Knowledge, Attitudes, and Practice: Adherence to Antimicrobial Guidelines Among Pharmacists in Balochistan

Antimicrobial resistance (AMR) is a major global health threat. As frontline providers, pharmacists play a crucial role in antimicrobial stewardship (AMS). However, data on their knowledge, attitudes, and practices (KAP) regarding AMS and guidelines in Balochistan, Pakistan, remain limited. The study was designed to assess the knowledge, attitudes and practices (KAP) with regard to antimicrobial stewardship (AMS) and clinical guidelines among pharmacists in Balochistan and also to determine the demographic and professional predictors of these, adherence to antimicrobial guidelines (AMGs) and impact on healthcare. A cross-sectional survey of 335 pharmacists across Balochistan utilized a structured questionnaire assessing demographics, knowledge (7 items), attitudes (8 items), and practices. Scores were dichotomized by median split into "good" or "poor/less favorable." Non-parametric tests (Mann-Whitney U, Kruskal-Wallis H), chi-square tests, and multivariable binary logistic regression evaluated subgroup differences and independent predictors (p < 0.05). The results showed that the overall, 73.4% of respondents demonstrated good knowledge, 60.3% positive attitudes, and 68.1% good practice. While 69.6% were aware of antimicrobial guidelines, only 32.8% had received formal AMS training. Female pharmacists scored significantly higher in knowledge and practice than males. Multivariable regression revealed that male gender was associated with lower odds of good knowledge (aOR=0.52, 95%CI, 0.28–0.94 and good practice (aOR=0.34, 95% CI, 0.19–0.62). Previous AMS training independently predicted good practice (aOR)=2.66, 95%CI 1.44–4.88). The pharmacists serving in the Balochistan show moderate knowledge, but gaps remain in attitudes and practices. Gender, experience, practice setting, and training significantly influence KAP outcomes. Our findings suggest that structured continuing professional development, point-of-dispensing guideline tools, and regulatory enforcement may help translate existing knowledge into practice, consistent with the priorities of Pakistan's National Action Plan on AMR.