Knowledge and attitudes toward antimicrobial stewardship and the WHO AWaRe antibiotic classification among healthcare professionals at a tertiary hospital in Ethiopia

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Antimicrobial stewardship (AMS) and the World Health Organization (WHO) Access, Watch, and Reserve (AWaRe) classification support the appropriate use and monitoring of antibiotics. However, evidence regarding healthcare professionals’ knowledge of and attitudes towards these approaches in Ethiopian tertiary hospitals remains limited. To assess healthcare professionals’ (HCPs) knowledge of and attitudes towards AMS and the WHO AWaRe classification at Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia. An institution-based cross-sectional study was conducted in 2025 using a structured, self-administered questionnaire. Of the 321 submitted questionnaires, 319 records with informed consent were included in the study. Responses were summarized using frequencies and percentages calculated from item-specific non-missing denominators. Responses to the 14 antibiotic-classification items were categorized as correct, incorrect, or unanswered using the WHO AWaRe classification. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 28. Over half (59.6%) of HCPs had heard of AMS, while 150 (47%) selected the correct description of AMS. A total of 114 (35.7%) had heard of the AWaRe classification, 105 (32.9%) correctly identified WHO as its publisher, and 97 (30.4%) correctly identified the WHO Model List of Essential Medicines as a source of AWaRe-classified antibiotics. Overall, 54.16% of HCPs correctly classified antibiotics according to the WHO AWaRe classification. Although Access antibiotics such as amoxicillin (86.4%) and ampicillin (71.8%) were generally classified correctly, misclassification was common for Watch and Reserve antibiotics. Most participants, 293 (91.8%), expressed a positive attitude toward guideline-based antibiotic prescribing. Primary perceived AMS implementation barriers included inadequate training (75.2%), limited resources (37.6%), inadequate access to monitoring tools and technology (27.6%), and insufficient patient awareness and engagement (27%). The top self-reported training priorities identified were AMS principles (69.3%), antibiotic classification (48.3%), and appropriate antibiotic selection and dosing (45.5%). AMS and WHO AWaRe classification knowledge was limited, but self-reported attitudes towards guideline-based prescribing were generally favorable. The findings identify perceived training, resource, and collaboration gaps at one tertiary hospital and support the evaluation of locally appropriate educational and institutional AMS interventions in the future.