Objective  To examine the status and main influencing factors of knowledge and attitudes regarding antibiotic use and the relationship between them among citizens in Hangzhou city.

  Methods  Using multistage stratified random sampling, we conducted a cross-sectional questionnaire survey among 438 permanent residents aged 18 years or over in Hangzhou city from September to December 2016. The relationship between social-demographic factors and the knowledge, attitude regarding antibiotics use was analyzed with chi-square test; while main impact factors of knowledge and attitude regarding antibiotics use were examined with binary logistic regression.

  Results   Among the residents, the average score for knowledge about antibiotic usage was 9.60 ± 3.39; the average score for attitude towards antibiotic usage was 3.80 ± 1.73. Age, education, and occupation of the residents were associated with their antibiotic use knowledge (P < 0.05 for all); age, occupation, and the score for antibiotic use knowledge were correlated to the attitude towards antibiotic usage. The results of binary logistic regression showed that the residents aged 18 – 39 years had a 2.805 times higher score for knowledge of correct antibiotic use compared to the residents ≥ 60 years old (P < 0.01) and the residents with the education of college or higher had a 4.511 times higher score for knowledge of correct antibiotic use compared to the residents with the education of junior high school or lower (P < 0.01). The score for antibiotic use knowledge was positively correlated with the right attitude towards antibiotic use.

  Conclusion   The citizens have some misunderstandings in antibiotic usage, especially in rational antibiotic use and antibiotic resistance. The male citizens and those at elder age, with low education and less antibiotic use knowledge have a poorer attitude towards antibiotic usage.