Table 1.

Studies assessing knowledge, attitudes and perceptions of medical students regarding Antimicrobial Stewardship (AMS).

Country/Study Years	Type of Study	Number of Participants	Main Findings/Outcomes	Reference
France (2012)	Cross-sectional	54 medical students (prefinal and final year)	Medical students feel more confident diagnosing infections than treating them. Four in five wanted more education on antimicrobial use. Almost all of them (96%) found unnecessary prescription unethical. The majority think that AMR is a national problem.	Dyar et al. [27]
USA (2012)	Cross-sectional	317, 4th year medical students at University of Miami, John Hopkins University and the University of Washington	The majority perceive that antimicrobial use is very important and would like more education on it. Around half of them answered correctly in knowledge-related questions depending on their educational sources. Those who completed an elective in infectious diseases felt more confident, however, this had no significant connection with better knowledge scores.	Abbo et al. [12]
Europe (2012)	Multi-centre, cross-sectional study	338 final year medical students from 7 European universities	Students wanted more education on antibiotic prescribing. Most of the students incorrectly believed that MRSA bacteraemia had increased in their country the last decade. They overestimated the burden caused by resistant bacteria compared to lung cancer.	Dyar et al. [10]
China (2015)	Multi-centre, cross-sectional	611, 4th year medical students from 5 teaching university hospitals of Central China	Medical students wish for more training on antimicrobial use through AMS programs and clinical rotations. No significant difference in knowledge of antimicrobial use between students who used textbooks and smartphones as teaching material.	Yang et al. [16]
France, Sweden (2015)	Multi-centre, cross-sectional	2085 medical students in France and 302 students in Sweden (all in final year)	Preparedness for antimicrobial use was higher in Sweden than in France. Students in France perceive that they need further education on antibiotic use. Swedish students had more working experience at the hospital than French students.	Dyar et al. [28]
Europe, 29 countries (2015)	Multi-centre, Cross-sectional	7328 final year medical students from 179 medical schools	Medical students tend to be more confident in diagnosis of infections than choosing an accurate therapeutic plan. Over a third of the students wanted more education on antimicrobial use. Northern countries show a higher amount of confidence. Clinical cases and small-group teaching sessions are preferred by students.	Dyar et al. [25]
China (2015)	Multi-centre, Cross-sectional	1819 medical students in 6 Universities (all grades of medical school)	The majority of students self-medicated their own illnesses and had a stock of antibiotics, in most cases without medical prescription. One in seven used antibiotics for common cold and asked their doctors for antibiotics.	Hu et al. [17]
Australia (2015)	Multi-centre, cross-sectional	163 final-year medical students from 8 universities in Australia	54% of medical students were ‘confident’ in their knowledge of infectious disease, while 70% were confident in Cardiology. They believe hands on clinical practise more helpful than lectures. Most of them were aware of AMR.	Weier et al. [24]
Thailand (2016)	Multi-centre, cross-sectional	455 final year medical students in 3 medical schools	Almost all of the participants perceive that prescribing board-spectrum antibiotics increases AMR. Half of them answered correct questions related to antibiotic use. Students evaluate bedside teaching as the most effective learning method for appropriate usage of antibiotics.	Chuenchom et al. [20]
South Africa (2017)	Multi-centre, cross-sectional	289 final year medical students in 3 medical schools	The majority assert that antibiotics are overused and that AMR is a major problem in South Africa. Only a third of the participants feel confident in prescribing antibiotics, which is related to use og guidelines and contact with infectious diseases specialists. Medical students who followed prescribing guidelines had a better score in the knowledge section of the questionnaire.	Wasserman et al. [22]
Nigeria (2018)	Cross-sectional	184 medical students (prefinal, final year) at Ebonyi State University, Nigeria	The vast majority wanted more training on antibiotic usage and resistance. Almost half of them had practical training on antibiotic use. Around 2/3 had adequate knowledge on antibiotic use and resistance. However, a high level of false antibiotic management was reported.	Oketo-Alex et al. [21]
Egypt (2018)	Multi-centre, Cross-sectional	963 medical students (all years) from 25 medical schools of Egypt	Almost all students had sufficient knowledge and attitudes towards AMR. Around 40% believed that antibiotics can treat the common cold. Nearly half of them would stop antibiotics when starting to feel well.	Assar et al. [23]
Spain (2019)	Multi-centre, cross-sectional	441 final year medical students from 21 Spanish medical schools	Medical students feel more confident diagnosing than treating infectious diseases. They want additional education regarding antibiotic usage.	Sánchez-Fabra et al. [26]
Japan (2019–2020)	Cross-sectional	661 undergraduate medical students at Okayama University Medical School (1st to 6th year)	90% of medical students knew the mechanism of action of antibiotics. 30% of all medical students believed that antibiotics could treat viral infections, while 46.4% considered antibiotics as treatment for the common cold. AMR plan awareness was poor (6.5%).	Hagiya et al. [18]
India (2020)	Cross-sectional	197 medical students (93 prefinal year and 104 final year) of a teaching institute in Southern Indian city	Insufficient knowledge of medical students about AMR and AMS. However, they recognize that appropriate use of antibiotics is essential, as well as training on AMS.	Meher et al. [19]