Understanding Responsible Antimicrobial Practices and Antimicrobial Resistance: A Cross-Sectional Study of Farmers in Rangpur, Bangladesh.

Abstract

Antimicrobial resistance (AMR) is a critical global health threat, intensified in low- and middle-income countries by rampant antibiotic misuse in livestock and poultry. This study assessed the knowledge, attitudes, and practices (KAP) of 537 farmers in Rangpur, Bangladesh, to identify drivers and pathways of high-risk antimicrobial use (AMU). Data on demographics, farm characteristics, and AMR-related KAP scores were collected, with disease treatments mapped to WHO AWaRe classifications. Logistic regression identified predictors of responsible practices, while additional analyses and visualizations explored patterns of antimicrobial use and misuse pathways. Results showed that 42.9% of antibiotic use was high-risk, with nearly half of diseases treated using Critically Important Antimicrobials (CIAs) from the Watch or Reserve groups, intended primarily for human medicine. Colistin and ciprofloxacin, last-resort drugs for human health, were commonly used for routine poultry diseases, raising serious public health concerns. Three misuse pathways emerged: (i) antibiotics applied to viral diseases, (ii) reliance on Watch/Reserve antibiotics for bacterial infections, and (iii) antibiotic use for parasitic diseases. Paravets and veterinarians influenced 76.2% of prescribing decisions, underscoring their pivotal role. AMR training was associated with more responsible practices, yet high practice scores did not consistently align with knowledge or attitudes, revealing a gap between behavior and awareness. Immediate One Health stewardship interventions combining regulatory enforcement, improved diagnostics, and sweeping educational reform are essential to reduce AMR risks and safeguard public health in Bangladesh.