Significant gaps in practice present despite higher levels of public awareness in antibiotic use and antimicrobial resistance in the western province of Sri Lanka.

Background. Antibiotic misuse, influenced by urbanization and limited healthcare access, has accelerated antibiotic resistance, impacting global health. Surveillance in Sri Lanka's National Strategic Plan for Combating Antimicrobial Resistance (2017-2022) shows significant multidrug resistance in hospitals, with 12.7% of the health budget (3.3 billion) spent on antimicrobials. This resistance complicates treatment and increases patient management costs, particularly in the Western Province, a focal area for analysing antibiotic misuse. Objectives. To assess public awareness of antibiotic misuse and antimicrobial resistance in the Western Province of Sri Lanka. Methodology. A cross-sectional study was conducted on 200 adults in the Western Province from 23 December 2023 to 16 January 2024, using in-person interviews and a Google form questionnaire. Descriptive statistics were applied to analyse the data, and a binary logistic regression analysis was conducted to identify predictors of antimicrobial resistance (AMR) knowledge among participants. The model included sociodemographic, behavioural and awareness-related variables, with statistical significance set at P<0.05. Results. Of the respondents, 83% knew antibiotics combat bacterial infections, while 71.5% adhered to completing antibiotic courses. However, 28.5% opposed doing so, with 65.5% stopping antibiotics once they felt better. Regarding antimicrobial resistance, 60.5% recognized the term, and 61% acknowledged that unnecessary antibiotic use could increase bacterial resistance. Participants from the Kalutara District had nearly nine times more good AMR knowledge (AOR=9.10, P=0.005), while those earning LKR 20,000-75,000 had almost 11 times more good knowledge (AOR=11.10, P=0.033) and those who followed the advice of a health professional had even more knowledge (AOR=851.08, P=0.016). Poor knowledge was observed from the rural population (AOR=0.15, P=0.006) and those who had ever been infected (AOR=0.21, P=0.023). Good knowledge was also present among those who had been divorced or widowed (AOR=12.21, P=0.029), had used antibiotics privately and without prescriptions (AOR=4.67, P=0.027) or who had heard of AMR but could not remember the source (AOR=51.60, P<0.001). Conclusion. Most participants understood antibiotics' role, though gaps in correct use and awareness of misuse consequences persisted. While there was a positive attitude towards antimicrobial resistance, further educational efforts are essential to address knowledge gaps, as recent studies show high resistance levels and limited progress in awareness.