Malta Survey Finds High Antibiotic Awareness but Persistent Resistance Misconceptions

A cross-sectional online survey of 476 Maltese residents has found that while public awareness of antibiotic resistance is widespread, deep misconceptions persist about what antibiotics can treat and how resistance actually develops. The study, conducted between 9 and 29 April 2024 and published in BMC Public Health, used a questionnaire adapted from the World Health Organization’s Antibiotic Resistance Multi-Country Public Awareness Survey and offers locally generated evidence to shape Malta’s national antimicrobial resistance communication strategies. The research team, led by Gavin Schranz with colleagues including Michael A. Borg and Ermira Tartari, recruited participants through convenience sampling with active demographic monitoring across gender, age and education groups, using census-derived targets as benchmarks.

The survey was offered in both English and Maltese and assessed knowledge of appropriate antibiotic use, awareness of resistance-related terminology, and attitudes towards antibiotic use and resistance. Responses were analysed with descriptive statistics and non-parametric tests, including the Mann-Whitney U, Kruskal-Wallis H, Chi-Square and Likelihood Ratio tests, to explore associations between demographic factors and knowledge or behavioural outcomes. Among the eligible respondents, 59.9% were female and the largest age group was 25 to 34 years, accounting for 31.9% of the sample.

The headline finding was a striking asymmetry in terminology awareness. Recognition of the phrase “antibiotic resistance” was high, at 88% of respondents, yet understanding of the broader term “antimicrobial resistance” dropped to 48%, and only 21% recognised its abbreviation, “AMR”. Attitudes towards appropriate prescribing were strongly aligned with clinical guidance: nearly all participants, 97%, agreed that antibiotics should only be used when prescribed by a health professional, and 96.7% agreed that individuals should use antibiotics responsibly.

However, factual knowledge lagged behind these attitudes. Misconceptions about what antibiotics can treat remained common: 16.6% of respondents believed antibiotics treat colds and flu, 33.6% believed they treat fever, and 39.9% believed they treat sore throats. Most strikingly, three-quarters of respondents, 75%, incorrectly attributed antibiotic resistance to the human body becoming resistant to the drugs, rather than to bacteria.

Demographic patterns in the data were clear and statistically significant. Older respondents and those with higher educational attainment showed significantly better knowledge and more appropriate attitudes, with associations reaching the p < 0.05 threshold across the non-parametric tests used. Conversely, younger adults and males were more likely to hold misconceptions about antibiotic indications and resistance mechanisms.

The survey also revealed uneven engagement with the broader threat of resistance. Personal concern about the impact of antimicrobial resistance was expressed by 67.2% of respondents, a higher share than the 53.4% who viewed antimicrobial resistance as a major global challenge. Meanwhile, one-third of participants believed they were not at risk of resistance if they used antibiotics correctly.

The study’s authors conclude that, despite high general awareness of appropriate antibiotic use, misconceptions about treatment indications and the mechanisms of resistance remain, particularly among younger adults and those with lower education. Improving public understanding of when antibiotics are genuinely needed, and of how resistance develops, will be critical to promoting responsible use. The findings provide locally generated evidence intended to inform targeted public health communication and to support antimicrobial resistance prevention efforts in Malta.

Subject of Research: Public knowledge, awareness and attitudes towards antibiotic use and antimicrobial resistance in Malta

Article Title: Public awareness and knowledge of antibiotic use and antimicrobial resistance in Malta

Article References: Schranz, G., Camilleri, V., Sciortino, M., Borg, M. A., & Tartari, E. (2026). Public awareness and knowledge of antibiotic use and antimicrobial resistance in Malta. BMC Public Health, 26(1), Article 2893. https://doi.org/10.1186/s12889-026-29529-w

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29529-w

Keywords: antimicrobial resistance, antibiotic use, Malta, public awareness, cross-sectional survey, health communication, misconceptions, antibiotic stewardship, WHO survey, public health, Public, awareness