Antibiotic prescribing and antimicrobial resistance awareness among medical students in Lebanon using novel assessment scales

In Lebanon, widespread antibiotic prescribing has led to antimicrobial resistance (AMR), a notable public health concern driven by inappropriate use. As future prescribers, medical students play a critical role in combating AMR. This study aimed to evaluate their AMR awareness and antibiotic prescribing practices, identify knowledge gaps, and suggest interventions to promote appropriate antibiotic use and limit local AMR emergence. A cross-sectional study was conducted among Lebanese medical students from July 1, 2021, to September 30, 2022. Data were collected via a structured online questionnaire using snowball sampling. The questionnaire was informed by published articles and the authors' expertise. It included sociodemographic data and novel, context-specific scales assessing antibiotic prescribing attitudes, knowledge of AMR drivers, and prudent prescribing practices, addressing gaps in existing tools. The sample included 164 medical students, with a mean age of 22.78 ± 3.94 years. Furthermore, 89.6% were interns, 50.6% were females, and 68.3% studied at a public university. Antibiotic prescription attitudes among the surveyed participants were affected by a better awareness of some contextual factors related to the prescribed drug and the pharmaceutical companies. Decreased awareness was observed for pharmacist-related factors, patient characteristics, and marketing-related factors. Interns had higher awareness than residents about marketing and the contextual factors influencing antibiotic prescribing. Participants had average knowledge levels of AMR and relatively high knowledge levels of strategies to manage it. A significant interrelation was found between awareness of factors influencing physicians' antibiotic-prescribing attitudes and AMR knowledge (p < 0.05). Lebanese medical students demonstrated adequate overall knowledge of antibiotic use and resistance, along with generally positive attitudes toward appropriate antibiotic prescribing. However, gaps were noted in their understanding of prudent antibiotic prescribing practices. Targeted interventions, including curriculum enhancement, AMR-focused workshops, stewardship training, and supportive national policies, are recommended to strengthen AMR awareness and promote responsible antibiotic use.