Global and regional knowledge of antibiotic use and resistance among the general public: a systematic review and meta-analysis

Antibiotic resistance threatens effective infection treatment and medical procedures. Global initiatives, such as World AMR Awareness Week, aim to improve public understanding and promote rational antibiotic use to combat this growing crisis. This systematic review synthesised and analysed existing evidence on the public's knowledge of antibiotic use and resistance to provide pooled global, regional and national estimates. Data sources: We searched PubMed®, Embase®, CINAHL, grey literature, and reference lists of primary studies. Observational studies published between January 2015 and October 2025 that reported the knowledge of antibiotic use and resistance among the public. Assessment of risk of bias: The Joanna Briggs Institute's critical appraisal framework for prevalence studies was used. of data synthesis: Pooled estimates of correct knowledge were determined using random-effects meta-analysis. Of the 13,960 articles identified, 227 studies from 98 countries were included. The majority of the public correctly understood that antibiotics are effective against bacterial infections, with a pooled estimate of 73.2% (95% CI: 70.2 - 76.0). However, only 42.1% (95% CI: 39.2 - 44.9) recognised that antibiotics are ineffective against viral infections. Notable national variations were observed regarding the ineffectiveness of antibiotics against viral infections, with estimates ranging from 7.2% (95% CI: 5.3 - 9.7) in Lao DPR to 77.0% (95% CI: 74.4 - 79.4) in Sweden. Our findings indicate that a substantial proportion of the public is aware that unnecessary antibiotic use reduces their effectiveness, with a pooled estimate of 72.5% (95% CI: 69.9 - 75.0). However, significantly fewer individuals (39.1%, 95% CI: 33.7 - 44.6) were aware that antibiotic-resistant bacteria can spread from person to person. Although antibiotic awareness campaigns have expanded globally, public understanding remains insufficient, particularly concerning the ineffectiveness of antibiotics against viral infections and the transmission of antibiotic-resistant bacteria. These findings underscore the need for multifaceted strategies to promote public awareness and advance sustainable antibiotic stewardship worldwide. [Abstract copyright: Copyright © 2025 The Author(s). Published by Elsevier Ltd.. All rights reserved.]