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Microb Drug Resist. 2017 Jan;23(1):71-78. doi: 10.1089/mdr.2015.0279. Epub 2016 Apr 19.

Knowledge, Attitudes, and Beliefs Regarding Antimicrobial Therapy and Resistance Among Physicians in Alexandria University Teaching Hospitals and the Associated Prescription Habits.

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1 Department of Surgery, Faculty of Medicine, University of Alexandria , Alexandria, Egypt .
2 Faculty of Medicine, University of Alexandria , Alexandria, Egypt .
3 Faculty of Pharmacy, University of Alexandria , Alexandria, Egypt .
4 Faculty of Veterinary Medicine, University of Alexandria , Alexandria, Egypt .
5 Innovation Project, Bibliotheca Alexandrina , Alexandria, Egypt .
6 Community Medicine Department, Faculty of Medicine, University of Alexandria , Alexandria, Egypt .


Irresponsible prescription of antimicrobials (AMs) is the driving factor for the growing antimicrobial resistance (AMR) crisis. In this study, we assessed the knowledge, attitudes, perceptions, and beliefs regarding AMs and AMR together with the prescription habits of physicians in three University hospitals in Alexandria, Egypt. A 40-question survey was used. Physicians were stratified into residents and practicing staff members, and further into various departments. Clinical pharmacists at the University main hospital were included for comparative purposes. A total of 319 questionnaires were completed (response rate = 91.4%). Participants demonstrated fair average knowledge about AMs (4.71 ± 1.29 out of 7), with no significant difference between residents and staff members, whereas clinical pharmacists scored significantly higher on knowledge questions (p < 0.005). Participants showed poor awareness regarding local AMR patterns of Klebsiella pneumoniae and Pseudomonas aeruginosa (13% and 23%, respectively). AMR was perceived as a global (95%), national (97%), and local (85%) problem. High confidence regarding use of AMs was noticed with significantly higher levels among staff members (70.3% vs. 86.7%, p < 0.05). Most participants agreed that the patients' demands (78.5%) and socioeconomic statuses (76.3%) do influence their choices. The most significant knowledge deficit was regarding dosage adjustment in renal patients, and the survey highlighted poor engagement in educational activities, limited awareness of local resistance patterns, and neglect in explaining the side-effects to patients. Patients' demands and socioeconomic statuses were also shown to influence the physicians' decisions.


KAP survey; antimicrobial stewardship; antimicrobials; prescription habits

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