Physicians' Attitudes as a Key Predictor of Responsible Antimicrobial Use: A Cross-Sectional Dual Physician-Patient KAP Study

Abstract Background and Objectives: Antimicrobial resistance (AMR) is a growing global public health threat associated with substantial morbidity, mortality, and economic burden. Both physicians' prescribing behaviors and patients' antimicrobial use influence antimicrobial stewardship; however, few studies have assessed AMR-related knowledge, attitudes, and practices (KAP) among both groups within the same setting. This study examined AMR-related KAP among physicians and patients in Khon Kaen Province, Thailand. Methods A cross-sectional KAP survey was conducted across 29 hospitals in Khon Kaen Province between July and September 2021. A total of 80 physicians and 412 patients participated. Data were collected using pilot-tested, expert-reviewed questionnaires. Descriptive statistics and multivariable linear regression analyses were performed to compare KAP patterns and identify factors associated with practice scores. Results Among physicians, more positive attitudes toward AMR were significantly associated with better practice scores (β = 0.26, 95% CI: 0.15–0.37; p < 0.001). Physicians demonstrated high mean knowledge scores (89.5%) but lower practice scores (71.4%), indicating a knowledge–practice gap. In contrast, patients had limited knowledge (31.2%) but relatively high practice scores (80.5%), suggesting compliance with antimicrobial-related instructions despite limited understanding. A shared concern in both groups was the management of upper respiratory tract infections (URTI): around half of patients believed antimicrobials were effective for fever, cough, and colds, while a similar proportion of physicians reported sometimes, often, or always prescribing antimicrobials for URTI. Conclusions The patient KAP pattern likely reflects strong reliance on and trust in physicians' recommendations in Thailand, underscoring physicians' pivotal role in antimicrobial stewardship. Alongside patient education, strengthening physicians' AMR attitudes and prescribing practices is critical for stewardship and health system resilience against AMR. In particular, the management of URTI represents a practical, high-yield intervention point, given its high prevalence and shared misconceptions and practices among both physician and patient groups.