Background: Antibiotic resistance has emerged as a major global public health crisis, driven by decades of antibiotic misuse, overuse, and poor adherence to prescribed therapies. In India, the problem is exacerbated by easy over-the-counter access, self-medication, and widespread misconceptions, particularly in rural and semi-urban areas like Mandi district, Himachal Pradesh. Understanding public awareness and behaviors around antibiotic use is crucial for formulating effective intervention strategies. Materials and Methods: This descriptive, cross-sectional study surveyed 400 adult residents of Mandi district between January and March 2025 using a structured, bilingual questionnaire. Participants were selected through purposive and snowball sampling across urban and rural settings. Data on demographics, knowledge, perceptions, and behavioral practices regarding antibiotic use and resistance were collected via face-to-face interviews and self-administered forms. Responses were analyzed using SPSS v26.0, and knowledge levels were categorized as Very Good, Good, Fair, or Poor. Results: The study revealed that 78% correctly identified antibiotics as bacterial infection treatments, and 81.5% recognized early cessation of antibiotics as a risk factor for resistance. However, significant misconceptions persisted, with 28.2% believing antibiotics could treat viral infections and only 62.8% aware of resistance impacting future generations. Knowledge scores classified 32.3% as Very Good, 41.8% as Good, 19.0% as Fair, and 7.0% as Poor. Unsafe practices such as self-medication and reuse of leftover antibiotics were noted despite high general awareness levels, particularly among rural populations. Conclusion: While awareness of antibiotic use and resistance among Mandi residents is encouraging, critical gaps remain, particularly regarding resistance transmission and societal impact. Rural communities showed lower understanding and riskier practices. Targeted educational interventions, stricter enforcement of prescription regulations, and strengthened healthcare engagement are essential to translate knowledge into safer antibiotic behaviors and curb the growing threat of resistance.
The discovery of antibiotics revolutionized modern medicine, transforming once-deadly infections into treatable conditions. However, decades of overuse, misuse, and improper prescribing have led to the alarming rise of antibiotic resistance a global health threat that compromises the effectiveness of these life-saving drugs. Antibiotic resistance occurs when bacteria evolve mechanisms to withstand the effects of antibiotics, rendering standard treatments ineffective, prolonging illnesses, increasing medical costs, and elevating the risk of mortality. Today, antibiotic-resistant infections claim hundreds of thousands of lives annually and are projected to become a leading cause of death worldwide if immediate corrective action is not taken [1-3].
In India, antibiotic resistance has reached critical levels, fueled by factors such as self-medication, easy over-the-counter availability, incomplete antibiotic courses, lack of public awareness, and insufficient regulatory enforcement. Rural and semi-urban areas like Mandi district in Himachal Pradesh face unique challenges: limited access to qualified healthcare professionals, reliance on informal healthcare providers, and deeply entrenched misconceptions about antibiotic use. Common practices such as prematurely stopping antibiotics once symptoms subside, using antibiotics for viral infections like the common cold, or demanding antibiotics without prescriptions exacerbate the problem at the community level [4-6].
Despite government initiatives and awareness campaigns, gaps in public understanding persist. Many individuals remain unaware of the importance of completing prescribed antibiotic courses, the dangers of unnecessary antibiotic use, and the long-term societal impact of resistance. As antibiotic resistance transcends individual health and poses a collective threat, understanding public attitudes and behaviors becomes crucial for designing effective interventions [7,8].
This study aims to assess the level of awareness, misconceptions, and practices related to antibiotic use and resistance among the residents of Mandi. By identifying knowledge gaps and behavioral trends, the research seeks to inform targeted educational strategies and policy actions that can curb misuse and promote responsible antibiotic practices at the grassroots level.
Study Design
This study employed a descriptive, cross-sectional design to evaluate public awareness, misconceptions, and practices related to antibiotic use and resistance among residents of Mandi district, Himachal Pradesh. The objective was to gather baseline data that could inform local health promotion efforts aimed at combating antibiotic misuse and resistance.
