Knowledge and perceptions regarding Antimicrobial Resistance and Antimicrobial potential of metal-based agents: Systematic Review of available Evidence

Abstract

Abstract 
Background: Antimicrobial resistance (AMR) is a major global public health concern that threatens the 
successful treatment of infectious diseases. The increasing prevalence of multidrug-resistant (MDR) bacteria 
has led to the exploration of alternative antimicrobial strategies, including metal-based antimicrobial agents 
such as silver, copper, and zinc. 
Objectives: To assess knowledge and perceptions regarding antimicrobial resistance among various human 
populations, and to investigate the antimicrobial potential of silver-, copper-, and zinc-based materials against 
multidrug-resistant bacteria. 
Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic 
Reviews and Meta-Analyses (PRISMA) guidelines. Literature published between January 2017 and June 2025 
was searched using PubMed, Google Scholar, Science Direct, and Scopus. We included 17 sources, including 
original research, systematic reviews, observational studies, cross-sectional studies, and relevant national or 
international surveillance reports and authoritative reports. The included human population studies comprised 
residents of Wah aged ≥16 years, adults in Punjab, Pakistan aged ≥18 to <80 years, and university students in 
Brunei Darussalam aged 18–29 years, while laboratory and surveillance studies were included according to 
their respective study designs and eligibility criteria. 
Results: The reviewed studies reported increasing antimicrobial resistance due to unsuitable antibiotic use, 
self-medication, and insufficient awareness. Studies among students reported varying levels of AMR 
knowledge, with important knowledge gaps and misconceptions remaining. Experimental evidence further 
indicated that silver-, copper-, and zinc-based antimicrobial agents possess important antibacterial activity 
against multidrug-resistant pathogens through multiple mechanisms of action. 
Conclusion: The available evidence suggests that improving awareness of AMR is essential for promoting 
responsible antibiotic use. However, none of the included studies directly assess students’ knowledge or 
perceptions regarding metal-based antimicrobial agents, highlighting a major research gap.