Knowledge, Attitude and Practices on Antimicrobial Resistance and Usage Among Medical Students in A Malaysian Medical University Abstractxe2x80x94 Drug resistance is a fast mounting crisis. Many factors, like the inappropriate use of antimicrobials by prescribing physician, unregulated sale of drugs and selfmedication, have been attributed to the increase in the incidence of antimicrobial resistance. Health care professionals are a significant determinant in this regard their indepth knowledge is essential for rationale antimicrobial usage. The objective of this study is to analyze the knowledge, attitude, and practice of antimicrobial usage and resistance among different years of medical students. This is a crosssectional questionnairebased study that was conducted among yr. 1 to yr.5 students. A validated Questionnaire was obtained. The questionnaire assesses the students on their attitude, practice, and knowledge of antimicrobial resistance and usage. The data were analyzed using descriptive statistics. A total of 543 students participated in the study. Antimicrobial resistance was recognized as an essential and serious public health issue in todayxe2x80x99s era by 92.16% Year 5 respondents, which was highest among all the years (Year 15).xc2xa0xc2xa0The awareness regarding the etiology of cold and flu was observed to be the highest among Year 4 respondents (65.74%).xc2xa0 Only 2.8% of the total respondents strongly agreed that skipping one or two doses of antimicrobials does not lead to the development of resistance. 49.02% of the year five respondents always consulted a physician before starting an antimicrobial, indicating a good practice. However, when it came to checking the expiry date of antimicrobials before taking it, the Year 1 respondents (53.95%) were more particular. The study revealed that some aspects of knowledge regarding antimicrobial resistance and usage were found to be significantly higher among the respondents in the clinical years. The said knowledge was wellreflected in some, but not all of the facets of the respondentxe2x80x99s attitude and practice.

EvidenceBased Strategies in Using Persuasive Interventions to Optimize Antimicrobial Use in Healthcare: a Narrative Review A rise in antimicrobial resistance, seen especially since 2000, is in part caused by indiscriminate antimicrobial use. Varied types of persuasive interventions aimed to optimize antimicrobial use have been tried with varying success. Our review seeks to identify and assess factors associated with the successful implementation of persuasive interventions. We searched five databases (MEDLINE, EMBASE, The Cochrane Library, PsycINFO, and ERIC) to identify critical studies published between 2000 and December 2018 of interventions employing audit and feedback, education through meetings, academic detailing, reminders, and patient, family, or public education. Outcome measures of interest were any means to measure antimicrobial use. We included 26 articles in our analysis. Seventeen examined multimodal interventions and the most common was audit and feedback and meeting (four studies). Nine examined single interventions and the most common was audit and feedback (five studies). Our findings inform four evidencebased strategies to enable healthcare administrators, clinicians, and researchers to make informed choices when planning and designing an antimicrobial stewardship program: (1) implement a combination of persuasive interventions from both groups: audit and feedback, academic detailing, or patient, family, or provider education; and meeting or reminders, (2) design interventions that last one year or longer; postintervention, assess the interventionxe2x80x99s longterm effects for at least another one year, (3) conduct quality improvement projects examining persuasive interventions if the prescribing database provides adequate diagnosis information, and most importantly, (4) make patient, family, or provider education an integral component of multimodal intervention.