Antibiotic resistance is growing to alarmingly high levels worldwide, endangering our capability to treat frequent infectious diseases. This antibiotic resistance is exacerbated by antibiotic misuse and overuse, as well as ineffective infection prevention and control [19].
Reinforcement of the global antimicrobial resistance surveillance is crucial for establishing global strategies, monitoring the effectiveness of public health interventions, and detecting new trends and threats. Hence, This study is an attempt to contribute to the available literature on antibiotic use and abuse, particularly when treating children in the Middle East [13].
The present study showed a tendency to overprescribe and overuse antibiotics in certain conditions like pulpitis, draining sinus tract, localized intraoral swelling, periapical abscess, apical periodontitis, dry socket which occurred more by general dentists in comparison to pediatric dentists. These findings were in accordance with several studies which indicate that inadequate understanding of the disease, uncertain diagnosis, time pressure, patient expectation, parental pressure, and refusal of operative treatment may be the primary reasons [5, 7, 13, 20].
Amoxicillin with clavulanic acid was the most frequently prescribed antibiotic followed by Amoxicillin. It may be contributed to the effectiveness of Amoxicillin against Streptococci and oral anaerobes which make them appropriate for the treatment of odontogenic infections and the advantage of Amoxicillin with clavulanic acid to preserve the activity against the Beta-lactamases commonly produced by microorganisms associated with odontogenic infections [14, 21].
According to the American Academy of Pediatric Dentistry, Metronidazole may be prescribed as a supplementary antimicrobial treatment in the presence of anaerobic bacterial involvement [15]. This may explain the variation in antibiotic prescription in the presence of an anaerobic infection between pediatric and general dentists in the present study.
Regarding the duration of antibiotic prescription, the majority of the dentists in both groups prescribed antibiotics for 5–7 days allowing resolution of signs and symptoms with no risk of clinical and microbiological relapse. Moreover, antibiotic prescription for the correct duration lowers the unfavorable results and relieves the dilemma of antibiotic resistance [14, 15, 21].
Concerning antibiotic prescription for systemic conditions, a majority of dentists would prescribe antibiotics in cases of cardiovascular diseases while in case of viral infections, juvenile diabetes, blood dyscrasias, respiratory disorders majority of dentists declared they would not prescribe any antibiotics.
While there is a possibility that oral microorganisms can germ and infects distant tissues after oral practices, there is no proven evidence that this happens. Therefore, the fact of when and for which situations systemic prophylactic antibiotics are needed is debatable [21, 22].
The American Heart Association (AHA) proposes antibiotic prophylaxis for patients with cardiac disorders as they have the greatest risk of an unfavorable outcome [16, 17].
The awareness of guidelines for the prescription and prophylaxis of antibiotics was found to be around 70% of the study population where only 30% felt inadequately informed and trained regarding antibiotic use with no statistical significance between both groups in line with previous studies [12, 20].
Pediatric dentists showed comparatively better adherence to the guidelines as compared to general dentists in our study which may be contributed to the fact that pediatric dentists treated children more often and usually have more years of education in treating children [11].
But still, adherence of pediatric dentists to guidelines was considered low (less than 60%). This finding was in accordance with previous studies that have demonstrated varying low levels of adherence among pediatric dentists in various parts of the world, ranging from 10 to 56% [3, 11,12,13].
Despite the awareness of antibiotic resistance and prescription guidelines among most of the participants, still there is a misuse in antibiotics prescription. This might be explained by the fact that although knowledge of clinical guidelines and research evidence directly influence antibiotic prescribing, other barriers or competing factors exist that hinder their use in the oral health setting [23].
The results of the present study showed that the majority of the participants inquire the patient about taking antibiotics in the past week before prescribing antibiotics and advise them to adhere to the dosage regimen. Also, the presence of too many patients in the waiting areas or the need to sustain the patient till the next appointment were not reasons for prescribing antibiotics. Dentists demonstrate a lack of worry in limiting this major problem which may be defended by the statement of self-medication as a trigger for its advancement.
This may be explained by the socially desirable responding phenomena, that is, when inquired about unprofessional acts, participants may reply in a way that they feel socially acceptable rather than disclosing information about their true behavior [24].
Study limitations
The data collected was self-reported by the participants and did not examine the actual prescription from the patient files. Furthermore, reporting bias is a concern, as dentists’ responses may not truly reflect their actual practice. In addition, non-response bias is another possible drawback of self-administered questionnaire research. Respondents' answers may have varied more positively or negatively from those of non-respondents, making it difficult to predict which direction the non-responders will lean.
