Abstract
Background/Objectives: Inappropriate antibiotic use in children is a major driver of antimicrobial resistance (AMR), especially in low- and middle-income countries. In Georgia, little is known about parental behaviors related to pediatric antibiotic use. This cross-sectional study assessed knowledge, attitudes, and practices (KAP) related to antibiotic use and AMR among parents of preschoolers in Tbilisi kindergartens, identifying factors associated with inappropriate practices to inform stewardship interventions. Methods: During March-May 2025, we conducted a two-stage cluster-sampled cross-sectional survey of parents of children aged 2-6 years attending public kindergartens in Tbilisi, Georgia. We assessed knowledge, attitudes, and practices concerning antibiotics and AMR. Multivariable Poisson regression was utilized to identify factors associated with inappropriate antibiotic use, defined as any of the following: early discontinuation, use without a prescription, or saving leftovers. Results: In total, 64.3% (95% CI 60.3-68.1%) reported antibiotic use in the past year, with 27.9% of respondents engaging in ≥1 inappropriate practice. Common reasons for use included bronchitis (35.9%) and sore throat (20.0%); Most antibiotics were prescribed by physicians (77.5%) or administered directly in a clinical setting (16.8%); 18.6% were obtained without a prescription. Forty percent believed antibiotics kill viruses. High knowledge (aPR 0.66, 95% CI 0.45-0.97) was independently associated with lower inappropriate practice; other sociodemographic factors were not significantly associated. Conclusions: Inappropriate pediatric antibiotic use in Tbilisi remains widespread and is linked to parental knowledge gaps rather than demographic factors. Interventions should prioritize correcting key misconceptions among caregivers, while addressing prescribing practices within outpatient settings. Strengthening both public and provider awareness may be essential for effective AMR containment in Georgia.