Rational antibiotic use among university students a study on knowledge, attitudes, and practices (KAP)

To examine the associations between antibiotic use behaviors and knowledge, attitudes, and practices (KAP), digital health literacy, general health literacy, and medication-related beliefs among university students. A cross-sectional study was conducted among 1,012 university students using a structured online questionnaire. Data on KAP, eHealth literacy (eHEALS), general health literacy (HLS-EU-Q6), and beliefs about medicines (BMQ) were collected. Non-parametric tests, correlation analyses, and multivariate logistic regression were performed to identify factors associated with non-prescription antibiotic use. The prevalence of non-prescription antibiotic use was 13.9%. Knowledge scores increased across academic years (p < 0.001) but were not associated with reduced risky behaviors. Attitude scores were negatively associated with non-prescription antibiotic use (OR = 0.536, p = 0.006), whereas risky behavior score was the strongest positive predictor (OR = 2.344, p < 0.001). Prior health literacy training was associated with increased odds of non-prescription use (OR = 1.814, p = 0.038). Knowledge and general health literacy were not significant predictors. Correlation analysis showed a moderate association between knowledge and attitudes (ρ = 0.415) and a negative association between attitudes and risky behaviors (ρ = -0.390). Antibiotic misuse among university students was more strongly associated with behavioral and attitudinal factors than with knowledge levels. These findings highlight the limitations of knowledge-based interventions and support the need for integrated strategies incorporating behavioral approaches and critical health literacy skills to reduce inappropriate antibiotic use.