Dental stewardship implementation and antimicrobial resistance awareness in India: prescribing patterns, knowledge gaps, and barriers–systematic review with narrative synthesis

Introduction: Antimicrobial resistance (AMR) is a critical global health threat, with drug-resistant infections projected to cause up to 10 million deaths annually by 2050. India bears a disproportionate share of this burden. Dental practitioners contribute approximately 10% of national antibiotic prescriptions; however, antimicrobial stewardship (AMS) in dental settings remains underdeveloped, with no national dental-specific guidelines. This systematic review with narrative synthesis evaluates AMR awareness and AMS implementation among Indian dental professionals. Methods: A systematic review with narrative synthesis was conducted in accordance with PRISMA 2020 guidelines. Five databases were searched for studies published between January 2014 and December 2024. Eligible studies of any design examined AMR awareness, AMS behaviors, or antibiotic prescribing practices among Indian dental practitioners. Methodological quality was independently appraised using CASP checklists. Due to substantial heterogeneity across study designs and outcomes, findings were synthesized narratively and analyzed thematically. Results: From 1,852 records, 14 studies involving 3,602 participants were included. All studies referenced guidelines or clinical pathways. Prescribing practices were the most frequently assessed outcome (12/14; 86%), followed by compliance (9/14; 64%) and knowledge or awareness (6/14; 43%). Key findings included significant knowledge-practice gaps, inappropriate prescribing patterns, and the absence of structured stewardship infrastructure. Facilitators included baseline AMR awareness and professional willingness to engage, while barriers included curriculum deficiencies and limited access to guidelines. Conclusions: Structured dental AMS programs are both urgently needed and feasible in India. Addressing modifiable drivers through national prescribing guidelines, integrated AMS education, and audit and feedback systems is essential to support AMR containment.