{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:37:23Z","timestamp":1785411443504,"version":"3.56.0"},"reference-count":30,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T00:00:00Z","timestamp":1775520000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006701","name":"Umm Al-Qura University","doi-asserted-by":"publisher","award":["26UQU4240001GSSR02"],"award-info":[{"award-number":["26UQU4240001GSSR02"]}],"id":[{"id":"10.13039\/501100006701","id-type":"DOI","asserted-by":"publisher"}]},{"award":["26UQU4240001GSSR02"],"award-info":[{"award-number":["26UQU4240001GSSR02"]}],"id":[{"id":"https:\/\/ror.org\/01xjqrm90","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background: Antimicrobial resistance continues to threaten effective infection management worldwide and is driven largely by inappropriate prescribing practices. In Saudi Arabia, the cities of Makkah and Al-Madinah experience intense seasonal healthcare demand due to the annual pilgrimage, creating additional challenges for rational antibiotic use. This study aimed to evaluate physicians\u2019 knowledge, attitudes, and prescribing behaviors related to antibiotics in these high-demand settings. Methods: A cross-sectional analytic study was conducted between June and August 2024 among physicians practicing in Makkah and Al-Madinah, including those participating in Hajj services. A previously validated, structured electronic questionnaire assessed knowledge of common pathogens, perceptions of antimicrobial resistance, prescribing influences, and counseling practices. The survey was distributed electronically to eligible physicians. Descriptive statistics were generated, and associations were examined using appropriate inferential tests with a 95% confidence level. Results: A total of 487 physicians participated. Most respondents (74%) correctly identified major bacterial causes of upper respiratory tract infections, and 90% acknowledged the association between prior antibiotic exposure and resistance. Nonetheless, misconceptions persisted regarding the benefit of antibiotics in viral conditions. Workload and patient expectations influenced prescribing behavior; 77% reported a greater likelihood of prescribing antibiotics during periods of high clinical pressure. While adherence to guideline-based practice was generally reported, variability existed in counseling practices and perceptions of stewardship policies. Conclusions: Although baseline knowledge was satisfactory, contextual and behavioral factors continue to influence prescribing decisions and may contribute to unnecessary antibiotic exposure, highlighting the need for strengthened antimicrobial stewardship strategies in high-demand healthcare environments.<\/jats:p>","DOI":"10.3390\/antibiotics15040376","type":"journal-article","created":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T14:00:31Z","timestamp":1775570431000},"page":"376","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Knowledge, Attitudes, and Antibiotic Prescribing Practices Among Physicians in Two High-Demand Healthcare Settings in Saudi Arabia"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0098-0187","authenticated-orcid":false,"given":"Nahla H.","family":"Hariri","sequence":"first","affiliation":[{"name":"Department of Community Medicine and Pilgrims Healthcare, College of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1352-5006","authenticated-orcid":false,"given":"Hanin Mohammed","family":"Alsaedi","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, College of Medicine, Taibah University, Madinah 42353, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0765-8000","authenticated-orcid":false,"given":"Bayan Fawaz","family":"Alzahrani","sequence":"additional","affiliation":[{"name":"College of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thekra Abdulhafith","family":"Alwafi","sequence":"additional","affiliation":[{"name":"College of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9496-3664","authenticated-orcid":false,"given":"Khalid Abdulrahman","family":"Basamih","sequence":"additional","affiliation":[{"name":"College of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4802-3821","authenticated-orcid":false,"given":"Donia Jamaan","family":"Alghamdi","sequence":"additional","affiliation":[{"name":"College of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2809-4151","authenticated-orcid":false,"given":"Hadeel Abdullah","family":"Alolowi","sequence":"additional","affiliation":[{"name":"College of Medicine, Alrayan Medical College, Madinah 42214, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9832-6175","authenticated-orcid":false,"given":"Hanin Mahmoud","family":"Qadah","sequence":"additional","affiliation":[{"name":"College of Medicine, Alrayan Medical College, Madinah 42214, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryam Abdulrahim","family":"Jadw","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, College of Medicine, Taibah University, Madinah 42353, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6453-754X","authenticated-orcid":false,"given":"Safaa M.","family":"Alsanosi","sequence":"additional","affiliation":[{"name":"Department of Pharmacology and Toxicology, College of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7359-0580","authenticated-orcid":false,"given":"Maram H.","family":"Alshareef","sequence":"additional","affiliation":[{"name":"Department of Community Medicine and Pilgrims Healthcare, College of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed A.","family":"Garout","sequence":"additional","affiliation":[{"name":"Department of Community Medicine and Pilgrims Healthcare, College of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9544-3321","authenticated-orcid":false,"given":"Nizar S.","family":"Bawahab","sequence":"additional","affiliation":[{"name":"Department of General Surgery, King Faisal Hospital, Ministry of Health, Makkah 24236, Saudi Arabia"},{"name":"Ministry of Health Branch in the Makkah Region, Makkah 24231, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9522-9198","authenticated-orcid":false,"given":"Saleh A. K.","family":"Saleh","sequence":"additional","affiliation":[{"name":"Directorate of Institutional Excellence, Batterjee Medical College, Jeddah 21442, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9222-9149","authenticated-orcid":false,"given":"Heba M.","family":"Adly","sequence":"additional","affiliation":[{"name":"Department of Community Medicine and Pilgrims Healthcare, College of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,7]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2024). 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