PHWR Public Health Weekly Report

In 2019, the World Health Organization (WHO) identified antimicrobial resistance (AMR) as one of the ten major global public health threats because it reduces treatment effectiveness and leads to treatment failure in infectious diseases, thereby increasing mortality. The O’Neill [1] report estimated that, by 2050, AMR infections would cause 10 million deaths annually and result in a loss of 3% of global gross domestic product. During the coronavirus disease 2019 pandemic, although the infection was viral, antibiotics were prescribed unnecessarily in more than 70% of cases; such misuse and overuse became a major driver of the spread of resistant bacteria [2]. The WHO Western Pacific Regional Office estimated that, by 2030, AMR in the Republic of Korea (ROK) would approximately cost USD 18.8 billion (KRW 27 trillion) and result in 134,330 deaths [3].

Antibiotics are an essential means of treating infectious diseases; however, the greater their use, the greater the emergence of resistance. As of 2019, it is estimated that 1.27 million deaths were directly attributable to AMR globally, and 4.95 million deaths were associated with it. This exceeds the combined death toll from human immunodeficiency virus/acquired immune deficiency syndrome and malaria [2]. In particular, children under 5 years of age accounted for approximately 20% of all deaths, indicating that the burden of disease is especially high in children and suggesting that this age group uses antibiotics most frequently and is most affected by AMR [4]. This high burden of disease continues at present, and in 2021, approximately 1.14 million deaths were reported to be directly associated with bacterial resistance. Furthermore, the economic and social burden is expected to increase further in the future, and cumulative deaths are projected to reach 39 million by 2050, underscoring the enormous global burden of AMR [5]. The spread of AMR is not simply a matter of medical technology but is closely related to how the public and healthcare professionals understand and use antibiotics. Accordingly, in the 「Global Action Plan on Antimicrobial Resistance」, adopted in 2015, WHO identified “improving awareness and understanding of antimicrobial resistance” as first of its five strategic objectives, emphasizing that incorrect knowledge and behaviors are key mechanisms driving the spread of resistance [6].

This study emphasizes the importance of improving awareness for the prevention and control of AMR, comprehensively reviews international response directions and major awareness-improvement activities implemented in the ROK, and presents the results of recent awareness surveys conducted among the general public and healthcare professionals to provide evidence for the development of future awareness-improvement strategies.

To comprehensively evaluate the importance and effectiveness of improving awareness of AMR, this study conducted a literature review and an awareness survey. First, policy documents and previous research findings from international organizations, including WHO, the Organization for Economic Co-operation and Development (OECD), and the European Centre for Disease Prevention and Control (ECDC) were reviewed to analyze the role of awareness-improvement and international trends in addressing AMR. In addition, policy materials related to public communication campaigns and promotional activities on preventive practices implemented in the ROK were reviewed.

The awareness survey was conducted in collaboration with the Ministry of Culture, Sports and Tourism and targeted general public who use antibiotics and healthcare professionals. The survey was administered online through a professional survey agency (Research Lab Co., Ltd.). For the public survey, 1,000 individuals nationwide aged 14 years or older were recruited using proportionate quota sampling based on sex, age, and region. The survey period was from April 1 to April 8, 2025.

The awareness survey of healthcare professionals was conducted among 1,000 physicians nationwide who routinely prescribe or manage antibiotics, using purposive quota sampling based on the type of healthcare institution and medical specialty. The survey period was from March 27 to May 7, 2025.

The questionnaire for the general public included antibiotic use behaviors, knowledge and awareness regarding antibiotics and AMR, and experience of exposure to educational and promotional information. The questionnaire for healthcare professionals included antibiotic prescribing behaviors, awareness of AMR, experience in obtaining information and receiving education, and awareness of antimicrobial stewardship programs.

The collected data were analyzed using descriptive statistical methods and patterns of change in awareness and behavior due to exposure to antibiotic-related information were also compared and analyzed.

1. Results of the Public Survey on Awareness of AMR

First, regarding antibiotic use behaviors, 16.0% of respondents reported having taken antibiotics without a physician’s prescription and 63.4% reported having stopped taking prescribed antibiotics once their symptoms improved (Figure 1).

Figure 1. Public antibiotic use behaviors and awareness about antibiotics

Second, regarding knowledge of antibiotics, the largest proportion of respondents (58.1%) answered that antibiotics are used to treat bacterial and viral infectious diseases, whereas only 22.6% correctly recognized that they are used to treat only bacterial infectious diseases. Furthermore, 72.0% incorrectly believed that antibiotics help treat the common cold, and 17.9% believed that the longer antibiotics are taken, the better the treatment effect (Figure 1).

