Appropriateness of antibiotic prescribing in dental practice: results of two clinical audits conducted at a university hospital
Abstract
Antimicrobial resistance (AMR) is a major global public health threat, and dentistry contributes substantially to unnecessary antibiotic use. Despite the publication of clear prescribing recommendations by the European Society of Endodontology (ESE) in 2018, inappropriate antibiotic prescribing remains common, particularly in dental emergency settings. This study aimed to evaluate the appropriateness of antibiotic prescribing in a university dental emergency department and to assess the impact of an audit-and-feedback intervention. A prospective two-phase clinical audit was conducted in 2025 at the University Hospital of Marseille. Two consecutive two-week audit periods were conducted before and after individualized feedback and educational workshops. Prescriptions were classified according to ESE guidelines as appropriate (A1, A2) or inappropriate (I1, I2). A secondary analysis evaluated the appropriateness of treatment modalities (A1C, A1NC). Statistical analyses were performed using Chi-squared or Fisher's exact tests. A total of 640 patients were included. Antibiotics were prescribed in 30.3% of consultations. The proportion of appropriate prescriptions did not improve significantly between audits (A1 + A2: 71.9% vs. 77.6%, p = 0.822). Among the 193 patients who received antibiotics, inappropriate prescriptions remained common (I2, 72.5%), particularly among patients presenting with pulpal or periapical diseases and among those consulting primarily because of pain. Among patients with a pulpal or periapical diagnosis who received antibiotics, 112 of 113 prescriptions (99.1%) were inappropriate, compared with 28 of 80 (35.0%) among other diagnoses. This pattern was consistent across the individual pulpal and periapical diagnostic subgroups. Inappropriate antibiotic prescribing remains frequent in dental emergency care. A single audit-and-feedback intervention was insufficient to significantly modify prescribing practices, highlighting the need for sustained and multifaceted antimicrobial stewardship strategies focused on improving diagnostic accuracy and ensuring timely operative management.
Related
- Antibiotic prescribing appropriateness for urinary tract infections in a tertiary emergency department: a retrospective cohort study.
- Determinants of Antibiotic Prescribing for Acute Respiratory Infections in Primary Care: A Retrospective Cross-Sectional Study at the Eduardo Mondlane University Health Center, Maputo, Mozambique
- Trends in antibiotic prescribing by general practitioners in Belgium (2014-2023) and association with changing workforce demographics.
- Antibiotic prescribing practices of community health extension workers in East Central Uganda: an exploratory qualitative study
- Indications for GP antibiotic prescribing and prescription-dispensing concordance, France, 2017-2019
BibTeX
@article{lan2026appropriateness,
title = {{Appropriateness of antibiotic prescribing in dental practice: results of two clinical audits conducted at a university hospital}},
author = {Romain Lan and Célia Lento and Delphine Tardivo and Carole Siani and Thomas Giraud and Jean-Hugues Catherine and Florence Carrouel and Nadim Cassir and Manon Roche},
journal = {Frontiers in Oral Health},
year = {2026},
month = sep,
doi = {10.3389/froh.2026.1913184},
url = {https://hal.science/hal-05755254v1},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Appropriateness of antibiotic prescribing in dental practice: results of two clinical audits conducted at a university hospital
AU - Romain Lan
AU - Célia Lento
AU - Delphine Tardivo
AU - Carole Siani
AU - Thomas Giraud
AU - Jean-Hugues Catherine
AU - Florence Carrouel
AU - Nadim Cassir
AU - Manon Roche
PY - 2026
DA - 2026/09/18
JO - Frontiers in Oral Health
DO - 10.3389/froh.2026.1913184
UR - https://hal.science/hal-05755254v1
AB - Antimicrobial resistance (AMR) is a major global public health threat, and dentistry contributes substantially to unnecessary antibiotic use. Despite the publication of clear prescribing recommendations by the European Society of Endodontology (ESE) in 2018, inappropriate antibiotic prescribing remains common, particularly in dental emergency settings. This study aimed to evaluate the appropriateness of antibiotic prescribing in a university dental emergency department and to assess the impact of an audit-and-feedback intervention. A prospective two-phase clinical audit was conducted in 2025 at the University Hospital of Marseille. Two consecutive two-week audit periods were conducted before and after individualized feedback and educational workshops. Prescriptions were classified according to ESE guidelines as appropriate (A1, A2) or inappropriate (I1, I2). A secondary analysis evaluated the appropriateness of treatment modalities (A1C, A1NC). Statistical analyses were performed using Chi-squared or Fisher's exact tests. A total of 640 patients were included. Antibiotics were prescribed in 30.3% of consultations. The proportion of appropriate prescriptions did not improve significantly between audits (A1 + A2: 71.9% vs. 77.6%, p = 0.822). Among the 193 patients who received antibiotics, inappropriate prescriptions remained common (I2, 72.5%), particularly among patients presenting with pulpal or periapical diseases and among those consulting primarily because of pain. Among patients with a pulpal or periapical diagnosis who received antibiotics, 112 of 113 prescriptions (99.1%) were inappropriate, compared with 28 of 80 (35.0%) among other diagnoses. This pattern was consistent across the individual pulpal and periapical diagnostic subgroups. Inappropriate antibiotic prescribing remains frequent in dental emergency care. A single audit-and-feedback intervention was insufficient to significantly modify prescribing practices, highlighting the need for sustained and multifaceted antimicrobial stewardship strategies focused on improving diagnostic accuracy and ensuring timely operative management.
SN - 2673-4842
SN - 2673-4842
ER -