Are Antibiotic Prescribing Patterns for Endodontic Infections Among Undergraduate Dental Students Consistent With Current Guidelines? A Multinational Cross-Sectional Study.

AIM: Appropriate antibiotic prescribing is a core competency in dental education. This study evaluated dental students' knowledge, antibiotic selection patterns, and adherence to international guidelines for the management of endodontic infections.

MATERIALS AND

METHODS

An online survey was administered to students in their final two clinical years across 19 countries. Three clinical scenarios were evaluated: first-line antibiotic choice, second-line when the first choice is ineffective, and drug of choice for penicillin-allergic patients. Participants reported drug, dose, frequency, and duration. Guideline adherence was quantified using a 0-5 scoring system based on European Society of Endodontology and American Association of Endodontists recommendations. Mixed-effects linear regression models with country as a random effect were used to identify predictors of guideline-concordant prescribing.

RESULTS

A total of 4226 responses were analysed. Amoxicillin was the most frequently selected first-line antibiotic (57.6%), followed by amoxicillin-clavulanic acid (18.4%), with marked between-country variation; adjusted first-choice concordance was highest in Colombia (4.57) and lowest in Bangladesh (2.49). For second-line therapy, amoxicillin-clavulanic acid predominated (33.2%), with the highest adherence in Ecuador (3.40) and the lowest in Switzerland (2.15). In penicillin-allergic patients, clindamycin was most commonly selected (47.8%), but allergy-specific concordance varied widely, ranging from 3.52 in Colombia to 1.06 in India. Age positively predicted second-line concordance, while lower allergy-specific concordance was observed among second-year students and males.

CONCLUSIONS

Marked variability and frequent deviations from guideline-recommended prescribing highlight persistent educational gaps. Strengthening antimicrobial stewardship training within undergraduate dental curricula is warranted.