Antibiotic Prescribing Practices for Apical Periodontitis and Acute Periapical Abscess in Children: A Systematic...

Background: Inappropriate antibiotic prescribing in dentistry contributes to antimicrobial resistance, a major global health concern. In pediatric dentistry, antibiotics are frequently prescribed despite guidelines discouraging their use in localized conditions such as apical periodontitis (AP). This systematic review aimed to evaluate patterns, indications, and adherence to clinical guidelines in antibiotic prescribing for AP and acute periapical abscess (APA) in children and adolescents. Methods: A systematic review was conducted in accordance with the PRISMA 2020 statement and registered in PROSPERO (CRD420261342269). The review question was structured using the CoCoPop framework. A comprehensive search was performed in PubMed/MEDLINE, Scopus, and Embase up to March 2026. Observational studies assessing antibiotic prescribing practices among pediatric dentists were included. Risk of bias was assessed using the Joanna Briggs Institute checklist, and certainty of evidence was evaluated using the GRADE approach. Results: Six cross-sectional studies were included. Adherence to prescribing guidelines ranged from 38.4% to 68.2%. Antibiotic prescribing rates ranged from 22.9% to 71.0% for AP and from 41.1% to 78.0% for APA. Pooled prevalence estimates increased from 36.0% (95% CI: 18.0-58.9%) for AP to 60.7% (95% CI: 46.1-73.5%) for APA. Amoxicillin was the most commonly prescribed antibiotic, followed by amoxicillin-clavulanic acid, and treatment duration was typically 5-7 days. Substantial variability in prescribing practices was observed. Conclusions: Antibiotic prescribing in pediatric dentistry remains inconsistent, with inappropriate use persisting in conditions where antibiotics are not indicated. Strengthening antimicrobial stewardship and improving adherence to evidence-based guidelines are essential to optimize antibiotic use.