Assessment of antibiotic prescribing patterns and antimicrobial resistance awareness among dentists: a mixed-methods study
Ridhi Ghodela, Naveen Kumar P.G., Mahesh R. Khairnar, Savitha Priyadarsini S, Tanya Thakkar, Neha Shukla, Unnati GuptaAbstract
Background:
Antimicrobial resistance is a global “silent pandemic” with dentistry contributing 10%–12% of outpatient antibiotic use. In low- and middle-income countries such as India, the absence of context-specific national dental antibiotic guidelines, widespread over-the-counter antibiotic access, and diagnostic limitations complicate rational prescribing and antimicrobial stewardship.
Methods:
A sequential explanatory mixed method study was conducted over 12 months in Varanasi. The quantitative component analyzed 2,844 dental prescriptions across primary, secondary, and tertiary care settings. Prescribing appropriateness was assessed using international evidence-based guidelines from the American Dental Association and Faculty of General dental Practice (UK). The qualitative component included 30 in-depth interviews with dental practitioners, analyzed using inductive thematic analysis to explore determinants of prescribing behavior.
Results:
Antibiotics were prescribed in 73.1% of cases, of which 69.6% were inappropriate. High prescribing rates observed in conditions where antibiotics are generally not indicated, including irreversible pulpitis (73.3%), apical periodontitis (92.3%), and implant procedures (100%). Broad-spectrum antibiotics predominated, particularly amoxicillin-clavulanic acid (43.0%) and cefpodoxime-clavulanic acid (21.7%). Qualitative findings identified that prescribing was driven by diagnostic uncertainty, defensive practice, patient expectations, and systemic constraints, including lack of national guidelines and unregulated antibiotic access.
Conclusion:
Inappropriate antibiotic prescribing in dentistry reflects a context-driven, multifactorial behavioral shaped by clinical, behavioral, and structural constraints rather than a simple knowledge deficit. Addressing this challenge requires context-specific national dental antibiotic guidelines, strengthened antimicrobial stewardship, improved diagnostic support, and regulatory enforcement. The proposed IDCARE+ framework offers a practical systems-based approach to promote rational antibiotic use in similar resource-constrained settings.