Factors driving antibiotic use and antimicrobial resistance among college-going students in Bangladesh: a cross-sectional study

Antimicrobial resistance (AMR) represents a significant global health challenge, particularly in resource-limited nations such as Bangladesh, where irrational antibiotic use and weak regulatory enforcement persist. This research sought to determine the key factors associated with antibiotic usage behavior through a comprehensive assessment of participants’ knowledge, attitudes, and practices (KAPs). A cross-sectional study was conducted from June to July 2025, involving 573 college-going students in Noakhali, Bangladesh. KAP levels were assessed using descriptive statistics, and the determinants of antibiotic use were further explored through multivariate analyses, including binary and ordinal logistic regression models. Among the 573 participants, 52% were male, and 48% were female, with the majority (59%) being undergraduate students. The findings indicated that 67% of the participants had a science background, whereas the remainder had a non-science background. Students with a science background demonstrated superior knowledge compared to their non-science counterparts. Approximately 45% of respondents exhibited moderate knowledge, 50% displayed positive attitudes, and 76% demonstrated appropriate antibiotic use. The tendency toward self-medication without medical consultation was notably low, as 96% of students reported consulting a doctor before using antibiotics, and over 90% supported prohibiting non-prescription antibiotic use. Although the majority (69%) reported completing their last antibiotic course, a notable proportion discontinued treatment prematurely, indicating partial non-adherence. Factors such as age, education level, educational background, and household income significantly influenced the KAP. To strengthen global efforts against AMR, these findings show that customized educational programs are needed to improve students’ knowledge and encourage responsible antibiotic consumption. Moreover, governmental enforcement of laws and regulations to stop antibiotic misuse is critically important.