Background In Scotland, guidance for prescribing in dentistry was published in 2008 in response to concerns about over-prescribing of antibiotics. The guidance recommends that antibiotic prescribing must be kept to a minimum. However, evidence from routinely collected data demonstrates that dental antibiotic prescribing is steadily increasing, now accounting for 9% of primary care antibiotic prescriptions.

Objectives To compare the effectiveness of different audit and feedback (A&F) strategies for the implementation of recommendations on dental antibiotic prescribing.

Methods The study is an 18 month, three-arm randomised controlled trial. All dentists in Scotland are being randomised to either: 1) access to a pre-approved national audit; 2) access to the audit plus individualised feedback; 3) access to the audit, individualised feedback and a persuasive message. The primary outcome is the number of antibiotic prescriptions per 100 patients. A process evaluation will be conducted to elucidate the mechanisms by which A&F influences practice. The trial was developed in collaboration with system-level stakeholders from policy, education and service providers.

Results Development of all interventions is complete and the trial will begin in March 2013. Processes are being developed to enable integration of the most effective intervention into national systems intended to reduce antibiotic prescribing.

Discussion Collaboration with system-level stakeholders has helped ensure that the trial addresses national priorities and has engendered system-level action for national implementation of the most effective intervention.

Implications for Guideline Developers/Users Generating robust experimental evidence on an intervention’s effectiveness and collaboration with system-level stakeholders can increase the likelihood of its adoption as a policy initiative.