Co-Producing an Intervention to Reduce Inappropriate Antibiotic Prescribing Among Dental Practitioners in India

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.