Dental antibiotic policies, stewardship, and implementation in India: A policy document analysis

IF 1.8 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE Community dentistry and oral epidemiology Pub Date : 2024-06-18 DOI:10.1111/cdoe.12989

Aarthi Bhuvaraghan, Rebecca King, John Walley, Badri Thiruvenkatachari, Vishal R. Aggarwal

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Abstract

Objectives

Dental antibiotic stewardship is crucial in low- and middle-income countries where the burden of antimicrobial resistance (AMR) is high and antibiotic misuse is common. Given that India is the most populous country, the largest antibiotic consumer and has a large dental prescriber population, this study investigated the extent to which current Indian policy and practice for dental antibiotic prescribing and stewardship aligns with the global policy and best practice.

Methods

The READ approach was used to identify and extract data and synthesize the findings. Policy documents on dental antimicrobial stewardship were identified using a systematic search strategy involving nine medical and grey literature databases (Medline, Global Health, Web of Science, Cochrane, CINAHL, Eldis, Global Index Medicus, Proquest and Opengrey), targeted websites (government organizations and dental regulatory bodies) and contact with experts. Framework analysis was used to code extracted data into themes related to dental antimicrobial stewardship.

Results

Of the 3039 records screened, 25 documents were included in the final analysis. The analysis showed a lack of guidelines or toolkits for appropriate antibiotic prescribing in dentistry in India. The treatment guidelines for antimicrobial use in common syndromes published by the Indian Council of Medical Research had no section or content for dental practitioners. Furthermore, the undergraduate dental curriculum developed by the Dental Council of India (DCI), included little content on appropriate antibiotic prescribing and no mention of AMR or stewardship. There were no educational resources either for dental practitioners or patients in the documents.

Conclusion

This document analysis showed that there was little or no mention of dental antibiotic prescribing guidelines in key policy documents such as the National Action Plan on AMR. In addition, contradictory and subjective information provided in some policy documents could encourage dentists and other health professionals such as general practitioners to prescribe antibiotics for common dental conditions for which they are contra-indicated. There is an urgent need to develop relevant guidelines and include these in Indian policy documents on AMR particularly the National Action Plan on AMR.

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印度的牙科抗生素政策、管理和实施：政策文件分析。

目的：在中低收入国家，牙科抗生素管理至关重要，因为这些国家的抗菌药耐药性（AMR）很高，滥用抗生素的现象也很普遍。鉴于印度是人口最多的国家，也是最大的抗生素消费国，同时拥有大量的牙科处方医生，本研究调查了印度目前的牙科抗生素处方和监管政策与实践在多大程度上与全球政策和最佳实践保持一致：方法：采用 "READ "方法识别和提取数据，并对研究结果进行综合。采用系统性检索策略，包括九个医学和灰色文献数据库（Medline、Global Health、Web of Science、Cochrane、CINAHL、Eldis、Global Index Medicus、Proquest 和 Opengrey）、目标网站（政府组织和牙科监管机构）以及与专家的联系，确定了有关牙科抗菌药物管理的政策文件。采用框架分析法将提取的数据编码为与牙科抗菌药物管理相关的主题：结果：在筛选出的 3039 份记录中，有 25 份文件被纳入最终分析。分析结果表明，印度牙科缺乏适当的抗生素处方指南或工具包。印度医学研究委员会发布的常见综合症抗菌药使用治疗指南中没有针对牙科医生的章节或内容。此外，印度牙科委员会（DCI）制定的牙科本科课程中几乎没有关于合理使用抗生素的内容，也没有提及AMR或管理。文件中也没有针对牙科医生或患者的教育资源：文件分析表明，在诸如《国家 AMR 行动计划》等重要政策文件中，很少或根本没有提及牙科抗生素处方指南。此外，一些政策文件中提供的自相矛盾和主观臆断的信息可能会鼓励牙医和其他医疗专业人员（如全科医生）为常见的牙科疾病开具抗生素处方，而这些疾病是不适合使用抗生素的。目前迫切需要制定相关的指导方针，并将其纳入印度的 AMR 政策文件，特别是《国家 AMR 行动计划》。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Community dentistry and oral epidemiology 医学-公共卫生、环境卫生与职业卫生

CiteScore

4.40

自引率

8.70%

发文量

审稿时长

6 months

期刊介绍： The aim of Community Dentistry and Oral Epidemiology is to serve as a forum for scientifically based information in community dentistry, with the intention of continually expanding the knowledge base in the field. The scope is therefore broad, ranging from original studies in epidemiology, behavioral sciences related to dentistry, and health services research through to methodological reports in program planning, implementation and evaluation. Reports dealing with people of all age groups are welcome. The journal encourages manuscripts which present methodologically detailed scientific research findings from original data collection or analysis of existing databases. Preference is given to new findings. Confirmations of previous findings can be of value, but the journal seeks to avoid needless repetition. It also encourages thoughtful, provocative commentaries on subjects ranging from research methods to public policies. Purely descriptive reports are not encouraged, nor are behavioral science reports with only marginal application to dentistry. The journal is published bimonthly.