A cross-sectional survey of knowledge, attitudes, and practices regarding antimicrobial resistance among Syrian health care professionals

Objectives Antimicrobial resistance (AMR) poses a global challenge, especially in conflict-affected settings such as Syria, where health care infrastructure is compromised. This study assessed Syrian clinicians’ knowledge, attitudes, and practices regarding AMR and antimicrobial stewardship (AMS). Methods A two-phase online survey was conducted from June-July to October-November 2024 among physicians, pharmacists, dentists, and nurses across 11 Syrian governorates. Participants were recruited through professional networks, social media, and snowball sampling. Results Of 1179 respondents, 54% were male and 56% were residents (doctors in training); 32% had over 5 years’ experience. Most practiced medicine (78%), pharmacy (13%), or dentistry (8%). Awareness of AMR as a global (98%), national (93%), and local (67%) issue was high. Although 90% supported AMS, only 47% rated their hospital’s program as effective. Most desired more education (94%) and favored local guidelines (83%). Prescribing confidence was strong for routine cases (63%), but lower for complex ones (40-45%). Concerns included drug quality (80%), cost (52%), and ineffectiveness (47%). Notably, 39% struggled to withhold antibiotics in viral cases. Conclusion The survey reveals strong AMR awareness but significant gaps in AMS practice, microbiology access, and clinical guidance. Strengthening Syria’s national AMR strategy is urgently needed.