Knowledge, attitudes, self-reported adherence to antibiotic use, and awareness of multidrug-resistant pathogens among residents of Port Harcourt, Nigeria

Antibiotic misuse accelerates antimicrobial resistance, increasing morbidity, mortality, and costs. This study assessed knowledge, attitudes, self-reported adherence to antibiotic use, and awareness of multidrug-resistant (MDR) pathogens among residents of Port Harcourt, Nigeria. A cross-sectional study using convenience sampling was conducted from March to July 2025 among 1,606 adults utilising interviewer-administered questionnaires. Data were analysed with Chi-square tests and multivariable logistic regression with significance set at p ≤ 0.05. Good antibiotic knowledge was observed in 50.4% and positive attitudes in 95.8%, yet only 5.2% reported high adherence; 39.0% were aware of MDR pathogens. Adherence increased with age (aOR = 1.04; 95% CI: 1.01–1.07; p = 0.0237) and with fair knowledge of antibiotic use (aOR = 2.90; 95% CI: 1.22–7.83; p = 0.0231) or good knowledge of antibiotic use (aOR = 4.14; 95% CI: 1.82–10.92; p = 0.0017). Conversely, taking antibiotics 2–3 times (aOR = 0.44; 95% CI: 0.25–0.82; p = 0.0078) or ≥ 4 times (aOR = 0.28; 95% CI: 0.09–0.73; p = 0.0154) in the previous year predicted lower adherence. MDR awareness was higher among students (aOR = 1.85; 95% CI: 1.05–3.33; p = 0.0371), retirees (aOR = 3.84; 95% CI: 1.09–13.66; p = 0.0359), those in healthcare occupations/studies (aOR = 2.86; 95% CI: 2.15–3.80; p < 0.0001), respondents reporting excellent health (aOR = 2.28; 95% CI: 1.34–3.94; p = 0.0027), private-hospital users (aOR = 9.07; 95% CI: 1.44–179.00; p = 0.0488), and those with fair knowledge of antibiotic use (aOR = 6.08; 95% CI: 3.53–11.20; p < 0.0001) or good knowledge of antibiotic use (aOR = 20.61; 95% CI: 12.22–37.35; p < 0.0001). Knowledge was found to be moderate, while attitudes were overwhelmingly positive; however, adherence and MDR-pathogen awareness were limited. Targeted education, stricter control of over-the-counter antibiotic access, and reinforced adherence counselling, particularly for repeat antibiotic users, are needed to curb misuse and stem antimicrobial resistance in Port Harcourt.