Reassessing Antibiotic Duration in Dental Infections: A Narrative Review and Marginal Benefit-Harm Framework with a...

Antibiotic duration is a central question in antimicrobial stewardship, yet dental prescribing often remains anchored to fixed five- or seven-day courses despite the source-control-dependent nature of many odontogenic infections. Current dental guidance supports short courses and clinical reassessment but provides limited structure for deciding whether continued antibiotic exposure remains justified once treatment has begun. This narrative review aimed to integrate clinical, pharmacokinetic/pharmacodynamic, dental, and ethical evidence within a marginal benefit-harm framework and to translate that framework into a practical reassessment checklist. A targeted narrative search identified 147 records from PubMed/MEDLINE, Google Scholar, professional guidance documents, and reference chaining; 52 references were selected across four evidence streams: studies comparing shorter and longer antibiotic courses, dental evidence and guidance on odontogenic infections, PK/PD literature on antimicrobial exposure, and ethics and stewardship literature on proportionality, antimicrobial resistance, and public-health responsibility. The review conceptualizes clinically sufficient antibiotic exposure as the patient-specific decision point at which the expected marginal clinical benefit of further antibiotic treatment no longer clearly exceeds its expected incremental harm. This is not defined by a fixed number of treatment days and may change according to source control, clinical trajectory, antimicrobial adequacy, infection severity, anatomical risk, and host factors. On this basis, the proposed checklist operationalizes the marginal model by structuring reassessment of infection severity, anatomical involvement, host-related risk modifiers, and the marginal benefit-harm balance of further treatment. Rather than promoting automatic shortening, the framework supports continuation only when a specific unresolved clinical factor provides a plausible justification for additional exposure. This approach reframes antibiotic duration in dental infections from a predetermined calendar course to a patient-specific judgment about whether further exposure remains clinically and ethically justified.