Antibiotic-Prescribing Practices of Pediatric Dentists in a University Setting

Purpose: To assess antibiotic-prescribing practices at a university-based pediatric dental clinic, evaluating adherence to the American Academy of Pediatric Dentistry (AAPD) best practice recommendations. It aimed to determine the appropriateness of antibiotic selection, dosing, frequency and duration, and identify factors associated with inappropriate prescriptions. Methods: A retrospective cross-sectional study of electronic health records was conducted for patients aged zero to 17 years who received antibiotics for odontogenic infections or related dental conditions over 27 months, including a three-month COVID-19-related clinic closure. Data on patient demographics, clinical diagnoses, prescribed antibiotic type, dosage, administration frequency and duration were analyzed. Adherence to the AAPD prescribing recommendations was assessed and statistical analyses, including chi-square tests and logistic regression models, identified factors linked to inappropriate prescribing. Cohen's kappa statistics determined intra- and inter-examiner reliability. Results: Among 279 patient records, adherence to AAPD guidelines was 61.6 percent. Inappropriate prescriptions were significantly more frequent in younger children aged zero to seven years and medically compromised patients, with the latter twice as likely to receive an inappropriate prescription (P=0.0033, odds ratio [OR]=2.15). Infections involving permanent teeth were associated with a higher likelihood of prescribing errors (P=0.0353, OR=1.95). Weight-based dosing errors occurred in 6.5 percent of cases, mostly due to underdosing. The COVID-19 pandemic reduced overall prescriptions, but the proportion of inappropriate prescriptions remained unchanged. Conclusions: Antibiotic prescribing in pediatric dentistry showed moderate adherence to AAPD guidelines, with inappropriate prescriptions influenced by patient age, medical status and tooth type. Strengthening antibiotic stewardship and provider education is necessary to improve prescribing practices.