Introduction <p>Antimicrobial resistance (AMR) is a major global health threat, driven by misuse and overuse of antimicrobials. This study evaluates awareness, attitudes, and practices regarding AMR among the patient bystanders in central Kerala, India, and identifies associated factors.</p> Methods <p>A hospital-based cross-sectional study was conducted among 300 adult patient bystanders (18–50 years), excluding healthcare professionals, using a convenience sampling method. Face-to-face interviews were conducted using a validated World Health Organization (WHO) questionnaire assessing awareness, attitudes, and practices regarding antibiotic usage. Quantitative variables were expressed as means ± SD, whereas qualitative variables were expressed as frequencies and percentages.</p> Results <p>Of the 300 participants, 38.7% were aged 18–30 years, and 52.3% were female. Most resided in urban areas (37.7%) and were employed (57.3%). Antibiotic use was higher among participants aged 18–30 years (53.2%), with 41.6% obtaining antibiotics through a doctor’s prescription, while 39.8% obtained them directly from pharmacies. Incomplete antibiotic courses were reported by 38.9%. AMR awareness levels were low, with only 12.0% demonstrating good awareness, 38.3% moderate awareness, and nearly half (49.7%) exhibiting poor awareness. Only 7.7% showed a positive attitude towards AMR and appropriate antibiotic use. Educational status was significantly associated with higher awareness levels (<i>p</i> &lt; 0.05) and positive attitude (<i>p</i> &lt; 0.05).</p> Discussion <p>Marked gaps in awareness, practices and attitude towards AMR were identified. Higher education correlated with better awareness, attitudes, and antibiotic use.</p> Conclusion <p>Suboptimal knowledge and inappropriate antibiotic practices persist among patient bystanders in central Kerala. Targeted community-focused AMR awareness and antibiotic stewardship interventions at primary care and pharmacy levels are essential to combat AMR.</p>