Global and regional knowledge of antibiotic use and resistance among healthcare students: A systematic review and meta-analysis

Abstract

Aims: We synthesized and analysed existing evidence on healthcare students' knowledge of antibiotic use and resistance to provide pooled global and regional estimates. Methods: The PubMed®, Embase® and CINAHL databases were searched for studies published between January 2015 and October 2025 that reported the knowledge of antibiotic use and resistance among healthcare students. Pooled estimates and 95% confidence interval (CI) of correct knowledge were determined using random-effects meta-analysis. Results: Of the 8623 articles identified, 131 studies with data from 43 countries met the inclusion criteria. Most healthcare students correctly understood that antibiotics are effective against bacterial infections (88.7%, 95% CI: 87.0–90.5) but ineffective against viruses (70.0%, 95% CI: 65.6–74.4). However, only 57.9% (95% CI: 51.5–64.3) knew that antibiotics are ineffective against colds and flu, while just over half (51.5%, 95% CI: 41.6–61.4) of the students correctly knew that antibiotics do not speed up recovery from common colds and flu. Significant regional differences were observed in the understanding that antibiotics do not speed up recovery from common colds and flu, ranging from 41.3% (95% CI: 33.5–49.1) in South Asia to 98.0% (85% CI: 94.5–99.3) in North America. Conclusions: Although our findings indicate a substantial level of antibiotic knowledge across many of the evaluated outcomes, there are significant knowledge gaps in understanding of the ineffectiveness of antibiotics against the common cold and flu. These knowledge gaps have important implications for the rational use of antibiotics and the prevention of resistance.