Antibiotic Prescribing Patterns and Antimicrobial Stewardship Among Indian Periodontists: A Cross-Sectional Survey

Background: Antimicrobial resistance is a growing concern, and inappropriate prescribing may contribute to its rise. Variability among periodontists highlights the need to understand prescribing patterns and factors influencing antibiotic selection. We aim to assess antibiotic prescribing patterns and perceptions of resistance among Indian periodontists and evaluate factors associated with prescribing practices and selection of the antibiotic regimen perceived by respondents as most effective. Methods: A cross-sectional questionnaire survey was conducted among Indian periodontists (January-April 2024), distributed via institutional email and LinkedIn. Descriptive statistics summarized responses; chi-square/Fisher's tests assessed associations with experience. Logistic regression was performed to identify factors associated with respondents' selection of the antibiotic regimen perceived as most effective for periodontal therapy. Results: Of 500 invited, 328 responded (65.6%). Respondents were mostly female (67.7%), with a mean age of 32.25 ± 6.05 years; 50.3% had <5 years' experience and 98.6% held an MDS in Periodontology. Amoxicillin plus metronidazole was the regimen most frequently perceived as effective by respondents (37.8%), followed by amoxicillin-clavulanic acid (35.4%) and amoxicillin alone (15.9%). Oral administration was preferred (89.0%). Prophylactic antibiotics were prescribed for infective endocarditis/CABG indications by 89.6%, while 48.2% did not prescribe after laser-assisted surgery. Experience was significantly associated with prescribing frequency and post-laser prescribing (p < 0.05); associations with crown lengthening and flap surgery lost significance after Bonferroni correction. Academic practice was associated with regimen selection univariably (OR = 0.56, 95% CI 0.34-0.93) but not after multivariable adjustment (aOR = 0.65, 95% CI 0.37-1.13). Most respondents (98.5%) viewed resistance as a growing concern. Conclusions: Prescribing practices varied with experience and practice setting. Amoxicillin plus metronidazole was most frequently considered effective, though no factor independently predicted selection. High awareness of resistance underscores the need for stronger antimicrobial stewardship in periodontal care.