Study Area and Population
The study was conducted in Mandi, a geographically diverse district with a mix of urban and rural populations. The target participants included adults aged 18 years and above, encompassing various educational and socioeconomic backgrounds. Both individuals with prior antibiotic use and those with no recent antibiotic exposure were included to capture a broad range of experiences and perceptions.
Study Duration
Data collection was carried out over a three-month period from January to March 2025, ensuring sufficient coverage across different community settings, including marketplaces, health centers, educational institutions, and residential areas.
Sample Size and Sampling Technique
A sample size of 400 participants was determined using a 95% confidence level, a 5% margin of error, and an anticipated 50% prevalence of basic antibiotic awareness, ensuring statistical reliability. Participants were selected through a combination of purposive and snowball sampling methods, leveraging community health workers, local NGOs, and social networks to maximize reach across urban and rural settings.
Inclusion and Exclusion Criteria
Inclusion Criteria
Residents of Mandi district aged 18 years and older
Ability to understand and respond in Hindi or English
Willingness to provide informed consent
Exclusion Criteria
Healthcare professionals (to minimize professional bias)
Individuals unable to provide informed consent due to cognitive or communication impairments
Data Collection Tool
A structured, pre-validated questionnaire was developed in consultation with infectious disease specialists and public health experts. The bilingual questionnaire (Hindi and English) comprised four sections:
Demographics: Age, gender, education, occupation, residential setting (urban/rural).
Knowledge Assessment: Questions on basic concepts of antibiotics, resistance, necessity of completing courses, and correct indications for antibiotic use.
Perceptions and Misconceptions: Beliefs about the efficacy of antibiotics against viral infections, use of leftover antibiotics, and self-medication practices.
Behavioral Practices: Frequency of antibiotic use, adherence to prescribed courses, sources of antibiotics, and consultation behaviors.
Data Collection Procedure
Data were collected through face-to-face interviews conducted by trained surveyors for participants with limited literacy and self-administered questionnaires for literate participants. Both online (via Google Forms) and offline (paper-based) modes were employed to ensure inclusivity, particularly for digitally disconnected populations in rural areas.
Scoring and Data Classification
Responses to knowledge and perception items were scored as correct or incorrect. Cumulative scores were classified into four categories: Very Good (≥80% correct responses), Good (60–79%), Fair (41–59%), and Poor (<40%). Behavioral data were analyzed to identify patterns of safe and unsafe antibiotic use practices.
Data Analysis
Data were entered into Microsoft Excel and analyzed using SPSS version 26.0. Descriptive statistics, including frequencies, percentages, and means, were used to summarize the findings. Cross-tabulations were performed to explore associations between demographic factors and awareness levels.
Ethical Considerations
Participation was voluntary and anonymous, with informed consent obtained digitally or verbally before data collection. No personal identifiers were collected, and confidentiality was strictly maintained. Ethical approval was secured from a recognized institutional ethics committee prior to commencement of the study.
Table 1 presents the socio-demographic profile of the 400 participants surveyed in Mandi district. The majority of respondents (39.5%) belonged to the 26–35 age group, followed by 25.5% aged 36–45 years, and 22.8% aged 18–25 years, reflecting a largely young to middle-aged adult population. Gender distribution was almost equal, with females accounting for 51.0% and males for 49.0%. Educational attainment varied, with 35.3% having completed secondary education and 29.8% holding an undergraduate degree, while 7.3% had no formal education. In terms of occupation, homemakers formed the largest group (34.3%), followed by self-employed individuals (22.3%) and students/unemployed (21.3%). A significant rural representation was observed, with 66.0% of respondents residing in rural areas, emphasizing the study's focus on semi-urban and rural healthcare awareness.
Table 2 summarizes the awareness and knowledge of antibiotic use and resistance among participants. Overall, knowledge levels were encouraging, with 78.0% correctly identifying antibiotics as drugs for bacterial infections and 71.8% understanding that antibiotics cannot treat viral infections. Awareness of critical issues such as the role of early antibiotic cessation in promoting resistance (81.5%), dangers of self-medication (75.3%), and necessity of prescriptions (84.8%) was notably high. Positive responses were also seen regarding misconceptions like sharing antibiotics (83.0%) and reusing leftover medications (76.0%). However, gaps remained regarding the transmission of resistant bacteria (65.5%) and the long-term impact on future generations (62.8%). These results reveal a generally strong awareness foundation, but highlight specific misconceptions that need targeted correction.
