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

BACKGROUND: Inappropriate prescribing of antibiotics by dental practitioners in India is largely attributed to the absence of clinical guidelines and antimicrobial stewardship resources. To help address this, a stewardship intervention for dental practitioners, comprising a chairside antibiotic guide, a training module focusing on antimicrobial resistance (AMR) and appropriate dental antibiotic prescribing and a patient information sheet, was co-developed by the authors and stakeholders from India. The aim of this study was to evaluate the feasibility and acceptability of the intervention in a primary care setting in a city in southern India, using mixed methods. METHODS: Thirty-two dentists from Chennai participated in the self-paced training on their laptops simulating online continuing professional development (CPD) training. The mixed-methods pragmatic research involved quantitative pre- and post-test scores, and sixteen qualitative semi-structured interviews conducted after 6 weeks evaluating dentists' experiences of the training and its subsequent implementation in clinical practice. These were analysed descriptively and using thematic framework analysis. FINDINGS: Participants showed significant improvement in pre-/post- scores from 6.53 (SD ± 3.9) to 15.9 (SD ± 2.7) with a mean difference of 9.4 [95% CI (10.68, 8.13)] after the training (p < 0.001). The intervention was acceptable to dental practitioners who reported increased understanding of AMR and willingness to change inappropriate prescribing behaviour. Concerns remained about pressure from visiting consultants, fear of consequences, changing established norms and record keeping practices. CONCLUSIONS: The intervention was acceptable to participant dentists who were willing to change inappropriate prescribing behaviour. Scale-up of the training in collaboration with stakeholders including the Indian Dental Association and National Dental Commission has the potential to significantly reduce inappropriate antibiotic use in dentistry. The findings are likely to be relevant, with adaptation, to other low- and middle- income countries.