Abstract
Background:
Antimicrobial resistance (AMR) is a growing global health threat driven substantially by irrational antibiotic prescribing, and India remains among the largest consumers of antibiotics worldwide. The WHO AWaRe (Access, Watch, Reserve) classification was introduced to guide rational antibiotic selection and strengthen stewardship, yet its awareness and application among practicing doctors in Indian teaching hospitals remain inadequately studied.

Aim:
To assess the knowledge, attitude, and practice (KAP) regarding the WHO AWaRe classification among doctors in a tertiary care teaching hospital, specifically to determine (i) the level of knowledge and attitude toward the classification, (ii) the corresponding antibiotic-prescribing practice, and (iii) the association of KAP with demographic and professional characteristics such as designation, age, gender, and years of experience.

Methods:
This cross-sectional study was conducted among 165 doctors, including consultants, faculty, senior, junior residents, and interns, selected through non-probability purposive sampling. Data were collected using a structured, pre-validated, self-administered questionnaire covering demographics and the knowledge, attitude, practice domains distributed electronically. Scores were categorized using pre-defined cut-offs, and associations were tested using chi-square, one-way ANOVA, and Pearson correlation, with p < 0.05 considered significant.

Results:
The mean knowledge score was 5.07 ± 0.97 out of 6, with 75.8% of doctors demonstrating good knowledge, though awareness of the WHO-recommended target of at least 60% antibiotic consumption from the Access group was weaker (69.1% correct). Attitude was overwhelmingly positive (99.4%, mean score 4.05 ± 0.32 out of 5), although many felt the classification could limit clinical autonomy. Practice scores were lower, with 33.9% classified as good and 64.8% as moderate (mean 72.24% ± 10.46%), documentation of prescribing indications was inconsistent. Overall KAP status was good in 29.7% and moderate in 69.7% of participants. Knowledge level was significantly associated with designation (p = 0.001), with interns showing the lowest scores, while no significant associations were found with age, gender, or years of experience. Weak but statistically significant positive correlations were observed among knowledge, attitude, and practice scores (p < 0.01)

Conclusion:
Doctors demonstrated good knowledge and strongly positive attitudes toward the WHO AWaRe classification, but this did not consistently translate into optimal prescribing practice, reflecting a persistent knowledge-practice gap. Targeted, designation-specific training and stewardship reinforcement, particularly for interns, may help bridge this gap and strengthen rational antibiotic use.

Key words: Antibiotic stewardship; Antimicrobial resistance; Attitude and practice; Rational antibiotic prescribing; WHO AWaRe classification.