselves as less vulnerable to the effects of antibiotic abuse may engage in risky practices, such as self-medication or relying on outdated prescriptions. This discrepancy between perceived risk and actual behavior underlines the need for targeted education that emphasizes not only the global implications of antimicrobial resistance, but also its immediate personal risks.

Integrating concepts of risk perception into educational interventions can make a significant difference. Role-play scenarios, case studies, and visualizations of resistance trends can help students better internalize the risks of inappropriate antibiotic use. By bridging the gap between knowledge and personal responsibility, educators can empower future pharmacists to make safer, more informed decisions – both for themselves and for the communities they will serve.

Regional nuances and their implications

The Middle East presents unique challenges when it comes to antibiotic resistance. Factors such as cultural norms, healthcare systems and regulatory frameworks vary significantly from country to country, influencing the way antibiotics are prescribed and consumed.

For example, students from Egypt showed the highest knowledge scores, perhaps reflecting a stronger emphasis on AMR education in pharmacy curricula. At the same time, countries with stricter laws on antibiotic dispensing reported fewer cases of self-medication among students, underscoring the crucial role of policy in shaping behavior.

Despite these regional differences, the research found common areas for improvement in all participating countries. For example, while many students agreed that governments should play a greater role in raising awareness about AMR, only a fraction had actively participated in related campaigns or initiatives. This indicates untapped potential for pharmacy schools to integrate community engagement into their programs, giving students not only knowledge but also the confidence and experience to advocate for responsible antibiotic use.

A call to action

When we look back at the results of this study, we feel a mix of hope and urgency. The pharmacy students surveyed represent the next generation of healthcare professionals, and their knowledge and attitudes position them well to make a difference. However, the gaps in their practices and regional differences in understanding and behavior remind us that there is no room for complacency.

Antibiotic resistance is a huge challenge, but not insurmountable. By investing in the education and empowerment of pharmacy students, we are laying the foundation for a future where antibiotics remain effective tools in our healthcare arsenal. The journey begins in classrooms and extends to communities, where knowledge meets practice and consciousness transforms into advocacy.

The question now is: are we doing enough to prepare these future leaders? The answer will determine the success of our fight against AMR – and the health of future generations.

This story is part of Science X dialoguewhere researchers can report findings from their published research articles. Visit this page for information about Science X Dialog and how to participate.

Dr. Amer Hamad Issa Abukhalaf is an assistant professor in the Nieri Department of Clemson University. The research of Dr. Abukhalaf focuses on risk management, mental health, safety design and crisis management. An engineer and designer by training, he also holds a master's degree in executive management from Ashland University in Ohio, and a PhD from the University of Florida. Dr. Abukhalaf is a member of the Hazard Mitigation and Disaster Recovery Planning Division of the American Planning Association. He has received the University of Florida Outstanding Merit Award in both 2021 and 2023. In addition, Dr. Abukhalaf authored 26 peer-reviewed articles in prestigious journals, including the International Journal of Disaster Risk Reduction And Disaster prevention and management.