Table 3 classifies participants based on their overall knowledge scores. A substantial 41.8% demonstrated a "Good" level of knowledge (60–79% correct responses), while 32.3% achieved a "Very Good" score (≥80%), indicating a promising level of public understanding. However, 19.0% fell into the "Fair" category (41–59%) and 7.0% into the "Poor" category (<40%), suggesting that approximately one-fourth of the population still holds significant misconceptions or inadequate knowledge about antibiotic resistance. These insights underscore the necessity for continuous public education campaigns, especially targeted at the lower-knowledge segments.
The findings of this study provide valuable insights into the current levels of awareness, misconceptions, and practices surrounding antibiotic use and resistance among the residents of Mandi district. Given the growing public health threat posed by antibiotic resistance globally and nationally, it is encouraging to observe that a substantial proportion of the study population demonstrated a good to very good understanding of basic antibiotic concepts. Notably, 78% correctly identified antibiotics as drugs for bacterial infections, and over 80% recognized that stopping antibiotics prematurely can contribute to resistance. These figures suggest that fundamental public health messages have begun to penetrate community consciousness, likely due to increased media exposure, health campaigns, and interactions with healthcare providers.
However, despite this foundational awareness, significant gaps remain. Alarmingly, nearly 30% of respondents still harbored misconceptions, such as believing antibiotics can treat viral infections, and about one-third did not fully grasp the concept of bacterial resistance transmission. Similarly, only 62.8% were aware that antibiotic resistance could impact future generations, indicating a limited understanding of the broader societal consequences of antibiotic misuse. This gap between basic awareness and in-depth knowledge points to the superficial nature of current information dissemination efforts people may have heard about antibiotic resistance but lack a comprehensive understanding of its implications.
Educational attainment appeared to correlate positively with knowledge scores, as individuals with secondary education or higher were more likely to fall into the "Good" or "Very Good" categories. Nevertheless, the high rural representation (66%) in the sample also revealed the persistent challenges faced by semi-urban and rural populations in accessing accurate health information.
Table 1: Socio-Demographic Characteristics of Participants
| Variable | Category | Frequency (n) | Percentage (%) |
| Age Group (Years) | 18–25 | 91 | 22.8 |
| 26–35 | 158 | 39.5 | |
| 36–45 | 102 | 25.5 | |
| 46 and above | 49 | 12.3 | |
| Gender | Female | 204 | 51.0 |
| Male | 196 | 49.0 | |
| Education Level | No formal education | 29 | 7.3 |
| Primary school | 76 | 19.0 | |
| Secondary school | 141 | 35.3 | |
| Undergraduate degree | 119 | 29.8 | |
| Postgraduate degree | 35 | 8.8 | |
| Occupation | Homemaker | 137 | 34.3 |
| Self-employed | 89 | 22.3 | |
| Government employee | 46 | 11.5 | |
| Private sector | 43 | 10.8 | |
| Student/Unemployed | 85 | 21.3 | |
| Residential Setting | Urban | 136 | 34.0 |
| Rural | 264 | 66.0 |
Table 2: Awareness and Knowledge of Antibiotic Resistance Among Participants
No. | Question | Options | Correct Responses (n) | Percentage (%) |
1 | What are antibiotics? | a) Painkillers, b) Drugs for bacterial infections, c) Antiviral drugs, d) Vaccines | 312 | 78.0 |
2 | Can antibiotics treat viral infections? | a) Yes, b) No, c) Only flu, d) Only with vitamins | 287 | 71.8 |
3 | What is antibiotic resistance? | a) Weak antibiotics, b) Bacteria resisting antibiotics, c) Drug allergies, d) Expired drugs | 268 | 67.0 |
4 | Does stopping antibiotics early cause resistance? | a) Yes, b) No, c) Only for children, d) Only for severe infections | 326 | 81.5 |
