Antibiotic Prescribing Practices and Guideline Adherence in Pediatric Dentistry: A Systematic Review

Introduction:
Inappropriate antibiotic prescribing in pediatric dentistry contributes to antimicrobial resistance, adverse drug reactions, and increased healthcare costs. Despite the availability of evidence-based prescribing guidelines, inappropriate prescribing remains prevalent. This systematic review aimed to assess adherence to established antibiotic prescribing guidelines in pediatric dental practice, identify the most commonly prescribed antibiotics, and examine factors associated with inappropriate antibiotic prescribing.

Methods:
A systematic review was conducted in accordance with the PRISMA 2020 statement. English language observational studies published between 2016 and 2026 were searched in PubMed and Google Scholar. Studies involving dental practitioners who gave dental care to children aged 0–18 years and therapeutic and/or prophylactic antibiotic prescribing practices were evaluated. Data were extracted on guideline adherence, commonly prescribed antibiotics, and factors associated with inappropriate prescribing. Study quality was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklists.

Results:
Ten studies from eight countries were included, comprising surveys of a total of 2,544 dental professionals and retrospective analyses of 279 pediatric patient records. Guideline adherence ranged from 11% to 44.2% across most studies, while one retrospective study reported an adherence rate of 61.6%. Amoxicillin was the most frequently prescribed first-line antibiotic (67–98%), whereas amoxicillin–clavulanate and metronidazole were the most commonly prescribed alternative antibiotics. Pediatric dentists generally demonstrated higher adherence to prescribing guidelines than general dentists. Factors associated with inappropriate prescribing included limited awareness of clinical guidelines, lack of postgraduate or pediatric dental training, prescribing antibiotics for non-indicated conditions, patient or parental pressure, rural practice settings, high pediatric workloads, and management of medically compromised children.

Conclusion:
Inappropriate antibiotic prescribing remains common in pediatric dentistry despite the availability of evidence-based guidelines. Strengthening antimicrobial stewardship initiatives, improving awareness of clinical prescribing guidelines, and providing continuing professional education may improve adherence to evidence-based prescribing practices and help reduce unnecessary antibiotic use in pediatric dental care.