Antibiotics | Co-Producing an Intervention to Reduce Inappropriate Antibiotic Prescribing Among Dental Practitioners in India

This study pioneers a computerized educational intervention developed in collaboration with local Indian stakeholders to address inappropriate antibiotic prescribing by dental practitioners. Tailored to Indian dental clinical practices, it offers scalable and feasible educational resources and tools.

 

Literature Overview
This study, published in the journal Antibiotics, systematically describes the co-production of an educational antibiotic stewardship intervention for dental practitioners in India. It details the design process of an intervention aligned with the Indian primary dental care context, optimized through focus group discussions, technical working group (TWG) feedback, and pre-testing in the absence of localized guidelines or regulatory support.

Background Knowledge
Antimicrobial resistance (AMR) has emerged as a critical global health challenge, particularly in low- and middle-income countries like India. Dental practitioners play a pivotal role in AMR due to frequent antibiotic prescriptions and the absence of localized guidelines or regulatory frameworks. Building on the Medical Research Council (MRC) framework for developing complex interventions, this study employed a co-production approach integrating systematic reviews, policy analysis, and global antibiotic stewardship guidelines to design an educational module tailored for Indian dental practitioners. It addresses the gap in systematic AMR resources within Indian dental clinical settings and establishes a foundation for large-scale implementation and feasibility testing.

 

 

Research Methods and Experiments
Following ethical approvals from UK and Indian institutions, the research team collaborated with the Indian Dental Association (IDA) to conduct focus group discussions (FGDs) identifying practical challenges in prescription documentation and antibiotic use among Indian dental practitioners. A tripartite educational intervention package was developed, comprising a chair-side antibiotic guideline, a training module, and patient information sheets. This package underwent iterative refinement through multiple rounds of technical working group (TWG) feedback before being evaluated for readability, comprehension, and content acceptability via pre-testing.

Key Conclusions and Perspectives

• The final educational intervention includes three core components: a chair-side antibiotic prescribing guide, a training module based on the guide, and a patient information sheet to enhance communication between dentists and patients.
• FGDs revealed significant barriers to appropriate prescribing, including lack of regulation, time constraints, data security concerns, and limited AMR awareness. Practitioners often overprescribed antibiotics due to patient expectations, non-sterile clinical practices, and regulatory gaps.
• Through TWG feedback, the training module was iteratively optimized and widely accepted. Indian-specific content—including national AMR data, government regulations, and patient communication scenarios—was incorporated to improve contextual relevance.

Research Significance and Prospects
The study delivers a viable educational intervention for reducing antibiotic misuse in Indian primary dental care while emphasizing the critical role of local stakeholders in resource-constrained settings. Future research should evaluate the intervention's feasibility and explore its adaptability across diverse dental practice environments.

 

 

Conclusion
This co-produced educational intervention successfully integrated global best practices with Indian dental clinical contexts through iterative stakeholder engagement. While pre-testing demonstrated high acceptability, challenges persist regarding AMR awareness and prescribing behaviors in the absence of regulatory frameworks. Subsequent studies must validate its real-world effectiveness, assess implementation strategies, and develop systems for prescription data documentation to support future audits and feedback mechanisms. This research establishes a methodological foundation for improving antibiotic stewardship in Indian dental care and provides a transferable model for similar AMR interventions in other low- and middle-income countries.

 

Aarthi Bhuvaraghan, John Walley, Rebecca King, and Vishal R Aggarwal. Co-Producing an Intervention to Reduce Inappropriate Antibiotic Prescribing Among Dental Practitioners in India. Antibiotics.