ترشيد استخدام مضادات الميكروبات وعلاقته بالممارسات الرشيدة لاستخدام المضادات الحيوية في مؤسسات الرعاية الأولوية بالمحافظات الجنوبية من فلسطين: دراسة مقطعية Submitted by: Mohammad A. Abu Rayya

ABSTRACT Antimicrobial resistance (AMR) has emerged as one of the most pressing threats to global health, posing substantial clinical, economic, and public health burdens worldwide. The challenge is particularly pronounced in fragile healthcare environments characterized by limited resources, constrained infrastructure, and ongoing systemic disruptions. In the Gaza Strip, primary healthcare (PHC) facilities operate under exceptional circumstances that can compromise the rational use of antibiotics. Factors such as reliance on empirical treatment decisions, inadequate access to microbiological diagnostic services, interruptions in pharmaceutical supply systems, and deficiencies in infection prevention and control measures create conditions that facilitate inappropriate antibiotic utilization. Consequently, these challenges contribute to the acceleration of antimicrobial resistance, negatively influencing patient outcomes, healthcare quality, and the overall effectiveness of health services and This study sought to examine the levels of knowledge, perceptions, and clinical practices of healthcare professionals regarding antibiotic use and antimicrobial resistance within governmental PHC clinics in the Gaza Strip. Additionally, it aimed to explore the individual, institutional, and health-system factors associated with inappropriate antibiotic use and to determine the effectiveness of a targeted educational intervention in improving physicians’ prescribing behaviors. To achieve these objectives, a mixed-methods research approach comprising two sequential phases was adopted. The first phase involved a descriptive cross-sectional analytical survey conducted among 280 healthcare providers, including physicians, nurses, pharmacists, and pharmacy technicians. The second phase consisted of a pre–post intervention study involving 102 physicians who participated in a structured educational program designed to promote evidence-based antibiotic prescribing. Data were gathered using a validated multidimensional instrument assessing knowledge, attitudes, practices, and antimicrobial stewardship competencies and were analyzed through descriptive and inferential statistical techniques, including independent-samples t-tests, one-way ANOVA, correlation analyses, and pre–post comparisons, with statistical significance established at p < 0.05, and The results demonstrated that healthcare providers generally possessed satisfactory knowledge and favorable attitudes toward antimicrobial stewardship principles. Nevertheless, prescribing practices revealed notable deficiencies, particularly regarding the routine utilization of microbiological culture results and local antimicrobial resistance surveillance data to guide therapeutic decisions. Several systemic barriers were identified, including inadequate diagnostic capacity, recurrent shortages of essential antibiotics, excessive clinical workload, and insufficient opportunities for specialized training. Furthermore, the educational intervention produced statistically significant improvements in physicians’ knowledge, attitudes, and reported prescribing behaviors. These findings highlight the importance of implementing comprehensive antimicrobial stewardship frameworks that integrate continuous professional development, enhanced diagnostic support, evidence-based prescribing oversight, and broader health-system strengthening initiatives to promote rational antibiotic use and mitigate the growing threat of antimicrobial resistance within primary healthcare settings. Keywords: Antimicrobial resistance; Antibiotic stewardship; Primary healthcare; Prescribing practices; Educational intervention; Gaza Strip.

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