Determinants of Public Knowledge, Attitude, and Practice on Antibiotic Use in Saudi Arabia: A Regional Cross-Sectional Study.

Antibiotic resistance (AMR) is a critical global and national health challenge, largely driven by the misuse and overuse of antibiotics. Understanding the public's knowledge and practices regarding antibiotic use is essential for informing effective interventions. This study aimed to assess the levels of knowledge, attitude, and practice (KAP) related to antibiotic use among adults in Saudi Arabia's Western Region and to identify the demographic and behavioral determinants of these outcomes. A regional cross-sectional survey was conducted from March to June 2025 using a 40-item self-administered online questionnaire. Adults aged ≥ 18 years residing in the Western Region of Saudi Arabia were recruited via social media using snowball sampling. Descriptive statistics and Chi-square tests were used to examine associations, while multivariate logistic regression was employed to identify determinants of high knowledge and good practices, presented as adjusted odds ratios (aOR) with 95% confidence intervals (CI). A total of 891 participants were included; most were female (63.6%) and aged 18-30 years (56.2%). Moderate knowledge of antibiotic use was observed in 54.0% of participants, while 30.8% had high knowledge. In terms of attitude and practice, 55.6% demonstrated good performance and 42.8% average performance. High knowledge was significantly associated with the female gender (aOR = 1.90; 95% CI: 1.34-2.70), age of 41-50 years (aOR = 2.22; 95% CI: 1.42-3.48), and a postgraduate education (aOR = 15.37; 95% CI: 1.84-128.13). Good practices were associated with the female gender (aOR = 2.32; 95% CI: 1.66-3.24) and being married (aOR = 1.99; 95% CI: 1.43-2.77). A moderate positive correlation was found between knowledge and practice scores (r = 0.406, < 0.001). Significant variability in public KAP regarding antibiotic use was identified. Female gender, older age, and higher education were key determinants of better KAP. These findings emphasize the need for targeted educational strategies focusing on high-risk groups to support rational antibiotic use and mitigate antimicrobial resistance.