Background <p>The implementation of antimicrobial stewardship programs (ASPs) in long-term care hospitals (LTCHs) is warranted to promote the appropriate use of antibiotics and improve patient outcomes. However, no studies have investigated physicians’ understanding of antibiotic use and their perceived need for ASPs within these settings in Korea. In this study, we aimed to assess physicians’ understanding of antibiotic use and their perceptions of ASPs in LTCHs.</p> Methods <p>In this multicenter cross-sectional study, we surveyed physicians working in LTCHs. The response rate of the survey was 15.8%. The questionnaire included questions regarding the perceptions and practices of antibiotic use, demand for ASPs, and factors necessary for successful ASPs implementation in LTCHs.</p> Results <p>Male physicians accounted for 79.2% of respondents. 66.0% and 72.6% of respondents held the incorrect belief that antibiotics were effective in treating unexplained fever and elevated levels of unexplained inflammation, respectively. Adherence to clinical guidelines was suboptimal, with only 46.2% and 28.3% reporting that they selected antibiotics and determined the duration of antibiotic use based on clinical guidelines, respectively. Among the five questions on antibiotic prescription appropriateness, the proportion of respondents who always performed bacterial culture tests before antibiotics initiation and adjusted antibiotics based on the susceptibility results was the lowest (16.0% and 11.3%, respectively). Regarding the perceived need for ASPs, 88.6% agreed that interventions are necessary to improve antibiotic use in LTCHs. The respondents most commonly indicated that a reward system for ASPs (85.8%) and guidelines specific to LTCHs (84.9%) were necessary for the successful implementation of ASPs in these settings.</p> Conclusion <p>This study highlights substantial gaps in physicians’ knowledge and adherence to antibiotic prescription guidelines for LTCHs, necessitating tailored ASPs strategies.</p>