Reducing inappropriate antibiotic prescribing behaviour among dental practitioners in a south Indian City through an educational intervention- a mixed methods feasibility study.

India has one of the highest Antimicrobial Resistance (AMR) burden in the world, with antibiotic misuse being a significant contributor [, ]. This issue is particularly concerning in the field of dentistry. A recent systematic review has shown that irrational antibiotic prescribing for dental conditions is widespread in India []. Dentists often prescribe antibiotics unnecessarily for routine procedures and dental pain, utilizing combination of antibiotics that are restricted for use by the World Health Organisation []. Furthermore, there are currently no comprehensive antibiotic prescribing guidelines specific to dentistry, nor are there readily available educational resources for dentists to support appropriate antibiotic use and mitigate misuse []. The updated ‘National Treatment Guidelines for Antimicrobial Use’ developed by the Indian Council for Medical Research and the National Centre for Disease Control do not adequately address common areas of antibiotic misuse in dentistry in the country particularly with respect to prescribing for routine dental procedures []. India’s National Action Plan (NAP-AMR) advocates for strategic interventions to enhance AMR awareness and to provide regular training to optimise antibiotic use by prescribers. Prior studies have demonstrated the effectiveness of training and educational resources in reducing antibiotic prescribing behaviour among physicians in low- and middle-income countries (LMICs) including India [–]. However, such resources have not been utilised for dental antimicrobial stewardship (AMS) in India. This study is the first of its kind to pilot an intervention with dental practitioners and assess its acceptability and feasibility in optimising antibiotic prescribing behaviour in the Indian context, with the goal of refining it for future scale-up. The development of this intervention was informed by a prior needs assessment which included a systematic review and a document analysis [, ] and was guided by the Medical Research Council (MRC) framework for complex interventions development []. In addition, evidence from global guidelines and research conducted in similar low- and middle-income country settings [–] contributed to the creation of a chairside guide, a training module around this guide and a patient information sheet, which were adapted and refined by Indian stakeholders to enhance acceptability and adoption. In keeping with the core components of the MRC framework, we engaged with local stakeholders to ensure contextual relevance and made refinements to suit local needs. A comprehensive description of the intervention development process is provided in a separate paper [].