The inappropriate overuse of antibiotics is considered the main source of antimicrobial resistance (AMR). Therefore, this study aimed to assess the knowledge, attitudes, and practices of antibiotic use and resistance among paramedical students. In addition, the study also assessed the perceptions, knowledge gaps, and educational needs of paramedical students regarding antibiotic use, resistance and related training. This descriptive cross-sectional study was conducted at Khyber Medical University by recruiting 500 students from twelve different paramedic disciplines. The self-administered questionnaire was distributed online through email and WhatsApp, resulting in 364 completed responses and a response rate of 72.8%. The study revealed that 41.21% of paramedic students were using antibiotics without a prescription, 23.63% admitted that they discontinued their prescribed antibiotic course once they felt better, 95.88% recognized the term ‘antibiotics’, and 79.67% acknowledged that inappropriate use contributed to resistance. A sex comparison revealed that male students (81.32%) were significantly more likely to complete their prescribed antibiotic courses than their female counterparts were (67.29%) (p = 0.002). This study identifies gaps in paramedical students' knowledge, attitudes, and practices related to antibiotic use and resistance. Despite a general awareness of key concepts, misconceptions and improper practices were also common. Therefore, there is a dire need to upgrade the curriculum and implement integrated modules on antibiotic stewardship, infection control, and responsible antibiotic use, which could enhance students' knowledge, enable them to make informed decisions, and contribute significantly to combating antibiotic resistance.