Knowledge, Attitudes and Dispensing Practices Regarding Antimicrobial Resistance and Stewardship: A comparative national assessment among primary healthcare pharmacists in Oman

Objectives: Antimicrobial resistance (AMR) is driven by inappropriate antibiotic use. This study aimed to assess the knowledge, attitudes and dispensing practices (KAP) regarding AMR and antimicrobial stewardship (AMS) among primary healthcare (PHC) pharmacists and assistant pharmacists in Oman. Furthermore, the study sought to compare these parameters across facilities with historically high versus standard antibiotic consumption to identify structural determinants of AMS. Methods: This national cross-sectional study was conducted among PHC pharmacy staff in February 2025. KAP were assessed via a structured electronic questionnaire. Data were analysed using generalized estimating equation models to identify KAP predictors while accounting for facility-level clustering. Results: A total of 333 PHC pharmacy staff were included in this study. Overall, 72.1% of participants had adequate knowledge and 78.7% showed favourable attitudes; however, only 56.2% demonstrated good practice. Knowledge was adequate in only 20.8% of staff at high-consumption centres compared to 76.1% at standard centres (P <0.001). Multivariable analysis confirmed that working in a high-consumption centre was strongly associated with reduced odds of adequate knowledge (adjusted odds ratio [aOR] = 0.08, 95% confidence interval: 0.05–0.14). While prior AMR training improved the odds of good practice (aOR = 2.04), this benefit was significantly diminished in high-consumption settings (interaction P = 0.030). Conclusion: Although Omani PHC pharmacy staff exhibit positive attitudes, significant knowledge gaps and practical barriers exist, particularly in high-consumption facilities. Interventions must move beyond generic training to include system-level strategies, such as integrating AMS tools within electronic health records, to address structural challenges in high-risk settings.