Specialty and age-based differences in awareness and attitudes towards antibiotic stewardship: a cross-sectional online survey on Japanese clinic physicians.

Background: Antimicrobial resistance (AMR) is a critical global health issue, with inconsistent adherence to antimicrobial stewardship contributing to its worsening. This study aims to assess physicians' awareness and attitudes towards AMR and appropriate antimicrobial use across different medical specialties in Japan.

Methods: An online cross-sectional survey was conducted from January 31 to February 5, 2024, among 280 physicians from three specialties (internal medicine, pediatrics, and otorhinolaryngology) who were working in outpatient clinics in Japan. Participants were asked about their familiarity with the National Action Plan (NAP) on AMR and the manuals of Ministry of Health and Labor Welfare (MHLW) on prudent antimicrobial use. Their opinions on AMR facts and antibiotic use were also surveyed using five-point Likert scales. Data were analyzed using descriptive statistics, multilevel mixed-effects ordered logistic regression and generalized linear models to examine factors influencing NAP/manuals adherence.

Results: Most respondents were male (85%) and predominantly aged 50 and above (73.9%), Familiarity with the AMR Action Plan varied, with 36.4% of respondents reported understanding its content, while 37.5% only knew its name. Similarly, 27.1% of respondents used the MHLW manuals, whereas 48.6% were aware of them but did not use them. Internal medicine physicians showed the highest adherence to antimicrobial stewardship and most concern about AMR facts, while pediatricians demonstrated the highest adherence to MHLW manuals (AOR = 2.4, p = 0.000 compared to internal medicine doctors). Otorhinolaryngologists reported higher awareness of NAP (AOR = 2.6, p = 0.006 compared to internal medicine doctors) but had the lowest adherence to NAP and MHLW manuals. Younger physicians (< 50 years) were more proactive in addressing AMR and adhering to antimicrobial stewardship than older physicians. Messages emphasizing the prevention of drug resistance and societal impacts of AMR were most associated with positive attitudes from physicians in outpatient clinics.

Conclusions: This study highlights significant variability in AMR awareness and adherence across specialties and age groups. Internal medicine physicians showed the highest adherence, while pediatricians were the most familiar with AMR manuals. Otorhinolaryngologists demonstrated strong awareness but lower adherence. Targeted educational interventions, particularly focusing on older physicians and specific specialties, are needed to improve antimicrobial use and combat the growing threat of resistance.