Health Literacy and Interventions on Antibiotics Use and AMR in Younger Generations in High-Income Countries-A Systematic Review.

Abstract

Antimicrobial resistance (AMR) is a growing threat to global health, accelerated by the widespread inappropriate use of antibiotics. Although educational initiatives have been launched worldwide, there is little evidence on how younger generations in high-income countries (HICs) understand and address AMR. Addressing the AMR crisis requires proactive education of younger generations, including children, adolescents, and young adults, who will shape future healthcare practices. This review analyzes existing research on AMR literacy among these age groups in HICs, as knowledge gaps and risky behaviors persist even in HICs, despite their strong education and health infrastructures. The purpose of this review is to examine the knowledge, attitudes, and behaviors related to antibiotic use and antibiotic resistance in younger generations while identifying effective educational interventions.

Methods: We performed a comprehensive literature search in PubMed until June 2025, followed by AI-assisted screening (Claude 4.0 Sonnet) and a manual review. The search strategy combined terms from the areas of health literacy, antibiotics, antibiotic resistance/AMR, and young populations. Studies in HICs that examined the younger generation's knowledge about antibiotics and AMR, analyzed their attitudes or behavior toward them, or evaluated relevant educational interventions were included. Data were synthesized thematically across all included studies.

Results: Nineteen studies from 11 HICs were included, including thirteen cross-sectional surveys and six educational intervention studies. The results showed that misconceptions about how antibiotics work are still very common. Several of those asked (22-80%) incorrectly stated that resistance develops in the human body and not in bacteria. Many (26-77%) mistakenly agreed with the statement that antibiotics treat viral infections. Concerning behaviors included high rates of self-medication, non-adherence to treatment, and unsafe storage practices. Several authors propose an amendment of curricula. Educational interventions, particularly gamification and peer education approaches, showed improvements in knowledge and sustained learning outcomes.

Conclusions: Knowledge of AMR among young people in HICs is still inadequate, despite educational advantages. Most existing studies focus on college students, while children and adolescents, crucial groups for early prevention, are underrepresented. Targeted, age-appropriate education employing interactive methods represents an evidence-based strategy to improve antibiotic use behavior and support global AMR control efforts.