Factors associated with knowledge attitudes practices and training interest and antibiotic dispensing challenges related to antimicrobial resistance among drug sellers in urban Bangladesh

Background and objective Drug sellers play a critical role in antibiotic dispensing in Bangladesh and can influence antibiotic use and antimicrobial resistance (AMR). This study assessed drug sellers’ knowledge, attitudes, practices and training interest regarding AMR, identified associated factors, and explored challenges related to dispensing antibiotics without prescription in an urban setting. Methods A mixed-methods cross-sectional study was conducted in Mirpur, Dhaka. We mapped 1,100 pharmacies and randomly selected 400 drug sellers for a structured KAP survey. Composite scores were transformed to 0–100 percentage of maximum possible (POMP) scores. Associations were examined using Spearman correlation and multivariable linear regression with HC3 robust standard errors. Two focus group discussions involving 20 drug sellers were analysed thematically. Results Mean POMP scores were 75.2 for knowledge, 72.3 for attitude, 69.6 for practice and 76.6 for training interest. The four scores were positively correlated (all P < 0.001), with the strongest correlation between attitude and practice (ρ = 0.648). In adjusted analyses, graduate-level education, licensed-pharmacy status and longer experience were associated with higher knowledge; knowledge was positively associated with attitude; and licensed-pharmacy status, knowledge (β = 0.22) and attitude (β = 0.56) were positively associated (p < 0.001) with practice. Knowledge and attitude were also positively associated with training interest. Qualitative findings identified customer demand and affordability, pharmacy competition, pharmaceutical-company incentives, training and awareness needs, prescriber responsibilities, and regulatory monitoring as influences on antibiotic dispensing. Conclusion Drug sellers showed moderate AMR-related knowledge, attitudes and practices, with high training interest. Strengthening training, supportive supervision, consistent regulatory monitoring and community awareness may help promote appropriate antibiotic use in urban Bangladesh.