5 | Can self-medication lead to antibiotic resistance? | a) Yes, b) No, c) Only with OTC drugs, d) Only in hospitals | 301 | 75.3 |
6 | Should antibiotics be taken only with a prescription? | a) Yes, b) No, c) Only for chronic diseases, d) Pharmacist can decide | 339 | 84.8 |
7 | Can overuse of antibiotics reduce their effectiveness? | a) Yes, b) No, c) Only for generics, d) Only in elderly | 317 | 79.3 |
8 | Is sharing antibiotics with others safe? | a) Yes, b) No, c) Only with family, d) Only for same symptoms | 332 | 83.0 |
9 | Can antibiotic resistance increase treatment costs? | a) Yes, b) No, c) Only in cities, d) Only for surgeries | 294 | 73.5 |
10 | Are antibiotics needed for a common cold? | a) Yes, b) No, c) Only with fever, d) Only in children | 279 | 69.8 |
11 | Does completing the full antibiotic course reduce resistance? | a) Yes, b) No, c) Only for new drugs, d) Only in hospitals | 323 | 80.8 |
12 | Can resistant bacteria spread to others? | a) Yes, b) No, c) Only in hospitals, d) Only through food | 262 | 65.5 |
13 | Are antibiotics safe for all ages without a doctor’s advice? | a) Yes, b) No, c) Only for adults, d) Only for OTC drugs | 336 | 84.0 |
14 | Can leftover antibiotics be reused later? | a) Yes, b) No, c) Only for same illness, d) Only with pharmacist advice | 304 | 76.0 |
15 | Does antibiotic resistance affect future generations? | a) Yes, b) No, c) Only in urban areas, d) Only with poor hygiene | 251 | 62.8 |
16 | Can proper hygiene reduce antibiotic resistance? | a) Yes, b) No, c) Only in hospitals, d) Only with vaccines | 313 | 78.3 |
17 | Should pharmacists dispense antibiotics without prescription? | a) Yes, b) No, c) Only for emergencies, d) Only for known customers | 328 | 82.0 |
18 | Can antibiotic resistance lead to untreatable infections? | a) Yes, b) No, c) Only in elderly, d) Only in rural areas | 272 | 68.0 |
19 | Is it safe to buy antibiotics from informal sources? | a) Yes, b) No, c) Only if cheap, d) Only for minor issues | 341 | 85.3 |
20 | Who educates about antibiotic resistance? | a) Media, b) Healthcare professionals, c) Family, d) Friends | 319 | 79.8 |
Table 3: Knowledge Score Classification
| Knowledge Category | Score Range | Frequency (n) | Percentage (%) |
| Very Good | ≥80% | 129 | 32.3 |
| Good | 60%–79% | 167 | 41.8 |
| Fair | 41%–59% | 76 | 19.0 |
| Poor | <40% | 28 | 7.0 |
In rural settings, where reliance on informal healthcare providers and pharmacies is common, misconceptions about the need for prescriptions, the safety of self-medication, and the reuse of leftover antibiotics are especially concerning. Although 84.8% agreed that antibiotics should only be taken with a prescription, anecdotal evidence and national trends suggest that enforcement of prescription-only policies remains weak in practice.
Behavioral practices also highlight a worrying trend: while the majority knew about the dangers of self-medication and incomplete courses, previous studies and the findings here suggest that knowledge does not always translate into behavior. Economic constraints, convenience, and ingrained habits often lead individuals to purchase antibiotics without prescriptions, share medications with others, or discontinue usage once symptoms abate. These risky behaviors not only endanger individual health but also contribute to the silent evolution of resistant bacterial strains within the community.
Another critical observation is the over-reliance on media and family members for antibiotic-related information, with healthcare professionals accounting for only a part of the information sources. Although 79.8% acknowledged healthcare workers as educators on antibiotic resistance, informal and non-expert advice still plays a considerable role, underlining the importance of strengthening the role of healthcare providers and community health workers as trusted messengers of accurate antibiotic stewardship principles.