Third, regarding trust in antibiotic prescriptions, 80.3% of respondents reported that they trust the antibiotics prescribed by the physician treating them (Figure 2).

Figure 2. Public perception of the severity of antimicrobial resistance and public access to related information

Fourth, regarding awareness of AMR, 77.5% of respondents considered AMR in the ROK to be a serious problem, and 92.9% believed that AMR increases when antibiotics are not used appropriately. In addition, 65.1% responded that the general public can contribute to reducing AMR (Figure 2).

Fifth, 40.0% of respondents reported having been exposed to information about antibiotic use or AMR, and 71.6% stated that such information had changed their thoughts or behaviors regarding antibiotic use (Figure 2).

In summary, these survey findings show that inappropriate antibiotic use behaviors persist among the general public, including asking physicians to prescribe antibiotics, taking antibiotics without a physician’s prescription, and arbitrarily discontinuing prescribed antibiotics. Misunderstandings about the purpose of antibiotics also remain common. However, considering that public trust in physicians’ prescriptions exceeded 80% and that the rate of behavioral change among those exposed to information on AMR was high (71.6%), these findings suggest that appropriate prescribing by physicians and the provision of accurate information on AMR can ultimately promote appropriate antibiotic use behaviors among the public. Therefore, continuously providing the public with accurate information on the purpose and appropriate use of antibiotics is essential for reducing the emergence of resistance.

2. Results of the Survey on Awareness of AMR among Healthcare Professionals

First, regarding antibiotic prescribing behaviors, 20.8% of respondents reported having prescribed antibiotics in unnecessary situations. The most common reason was “because the patient requested it” (30.4%), followed by “because of concern about worsening symptoms” (24.0%) and “because it was difficult to perform tests and accurately determine whether antibiotics were necessary” (18.8%). Regarding indications for antibiotic prescribing, 91.2% responded that their prescribing adhered to antibiotic use guidelines (Figure 3).

Figure 3. Awareness and prescribing behaviors of healthcare workers and their perceptions of the severity of antimicrobial resistance

Second, regarding awareness of AMR, the most commonly identified main cause of increasing AMR was “excessive antibiotic prescribing” (41.0%), and 89.1% rated the seriousness of AMR as high from a public health perspective (Figure 3).

Third, 64.3% of respondents believed that they had received sufficient education over the past year on appropriate use of antibiotics and AMR, whereas 89.1% responded that education on appropriate antibiotic use and AMR is necessary (Supplementary Figure 1; available online).

Fourth, 39.3% reported that they were aware of antimicrobial stewardship programs. When asked what physicians who prescribe antibiotics should do to address AMR, the most common response was “accurate diagnosis and appropriate antibiotic selection” (46.3%), followed by “adherence to antibiotic use guidelines and domestic and international clinical guidelines” (24.3%) and “education and explanation to patients regarding antibiotic use” (11.8%) (Supplementary Figure 1; available online).

These findings indicate that although misuse and overuse of antibiotics are major causes of AMR, unnecessary prescriptions by physicians still persists, and a substantial proportion of such prescriptions is driven by patient demands or concerns about worsening symptoms. Furthermore, although a high proportion recognized the need for education (89.1%), the proportion who had actually received such education was lower (64.3%). Therefore, to reduce inappropriate prescribing practices, it is necessary to provide sufficient explanations during clinical encounters as to why antibiotics are unnecessary and expand educational opportunities for healthcare professionals on appropriate antibiotic use so that prescription of antibiotics can be conducted in accordance with relevant guidelines.

The findings of this awareness survey provide baseline data that can be used to assess educational and promotional strategies for the prevention and control of AMR in the ROK. Public trust in the physician treating them was very high, at 80.3%. This high level of trust suggests that public’s antibiotic use behavior depends heavily on the recommendations and prescriptions of healthcare professionals. In response, the Korea Disease Control and Prevention Agency has focused on developing and operating educational programs for healthcare professionals and on developing and disseminating evidence-based, disease-specific antibiotic use guidelines so that healthcare professionals can properly explain the need for appropriate prescriptions to patients and make evidence-based prescribing decisions grounded in their expertise. This is a strategy intended to change prescribing behaviors among healthcare professionals and reduce unnecessary prescriptions by enabling them to explain situations in which antibiotics are not required.

