Public awareness and knowledge of antibiotic use and antimicrobial resistance in Malta

Abstract Introduction Antimicrobial resistance (AMR) is a major global threat, driven partly by inappropriate antibiotic use. Understanding public knowledge, awareness, and behaviours is critical for designing effective interventions. This study assessed these dimensions within the Maltese population to inform national AMR awareness and stewardship strategies. Method A cross-sectional online survey was conducted between 9 and 29 April 2024 among Maltese residents using a questionnaire adapted from the World Health Organization (WHO) Antibiotic Resistance Multi-Country Public Awareness Survey. A convenience sampling approach with active demographic monitoring was used across gender, age, and education groups, using census-derived targets as benchmarks. The survey, available in English and Maltese, assessed knowledge of appropriate antibiotic use, awareness of AMR-related terminology, and attitudes towards antibiotic use and resistance. Data were analysed using descriptive statistics and non-parametric tests (Mann-Whitney U, Kruskal-Wallis H, Chi-Square, Likelihood Ratio) to explore associations between demographic factors and knowledge or behavioural outcomes. Results A total of 476 eligible respondents completed the survey and were included in the analysis. Among respondents, 59.9% were female and the largest age group was 25–34 years (31.9%). Awareness of “antibiotic resistance” was high (88%) yet understanding of “antimicrobial resistance” (48%) and its abbreviation “AMR” (21%) was lower. Most participants (97%) agreed that antibiotics should only be used when prescribed, but misconceptions persisted: 16.6% believed antibiotics treat colds and flu, 33.6% for fever, and 39.9% for sore throats. Three-quarters (75%) incorrectly attributed resistance to the body becoming resistant rather than bacteria. Older and more educated respondents showed significantly better knowledge and more appropriate attitudes ( p < 0.05), whereas younger adults and males were more likely to hold misconceptions. While nearly all respondents (96.7%) agreed that individuals should use antibiotics responsibly, fewer (53.4%) viewed AMR as a major global challenge or expressed personal concern (67.2%) about its impact, and one-third believed they were not at risk if they used antibiotics correctly. Findings indicate general awareness but persistent conceptual and demographic gaps. Conclusion Despite high awareness of appropriate antibiotic use, misconceptions about treatment indications and the mechanisms of AMR remain, particularly among younger adults and those with lower education. Improving public understanding of when antibiotics are needed and how resistance develops will be critical to promoting responsible use. These findings provide locally generated evidence to inform targeted public health communication and support AMR prevention efforts in Malta.