Dental Stewardship Implementation and Antimicrobial Resistance Awareness in India: Prescribing Patterns, Knowledge Gaps, and Barriers

Background :Antimicrobial resistance (AMR) is a major global health concern, with estimates suggesting up to 10 million deaths annually by 2050. India, one of the world’s largest consumers of antibiotics, faces significant challenges in addressing AMR. Dental practitioners contribute nearly 10% of national antibiotic use, yet antimicrobial stewardship (AMS) in dental settings remains poorly developed and understudied. This systematic review evaluates AMR awareness and AMS implementation among dental professionals in India, focusing on knowledge gaps, prescribing behaviours, and barriers to effective stewardship. Methods :A systematic search was conducted in accordance with PRISMA guidelines across PubMed, Web of Science, CINAHL, Scopus, and Google Scholar for studies published between January 2014 and December 2024. Eligible studies assessed AMR awareness, AMS-related behaviours, or antibiotic-prescribing practices among Indian dental practitioners. Methodological quality was appraised using the Critical Appraisal Skills Programme (CASP) checklist. Results :From 1,852 records, 14 studies involving 3,602 participants met inclusion criteria. Marked deficits in AMR awareness and limited understanding of AMS principles were consistently identified. Common prescribing problems included inappropriate antibiotic selection, incorrect dosing and duration, and frequent use of broad-spectrum agents where narrow-spectrum options were appropriate. Educational interventions showed short-term improvements, though sustained practice change was seldom assessed. Major barriers included insufficient undergraduate AMS training, limited access to dental-specific guidelines, and the absence of institutional stewardship structures. Conclusions :Substantial gaps persist between AMR awareness and effective AMS practice in Indian dentistry. Strengthening undergraduate and continuing education, improving access to context-specific guidelines, and establishing formal AMS programmes are essential to optimise antibiotic use and contribute to India’s AMR containment strategies.