Background: Infections caused by antibiotic resistance pose a serious global health threat, undermining our ability to treat common infections and deliver complex medical procedures. Antibiotic misuse, particularly in low-–middle-income countries, is accelerating this problem. Aim: The aim of this systematic review was to investigate the use and misuse of antibiotics in dentistry in India. Method: We included studies carried out on Indian populations evaluating the prescription of prophylactic or therapeutic antibiotics by dental practitioners or other healthcare providers, along with antibiotic self-medication by the general population. The primary outcome measure was prescription rate/use of antibiotics for dental/oral problems. The secondary outcome measures included indications for antibiotic use in dentistry, their types and regimens, factors influencing practitioners’ prescription patterns and any differences based on prescriber and patient characteristics. Multiple databases were searched with no restrictions on language or publication date. The quality assessment of all included studies was carried out using the AXIS tool for cross-sectional studies and the Joanna Briggs Institute checklist for qualitative studies. Results: Of the 1377 studies identified, 50 were eligible for review, comprising 35 questionnaire surveys, 14 prescription audits and one qualitative study (semi-structured interviews). The overall quality of the included studies was found to be low to moderate. The proportion of antibiotic prescriptions amongst all prescriptions made was found to range from 27% to 88%, with most studies reporting antibiotics in over half of all prescriptions; studies also reported a high proportion of prescriptions with a fixed dose drug combination. Worryingly, combination doses not recommended by the WHO AWaRe classification were being used. The rate of antibiotic self-medication reported for dental problems varied from 5% to 35%. Conclusions: Our review identified the significant misuse of antibiotics for dental diseases, with inappropriate use therapeutically and prophylactically, the use of broad spectrum and combination antibiotics not recommended by WHO, and self-medication by the general population. There is an urgent need for targeted stewardship programmes in this arena.

Background: Inappropriate antibiotic prescribing by dental practitioners is a significant problem in low- and middle-income settings, such as India, where there are no guidelines for dental prescribing. This study aims to report, in a step-by-step process, the co-development of a computer-based stewardship educational intervention with Indian stakeholders to reduce inappropriate antibiotic prescribing by primary care dental practitioners in India. Methods: The development process of our intervention was guided by the Medical Research Council framework for developing and evaluating complex interventions. In alignment with the framework’s core elements, a co-production research approach was employed. Engagement with local stakeholders, including primary care dental practitioners, academic dentists, and those from the Indian Dental Association, facilitated the development of a contextually appropriate intervention that was informed by a prior needs assessment (a systematic review and a policy document analysis conducted in India) and evidence from global literature. The intervention was refined through iterative feedback from stakeholders and pre-testing. Results: An educational antibiotic stewardship intervention was co-developed in collaboration with stakeholders from Chennai, a major city in southern India. The final intervention comprised three components: 1. A one-page chairside guide summarising common areas of dental antibiotic use for easy reference in clinical settings; 2. A training module based on the chairside guide; and 3. A patient information sheet to facilitate dentists’ communication with patients. The intervention components were designed to be clear, practical, and contextually relevant, with the potential to enhance clinical decision-making and promote evidence-based antibiotic prescribing practices. Conclusions: This research paper describes, in a structured manner, how an educational antibiotic stewardship intervention for dental practitioners in India was co-developed by researchers and local stakeholders. Further feasibility testing is required to address uncertainties identified at the conclusion of the development process, including those related to dentists’ perceptions of the intervention, the utility of the intervention tools, and prescription recording.