Healthcare Workers’ Knowledge, Awareness, and Practices Regarding Antimicrobial Use, Resistance, and Stewardship in Saudi Arabia

Mahmoud S Abdallah,1 Osaid T Al Meanazel,2 Mohammed Mudhhi Alruwaili,2,3 Hayam Ali AlRasheed4 1Department of PharmD, Faculty of Pharmacy, Jadara University, Irbid, 21110, Jordan; 2Department of Pharmacy, Faculty of Pharmacy, Jadara University, Irbid, 21110, Jordan; 3Judidah Arar Hospital, the Northern Border Health Cluster, Arar, Saudi Arabia; 4Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh, 11671, Saudi ArabiaCorrespondence: Mahmoud S Abdallah, Department of PharmD, Faculty of Pharmacy, Jadara University, Irbid, 21110, Jordan, Email [email protected] Hayam Ali AlRasheed, Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, P.O.Box 84428, Riyadh, 11671, Saudi Arabia, Email [email protected] and Aim: Antimicrobial resistance (AMR) is a major global health threat, primarily driven by inappropriate antibiotic use. This cross-sectional study assessed the knowledge, attitudes, and practices of healthcare professionals in Saudi Arabia regarding antimicrobial use, resistance, and stewardship to identify gaps contributing to misuse.Methodology: An observational cross-sectional study was conducted using a validated self-administered questionnaire among physicians, nurses, and pharmacists. Data were analyzed using univariate and multivariate methods.Results: Among 236 respondents (45.3% physicians, 31.8% nurses, 22.9% pharmacists), most were aged 26– 35 (33.9%), with nearly equal gender distribution (53.0% women). While 85.2% were aware of AMR, 64.1% reported limited access to infection control policies. Most (94.9%) acknowledged that unnecessary antibiotic use contributes to resistance, and 96.2% understood its transmissibility. Daily antibiotic prescribed, dispensed, or administered was reported by 57.6%. Key barriers to appropriate prescribing included time constraints (84.7%) and diagnostic uncertainty (75.8%). Only 20.3% used clinical guidelines, whereas 35.2% relied on pharmaceutical industry materials. In the multivariate regression, knowledge scores increased with age (+0.31 per decade, p = 0.024), profession was the strongest predictor (β = 6.4, p < 0.001), and antimicrobial stewardship (ASP) training improved scores by 1.6 points.Conclusion: Significant gaps exist in access to guidelines and adherence to evidence-based practices. Targeted ASP interventions focusing on professional education, improved resource availability, and institutional support are essential to enhance stewardship and combat AMR in Saudi Arabia.Keywords: healthcare workers, knowledge, practices, antimicrobial resistance, antimicrobial stewardship, Saudi Arabia