Knowledge, Attitudes, and Practices of Antibiotic Use and AMR in Low-Income Urban Delhi, India: A Community-Based Cross-Sectional Study

Abstract

Background: Antimicrobial resistance (AMR) is a major public health threat in India, driven by the misuse of antibiotics. However, there is a lack of community-level data on AMR awareness and antibiotic use practices, especially in low-income urban settings. This study aimed to assess the knowledge, attitudes, and practices (KAPs) regarding antibiotic use and AMR among residents of a low-income area in Delhi. Methods: A community-based, cross-sectional study was conducted from April to June 2025 among 1601 adults in a low-income urban area of Delhi, using a validated questionnaire. Data on sociodemographic and KAP regarding antibiotics and AMR were collected. Ordinal and binary logistic regression analyses were performed to identify sociodemographic determinants of KAP. Results: While 68.0% of participants had heard of antibiotics, specific knowledge was poor. Only 19.4% were aware of AMR, and significant misconceptions were prevalent, with 47.5% believing that antibiotics were effective for colds and flu. Self-medication with antibiotics was reported by 24.6% of respondents. Lower educational attainment, female gender, and lower income were significantly associated with poorer antibiotic knowledge and practices. Higher knowledge scores were strongly associated with better practices (AOR: 1.30, 95% CI: 1.23, 1.37, p < 0.001). Conclusions: Critical knowledge gaps and high-risk antibiotic use practices are prevalent in this low-income urban community, strongly linked to social determinants like education, gender, and income. There is an urgent need for evidence-informed and tailored educational and behavior change interventions to curb irrational antibiotic demand and preserve these vital medicines.