Reducing the growth of antimicrobial resistance (AMR) through public understanding is a goal of the World Health Organization. It is especially important in countries where antibiotics are widely available for common ailments without prescription. This study assessed understanding of antibiotics and AMR alongside perception of antibiotic usage among the general public in two diverse Sri Lankan communities: ordinary urban and indigenous rural. A cross-sectional questionnaire survey was conducted, gaining 182 urban and 147 rural responses. The majority of urban respondents (69.2%) believed that they had very good or good knowledge about antibiotics compared to 40.1% of rural respondents. Belief about knowledge and actual knowledge (measured via a test question) were correlated (r = 0.49, p = 0.001) for rural respondents, but not for urban respondents. Several misconceptions about antibiotics were highlighted, including that Paracetamol, a painkiller, was thought to be an antibiotic by more than 50% of both urban and rural respondents. In addition, 18.5% of urban and 35.4% of rural participants would keep and re-use what they perceived as leftover antibiotics. It is urgent that we pay attention to educating the general public regarding the identified misconceptions of these powerful drugs and their appropriate use.

Antimicrobial resistance (AMR) is a global health threat, but little is known about the perceptions regarding antimicrobials and AMR among healthcare professionals in Sri Lanka. This research aimed to take a One Health approach to explore the knowledge, attitudes and perceptions of antibiotic stewardship and AMR among healthcare professionals in Sri Lanka. A qualitative study, using telephone interviews, allowing for an in-depth exploration of attitudes, beliefs and perspectives was conducted. Healthcare professionals from both the medical and veterinary sectors were included (n = 29). Interviews were conducted by an independent interviewer and were audio-recorded and transcribed. Conventional qualitative content analysis was undertaken. Four main categories were identified: (1) understanding of AMR and observing AMR, (2) barriers to antimicrobial stewardship, (3) personal factors in, and as a result of, inappropriate antibiotic usage and (4) how to tackle AMR. Healthcare professionals showed poor awareness regarding the spread of AMR and identified inappropriate prescribing behaviours by their inter- and intra-professional colleagues. Patient demands and the influence of pharmaceutical companies were factors contributing to poor prescribing behaviour. Suggestions for the future are stricter regulation of AMR control policy, effective government involvement, and awareness campaigns for healthcare professionals and the public.

Background: Antimicrobial resistance can be the next global pandemic. Because of high population density, urban areas will be more vulnerable. Urban wild animals may be exposed to antimicrobials through livestock, humans, and the environment. Hence, they could act as reservoirs and indicators of environmental contamination. This study aimed to investigate the antimicrobial resistance profile in Escherichia coli isolated from livestock and wild animals in an urban ecosystem and to investigate the knowledge, awareness and perception of antibiotics and antimicrobial resistance among general public and health professionals in an urban setting in Sri Lanka. Methods: A one-square kilometer area with potential antimicrobial resistance sources was selected. Freshly voided fecal samples were collected from livestock and wild animals. Isolation, identification of E. coli and antimicrobial sensitivity test was performed for 12 antibiotics according to standard protocols. A self-administered questionnaire was conducted among the general public and analyzed. Health professionals were interviewed by an independent interviewer and analyzed using thematic content analysis. Results: Out of all tested E. coli isolates, 54.4% and 46.7% isolates from livestock and wildlife were resistant to at least one antibiotic. The highest resistance was for Ampicillin (36%) followed by Tetracycline and Nalidixic acid. Only 26% of the general public had a good ability to identify antibiotics correctly and 40% of them thought they had poor knowledge on antimicrobial resistance. Ten major themes were identified including thoughts among health professionals regarding how antimicrobial resistance develops and spreads. Conclusions: Antibiotic resistance was observed for commonly used antibiotics in both livestock and wildlife in urban ecosystems. Both health professionals and the general public showed poor awareness regarding how antimicrobial resistance develops and spreads. This lack of awareness can lead to AMR development. Therefore, it is important to educate both health professionals and the general public regarding antimicrobial resistance in said setting in Sri Lanka.