The study findings underscore the urgent need for multifaceted intervention strategies. Public education campaigns must move beyond basic awareness to deeper, behavior-focused messaging that emphasizes the consequences of misuse and the importance of completing antibiotic courses. School-based education, community workshops, and mass media campaigns tailored to rural literacy levels and local languages could significantly enhance understanding. Additionally, stricter regulation and monitoring of over-the-counter antibiotic sales, coupled with pharmacist training to reinforce prescription-only policies, are necessary structural changes.
Finally, while this study's robust sample size and balanced representation of urban and rural residents enhance the generalizability of the findings, certain limitations exist. The exclusion of healthcare professionals, although methodologically justified to avoid bias, also excluded a potential perspective on healthcare system gaps. Moreover, the self-reported nature of the questionnaire may introduce social desirability bias, where respondents overstate good practices. Nevertheless, the insights gathered serve as a crucial baseline for public health authorities, indicating both progress made and areas requiring intensified efforts to curb antibiotic resistance at the grassroots level.
This study highlights that while a substantial portion of Mandi's residents possess a good foundational understanding of antibiotics and antibiotic resistance, significant knowledge gaps and behavioral inconsistencies persist particularly regarding misconceptions about antibiotic use for viral infections, transmission of resistance, and the societal impact on future generations. Although awareness of prescription-only use, completion of antibiotic courses, and the dangers of self-medication was encouraging, the persistence of unsafe practices underscores the urgent need for more intensive, behavior-focused educational interventions. Rural populations, in particular, require targeted outreach through culturally appropriate, community-driven programs to deepen understanding and promote responsible antibiotic use. Strengthening healthcare provider engagement, enforcing prescription regulations, and integrating antibiotic stewardship into local health policies are crucial steps toward mitigating the growing threat of antibiotic resistance at the grassroots level. Ultimately, sustainable change will depend on bridging the gap between knowledge and practice, ensuring that awareness translates into consistent, responsible behaviors that protect both individual and public health.
Reena, A., and A. Ittyachen. "Awareness of Antibiotic Resistance among Medical Students in Kerala State, India: A Cross-Sectional Study." Current Medical Issues, vol. 20, no. 4, Oct.-Dec. 2022, pp. 245–252.
Nguyen, N.V., Y. Marothi, and M. Sharma. "Knowledge, Attitude, and Practice Regarding Antibiotic Use and Resistance for Upper Respiratory Tract Infections among the Population Attending a Mass Gathering in Central India: A Cross-Sectional Study." Antibiotics (Basel), vol. 11, no. 11, 25 Oct. 2022, p. 1473.
Khan, R.T., M. Bhardwaj, S. Kailoo, R. Khajuria, and S. Rasool. "A Statistical Study on Awareness of Antibiotic Resistance among the General Population." Indian Journal of Biochemistry and Biophysics, vol. 61, Aug. 2024, pp. 504–509.
Laxminarayan, R., and R.R. Chaudhury. "Antibiotic Resistance in India: Drivers and Opportunities for Action." PLoS Medicine, vol. 13, no. 3, 2 Mar. 2016, p. e1001974.
Bhardwaj, K., S.M. Shenoy, S. Baliga, B. Unnikrishnan, and B.S. Baliga. "Knowledge, Attitude, and Practices Related to Antibiotic Use and Resistance among the General Public of Coastal South Karnataka, India: A Cross-Sectional Survey." Clinical Epidemiology and Global Health, vol. 11, Jul.-Sep. 2021, p. 100717.
Rana, S., K.N. Kaur, P. Narad, K. Walia, S. Saeed, A. Chandra, eta al. "Knowledge, Attitudes, and Practices of Antimicrobial Resistance Awareness among Healthcare Workers in India: A Systematic Review." Frontiers in Public Health, vol. 12, 2024, p. 1433430.
Singh, V.P., D. Jha, B.U. Rehman, V.S. Dhayal, M.S. Dhar, and N. Sharma. "A Mini-Review on the Burden of Antimicrobial Resistance and Its Regulation across One Health Sectors in India." Journal of Agriculture and Food Research, vol. 15, Mar. 2024, p. 100973.
Download PDF
Download PDF
Download PDF
Download PDF
Download XML
