Antibiotic use patterns and misuse

Approximately half of the students reported antibiotic use within the past year, consistent with rates observed among university students internationally. ^{Reference Azim, Ifteakhar, Rahman and Sakib15,Reference Precha, Sukmai and Hengbaru16} Almost one in five had self-medicated using leftover or non-prescribed antibiotics, a pattern mirroring studies in higher education student populations ^{Reference Leal, Mamani, Quach and Bedard10,Reference Shahpawee, Chaw, Muharram, Goh, Hussain and Ming17} . This inappropriate antibiotic use, both incomplete course adherence and reuse, reinforces the need for AMS interventions to address these issues in practice. Misuse was observed across both health-related and non-health-related disciplines, indicating that disciplinary education on AMR may not sufficiently shape behavior.

Fewer than one in five students reported undergoing diagnostic testing prior to receiving antibiotics, reinforcing persistent limitations in diagnostic investigations for managing infections in clinical practice. These findings highlight the need for multifaceted strategies that combine education with system-level reinforcement of evidence-based prescribing norms and easier access to diagnostic investigations in primary care settings.

Knowledge gaps and persistent misconceptions

Although overall knowledge of AMR was high (mean score: 77.9%), notable misconceptions persisted. Approximately one-third of respondents mistakenly believed that the human body (rather than bacteria) develops resistance. These misconceptions are not uncommon. Similar findings have been reported among students in other countries and persist even among students who report awareness of AMR, indicating that knowledge does not reliably translate into appropriate antibiotic use. ^{Reference Shahpawee, Chaw, Muharram, Goh, Hussain and Ming17–Reference Hill21} Furthermore, most students believed antibiotics were appropriate for viral infections. These findings reflect ongoing confusion about appropriate antibiotic indications and a limited understanding of the bacterial-viral infection distinction. A recent systematic review evaluating public knowledge of antibiotic use and AMR identified similar gaps in knowledge, with only 42.1% (95% CI: 39.2–44.9) recognizing that antibiotics are ineffective against viral infections. ^{Reference Shahpawee, Chaw, Muharram, Goh, Hussain and Ming17,Reference Auta, Adewuyi and Hedima22} Furthermore, a systematic review of healthcare professional and healthcare student knowledge, attitudes and practice regarding AMS and infection prevention reported significant gaps, with knowledge varying widely across professions, settings, and experience levels. ^{Reference Ghosh, Adedunmola and Alkan23} The persistence of such misconceptions, even among students from science and health-related disciplines, reinforces the need for curriculum enhancement, particularly in microbiology and application of AMR and AMS principles in clinical practice.

Attitudes, knowledge, and the perception-action gap

PCA identified four underlying attitudinal dimensions: responsible use and preventive behavior, global and collective awareness, innovation and policy solutions, and perceived helplessness and reliance on experts. “Global and Collective Awareness,” captured strong recognition of AMR as a major global issue, paired with weak perception of personal susceptibility. This divergence reflects a perception-action gap supported by a systematic review of medical students, in which recognition of AMR as a major global health threat did not consistently translate into perceived personal responsibility or stewardship behaviors. ^{Reference Nogueira-Uzal, Zapata-Cachafeiro, Vázquez-Cancela, López-Durán, Herdeiro and Figueiras12} This interpretation is further supported by recent evidence showing that inappropriate antibiotic use is more strongly associated with behavioral and attitudinal factors than with knowledge alone. ^{Reference Marzi, Tunc, Donmez, Sener and Marzi24}

Addressing this gap requires educational approaches that move beyond information provision toward activation of personal relevance and agency. Behavioral-science evidence suggests that interventions combining factual reinforcement with emotionally salient framing, such as peer narratives or interactive digital media, can transform abstract concern into personal motivation, heighten personal risk perception, and emphasize social accountability. ^{Reference Hill21,Reference Scott-Dearing, Carter, Corley, Mathew and Darzi25,Reference Krockow, Jones, Tarrant, Mendelson and Flusberg26}

Source credibility and public health campaigns

Healthcare professionals were the most trusted source of AMR information; however, only 16% of students identified them as their most recent source. This credibility-access gap indicates that although healthcare professionals remain highly trusted, traditional information channels are underutilized. Instead, students appear to seek updated information primarily from peers, academic environments, and digital networks. A similar pattern was noted by Sharma et al. (2025), who found that while healthcare professionals maintain strong credibility, students predominantly rely on peer networks for current knowledge. ^{Reference Sharma, Chauhan and Ranjan27} The low recall of national and international public health initiatives such as European Antibiotic Awareness Day or e-Bug (3%–27%) echoes trends reported elsewhere and may reflect broader weaknesses in AMR risk communication, where abstract and conventional messaging limits memorability and engagement. ^{Reference Krockow, Jones, Tarrant, Mendelson and Flusberg26,Reference Wiese-Posselt, Lam and Schroder28,Reference Min, Zhou and Sun29} These findings point to a pressing need to optimize public and patient engagement in AMR outreach to better engage populations through digital, peer-driven, and context-relevant channels. ^{Reference Barello and Acampora30}

Strengths, limitations, and future opportunities

A limitation of the study was that the sample was dominated by students from science and health-related disciplines which may limit generalizability of results to the broader university population. Students from non-health programs, who represent a key audience for public awareness efforts, were comparatively underrepresented. As data were self-reported, recall and social desirability bias may have influenced reporting of responses, a limitation also identified in studies of university students’ antibiotic use. ^{Reference Hill21} Although the survey instrument was adapted from validated WHO and Eurobarometer tools, contextual differences may influence comparability with other studies. Nonetheless, the instrument provided a reliable framework for capturing key dimensions of AMR awareness and behavior within the Irish university context. The resulting data set provides a rich and in-depth overview of university student knowledge and attitudes toward antibiotic use and AMR. The findings reinforce strategic objectives by national and international AMR action plans to improve education and public awareness of AMR. ^2,3 Tailored AMS campaigns for university students have the potential to contribute significantly to improving antimicrobial and infection health literacy in the population.

Conclusion

This study provides the first systematic assessment of AMR knowledge, attitudes, and behaviors among Irish university students. This study reveals that Irish university students possess high baseline awareness of AMR but retain notable misconceptions and inconsistent antibiotic practices. Consistent with prior research these findings indicate that factual knowledge alone is insufficient to promote responsible antibiotic behaviors without corresponding personal agency, revealing a complex interplay between awareness, perception, and practice. To close this gap, educational interventions must couple scientific knowledge with behavioral activation; making AMR personally relevant, emotionally engaging, and socially reinforced. The findings will inform key strategic objectives in national action plans to address public education and awareness of antibiotic use and AMR.