However, in addition to the efforts of healthcare professionals, changes in awareness and the practice of appropriate antibiotic use among the public is necessary. Behaviors such as arbitrary discontinuation of antibiotics (63.4%) and misconceptions about the common cold (72.0%) identified in the survey arise after the prescribing stage, supporting the need for public awareness-improvement activities to be promoted as an ongoing task rather than a one-time intervention. In particular, the observation of behavior change (71.6%) among those exposed to antibiotic-related information in this study suggests that awareness-improvement activities can lead to actual changes in antibiotic use behavior. International cases likewise show that such awareness campaigns are used as key strategies for establishing a culture of appropriate antibiotic use. In the United Kingdom, the “Keep Antibiotics Working” campaign, implemented alongside adherence to the “Start Smart, Then Focus” prescribing guidelines, led to an approximately 7.5% reduction in nationwide antibiotic use between 2012 and 2017 [7]. In France, the “Antibiotics Are Not Automatic” campaign also reduced community antibiotic use by 26.5% over 5 years [8]. OECD and ECDC have evaluated such awareness-improvement and educational interventions as highly cost-effective strategies [1,9].

In line with these international trends, the ROK also operates annual activities for World Antimicrobial Awareness Week and is promoting campaigns in which the public and healthcare professionals respond together in their respective roles. In 2025, tailored slogans were developed based on the findings of this survey (Tables 1, 2). For the public, the message “Antibiotic misuse lasts a moment, resistance lasts a lifetime” was designed to encourage responsible use. For healthcare professionals, the slogan “The public trusts you; that trust prevents resistance” was distributed to emphasize their leading role as experts. This was based on the understanding that the response to AMR can be more effective when appropriate prescription by healthcare professionals and responsible use by the public occur together.

Table 1 Public awareness week slogans (public)

Slogan
To improve public awareness and promote the proper use of antibiotics.
- Antibiotic misuse can take a moment! Resistance lasts a lifetime!
- When you overuse antibiotics you think are helping, neither your doctor nor your medicine can protect you.

Table 2 Public awareness week slogans (healthcare professionals)

Slogan
To promote improved prescribing practices and encourage appropriate antibiotic use.
- Your actions matter. The public follows your lead on appropriate antibiotic use.
- The public trusts you. That trust is our strongest defense against resistance.

This survey may serve as baseline data for future AMR awareness-improvement programs. However, because it was conducted as a web-based online survey, the results may not reflect groups with limited internet access and may therefore have either overestimated or underestimated actual awareness levels. Moreover, the survey of healthcare professionals used purposive quota sampling, limiting the extent to which it can be regarded as fully representative of the entire population of healthcare professionals. Nevertheless, given that the purpose of this survey was to identify the overall trend in awareness levels in the ROK, it is expected that future repeated surveys based on fixed core items will allow time-series comparisons, thereby supplementing and enhancing the use of these findings.

In conclusion, AMR is one of the most serious health threats, but it is also a preventable threat. The spread of AMR can greatly vary depending on how the public and healthcare professionals understand and use antibiotics. As confirmed by the results of this awareness survey, inappropriate antibiotic use behaviors and gaps in knowledge still persist, and these may act as potential factors that accelerate the spread of resistance. Therefore, to effectively curb AMR, strategies that not only provide accurate information but also improve understanding and induce behavior change among the public and healthcare professionals are essential. Therefore, awareness-raising campaigns and strengthened education for healthcare professionals are important tools for achieving appropriate antibiotic use and preventing the increase of resistance.

Currently, separate campaigns are being conducted across multiple sectors, including humans, animals, and food; however, the same messages are delivered in a fragmented manner. In the future, it is necessary to establish joint interministerial promotional efforts and an integrated communication strategy so that resources can be used efficiently and more consistent and clearer messages can be delivered to the public. This collaborative approach will serve as a foundation for strengthening social consensus and the willingness to act among various stakeholders in responding to AMR.

Furthermore, AMR cannot be resolved by a single sector within a short period of time. It can be expected to progress only when long-term improvements in public participation and awareness are supported across multiple sectors, including humans, animals, plants, food, and the environment. Ultimately, the public’s and healthcare professionals’ correct understanding of AMR and their responsible behavior constitute the first line of defense in protecting the health of future generations. The education, communication, and policy efforts we undertake now will serve as an important foundation for preventing the spread of AMR and maintaining a sustainable healthcare system.

Ethics Statement: Not applicable.

Funding Source: None.

Acknowledgments: None.

Conflict of Interest: The authors have no conflicts of interest to declare.

Author Contributions: Conceptualization: UJC, JMK. Data curation: UJC, JMK. Formal analysis: UJC, JMK. Investigation: UJC, JMK. Methodology: UJC, JMK. Project administration: UJC, JMK, SYL, SHS, NRS. Supervision: SHS, NRS. Visualization: UJC, JMK. Writing – original draft: UJC. Writing – review & editing: UJC, JMK, SYL, SHS, NRS.

Supplementary data are available online.