Risk perception and antibiotic resistance: Bridging knowledge and action

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

As we conducted a recent cross-sectional study examining the knowledge, attitudes, and practices (KAP) of pharmacy students across seven Middle Eastern countries, I was struck by both the promise and the challenges presented.

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

A promising foundation of knowledge

One of the standout findings was the students’ median knowledge score: 5 out of 7, or 71.4%. This figure is heartening, especially given the importance of equipping future pharmacists with a robust understanding of antimicrobial resistance (AMR). Notably, students in their fourth and fifth years of study and those enrolled in Bachelor of Pharmacy programs displayed higher levels of knowledge compared to their peers. This progression underscores the transformative impact of formal education, hands-on training, and years spent immersed in the subject.

Pharmacists are at the frontline of health care. They play a pivotal role in antibiotic stewardship by educating patients, preventing misuse, and ensuring the rational use of medicines. The foundational knowledge displayed by the students in this study is a crucial asset for addressing AMR effectively in their future careers. However, as the findings suggest, there remains significant room for improvement, particularly in translating this knowledge into everyday practices.

Risk perception and attitudes

Beyond knowledge, the students’ attitudes toward AMR were overwhelmingly proactive. An encouraging 89.2% recognized the growing threat of antibiotic resistance, while more than 93% emphasized the need for greater awareness and education about antibiotic use. Many also agreed about the importance of stricter regulations, particularly regarding antibiotic use in industries like 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 use antibiotics only with a doctor’s prescription, more than half (51.7%) admitted to taking antibiotics to manage fever—an approach that is often unnecessary and can exacerbate resistance. This disconnect between knowledge and behavior points to the need for targeted interventions that go beyond theoretical understanding, focusing instead on shaping practical decision-making and habits.

Understanding the role of risk perception in combating antibiotic resistance is critical. In the context of the study, pharmacy students’ knowledge and attitudes reflect varying levels of awareness about the risks associated with improper antibiotic use. While many students recognized antibiotic resistance as a significant and growing threat, their practices—such as using antibiotics for fever or other non-specific ailments—indicate a potential underestimation of personal risk.

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

Incorporating concepts of risk perception into educational interventions can make a significant difference. Role-playing scenarios, case studies, and visualizations of resistance trends could help students better internalize the risks of inappropriate antibiotic use. By bridging the gap between knowledge and personal accountability, educators can empower future pharmacists to make safer, more informed decisions—both for themselves and 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, health care systems, and regulatory frameworks vary significantly across countries, influencing how antibiotics are prescribed and consumed.

For instance, students from Egypt demonstrated the highest knowledge scores, a reflection perhaps of a stronger emphasis on AMR education in pharmacy curricula. At the same time, countries with stricter antibiotic dispensing laws reported lower instances of self-medication among students, underscoring the critical role of policy in shaping behavior.

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

A call to action

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

Antibiotic resistance is a formidable challenge, but it is not insurmountable. By investing in the education and empowerment of pharmacy students, we are laying the groundwork for a future where antibiotics remain effective tools in our health care arsenal. The journey starts in classrooms and extends to communities, where knowledge meets practice, and awareness 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 generations to come.

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

More information:
Abdallah Y. Naser et al, Knowledge, attitude, and practices of pharmacy students in 7 Middle Eastern countries concerning antibiotic resistance: A cross-sectional study, Medicine (2024). DOI: 10.1097/MD.0000000000039378

Dr. Amer Hamad Issa Abukhalaf is an Assistant Professor in the Nieri Department at Clemson University. Dr. Abukhalaf’s research focuses on risk management, mental health, safety design, and crisis management. An engineer and a designer by training, he also holds a master’s in executive management from Ashland University in Ohio, and he earned his doctorate from the University of Florida. Dr. Abukhalaf is a member of the Hazard Mitigation and Disaster Recovery Planning Division at the American Planning Association. He has received the University of Florida Outstanding Merit Award in both 2021 and 2023. Additionally, Dr. Abukhalaf has authored 26 peer-reviewed papers in prestigious journals, including the International Journal of Disaster Risk Reduction and Disaster Prevention and Management.