The Pattern of Antibiotic Prescription for Children Among a Group of Pediatric Dentists.

Antibiotic prescriptions for children is a cause for concern in both developed and developing countries, especially for its excessive use in non-established infections or in infections with viral etiology (Friedman et al., 2011). Although antibiotics play a crucial role in reducing child morbidity and mortality (De Jong et al., 2009), its irrational use directly increases antibiotic resistance by promoting the emergence of resistant bacteria leading to increased rates of treatment failures and more severe illness episodes with higher costs and mortality rates (Adisa et al., 2018).

Rational prescribing implies using the right drug for the right patient at the right time in the right dose and manner of administration at affordable cost with the right information. Thus, rational antibiotic prescription has to be tailor-made for individual patients taking into account the diagnosis, age, sex, weight, microorganism susceptibility, vital organ functions, drug and food interactions, as well as socioeconomic background of a patient (Aronson, 2014).

Within the dental community, awareness of clinical indications of antibiotic prescriptions to the child dental patient is lacking. It was found that a substantial proportion of children who received dental treatment for pain or localized swelling under general anaesthesia had also received antibiotics, with wide variation in antibiotic regimens (Dar-Odeh et al., 2018). Further, among members of the American Academy of Pediatric Dentistry, there was a trend toward overuse of antibiotics for non-indicated clinical conditions, like pain relief, irreversible pulpitis, and localized dentoalveolar abscess (Sivaraman et al., 2013).

Conditions requiring antibiotic treatment in dentistry is limited and there should be (i) a therapeutic goal to help treatment of acute/chronic infections (where drainage or debridement is impossible) or (ii) a prophylactic goal to prevent metastatic infections (e.g., bacterial endocarditis) or local or systemic spread of the infection (Dar-Odeh et al., 2010).

The non-clinical factors initiated antibiotic prescribing for some clinicians, such as unavailability of close appointments and seeking parental satisfaction (Sivaraman et al., 2013). A similar trend was observed in developing countries, where a substantial proportion of dentists prescribe for non-indicated clinical conditions, such as dry socket, localized periapical infection, marginal gingivitis, periodontitis, and pulpitis (Kouidhi et al., 2011). This insufficient knowledge of the appropriate clinical indications is paralleled by a lack of awareness of important interventions that promote the optimal use of antibiotics, such as antibiotic stewardship programs. Other forms of abuse in prescribing antibiotics include prescribing broad-spectrum antibiotics for infections that can be treated by narrow-spectrum antibiotics, prescribing antibiotics for long periods, and adopting inappropriate dosing regimens (Sivaraman et al., 2013).