Antimicrobial resistance, or AMR, arises when bacteria evolve to survive the drugs designed to kill them. The World Health Organization considers it one of the top global threats to public health, and the United Nations Environment Programme has linked it to an estimated five million deaths worldwide in 2019, alongside a steady annual drag on economic output. Livestock farming sits squarely in the middle of the problem. Antimicrobials are used worldwide to treat infections, promote growth and prevent disease in food animals, and consumption in developing countries is projected to double by 2030 as livestock sectors intensify to meet rising demand for animal protein. Because many of the drugs used on farms are identical, or work through the same mechanisms, as those used in human medicine, imprudent use in animals can breed resistant bacteria that travel through meat, milk and the environment into human populations.

The research team, led by Rita Rosmala Dewi of Universitas Tjut Nyak Dhien with colleagues from several Indonesian and Nigerian institutions, chose Langkat Regency for good reason. The region is the northernmost administrative division of North Sumatra and its leading beef production hub, home to roughly 225,650 cattle, about 23.7 percent of the province’s entire herd. Between March and July 2024, the researchers randomly selected farmers from five of the regency’s twenty-three districts, Selesai, Salapian, Bahorok, Binjai and Kuala, using a sampling frame provided by the Langkat Livestock Offices. Most participants were cattle farmers, with smaller numbers raising goats and sheep. Crucially, the team did not rely solely on self-reported answers: during farm visits they verified antimicrobial use by inspecting treatment records and, where records were absent, examining the used drug bottles themselves to confirm brand names, dosages and antimicrobial classes.

The results paint a sobering picture. About 64.4 percent of the surveyed farmers used antibiotics on their farms, and the most common drug was oxytetracycline, a broad-spectrum tetracycline antibiotic, followed by penicillin, erythromycin, sulfadiazine and trimethoprim. Several of these classes are classified by the WHO as critically important for human medicine, meaning that resistance emerging on a farm could directly undermine treatments used in clinics. Yet the knowledge scores told a different story from the usage rates. Although 94.8 percent of farmers said they were aware of antibiotics, only 11.5 percent correctly understood what antibiotics actually do, that they target bacteria rather than viruses or fungi. Just 22.9 percent had heard of antimicrobial resistance, and a mere 12.5 percent could explain it accurately.

Gaps extended into the more technical corners of drug stewardship. Only about 15.6 percent of farmers knew about drug residues, and just 10.4 percent could correctly define an antibiotic residue as the accumulation of the drug in animal or human bodies through the ingestion of treated meat and milk. Roughly 40.6 percent had heard of a withdrawal period, the mandatory interval between the last antibiotic dose and the slaughter or milking of an animal, designed to keep residues out of the food supply. Only 36.5 percent knew that antibiotics can cause side effects, and fewer than a third were familiar with the concept of biosecurity, the hygiene and management measures that reduce disease pressure and thereby the need for drugs in the first place. Scored against a modified Bloom’s classification, 80.2 percent of farmers fell into the poor knowledge category.

Attitudes, by contrast, were a patchwork of encouraging signals and worrying contradictions. Nearly all farmers, 99 percent, agreed that only a veterinarian should prescribe antibiotics, and 95.8 percent endorsed using antibiotics only when needed. Almost none, just 2.1 percent, considered antibiotics necessary as growth promoters. But when practice was probed, the consensus fractured: 61.5 percent believed antimicrobials could treat any type of animal disease, 70.8 percent said they would sell animal products or slaughter animals during treatment or without observing the withdrawal period to cut costs, and 87.5 percent admitted they stop antimicrobial treatment once animals appear better, an underdosing habit that is a classic driver of resistance. Nearly two-thirds also said they would alter doses without consulting the prescriber. Overall, 46.9 percent showed unfavourable attitudes, while a striking 80.2 percent demonstrated poor practices.

The statistical analysis revealed which farmers were most at risk, and where interventions might pay off. Multivariable logistic regression showed that farmers keeping six to ten animals were about six times more likely to have good knowledge than those with three to five animals, possibly because medium-scale farmers show greater curiosity about new farming practices and tend to be better educated. Farmers with herds larger than twenty animals were significantly less likely to hold poor attitudes, and those in the Selesai district had roughly eleven-fold higher odds of a desirable attitude compared with Binjai, a disparity the authors suggest may reflect differences in educational access between rural and urban areas. Most tellingly for policy, attending training on AMR and antimicrobial residues increased the odds of good practices five-fold, and farmers in Kuala district, many with more than five years of experience, also practised better. Spearman’s rank correlation showed weak positive links between knowledge and attitudes, and between knowledge and practice, but no correlation at all between attitude and practice, a reminder that believing the right thing does not guarantee doing it.

The study’s context matters. Indonesia adopted a national action plan on AMR covering 2017 to 2019, followed by a second plan for 2020 to 2024, aiming to raise public awareness and promote judicious antibiotic use. Yet implementation remains incomplete, and farmers can still buy antibiotics over the counter at pharmaceutical counters without a veterinary prescription. That regulatory gap, combined with limited animal health services, helps explain why misuse persists even among farmers who say they trust veterinarians. Previous KAP studies in Java and Aceh had already flagged inadequate practices among Indonesian livestock farmers, but North Sumatra, with its vast agricultural system and diverse animal species, had remained largely unexamined until now.

The authors are careful about the limits of their work. The cross-sectional design cannot establish cause and effect, self-reported answers may be distorted by recall bias, and the sample of five districts out of twenty-three means the findings cannot be generalized across the region. Still, the study provides a baseline that Indonesian policymakers have lacked, and its implications are clear. Training works: even the small fraction of farmers who had received AMR education practised measurably better. With antimicrobial consumption in developing-world livestock projected to climb steeply, closing the gap between what farmers believe and what they do, through targeted training programmes, stronger veterinary oversight and enforcement of prescription rules, may be one of the most cost-effective defences available against a post-antibiotic era.

Subject of Research: Knowledge, attitudes and practices of livestock farmers regarding antimicrobial resistance, usage and residues in North Sumatra, Indonesia

Article Title: Knowledge, attitudes and practices regarding antimicrobial resistance, usage and residues among livestock farmers in North Sumatra, Indonesia

Article References: Dewi, R. R., Sihombing, J. M., Jajere, S. M., Purba, A., Ma’arif, I., & Hafid, H. (2025). Knowledge, attitudes and practices regarding antimicrobial resistance, usage and residues among livestock farmers in North Sumatra, Indonesia. BMC Agriculture, 1(1), Article 19. https://doi.org/10.1186/s44399-025-00019-5

Image Credits: AI Generated

DOI: 10.1186/s44399-025-00019-5

Keywords: antimicrobial resistance, antimicrobial use, livestock farming, Indonesia, North Sumatra, antibiotic residues, withdrawal period, food safety, One Health, veterinary medicine, KAP survey, public health