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Research Article
Volume 20(3)
Received March 1, 2024; Revised March 31, 2024; Accepted March 31, 2024, Published March 31, 2024

DOI: 10.6026/973206300200282

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Citation: Alelyani et al. Bioinformation 20(3): 282-291(2024)

Awareness on antibiotic prescription for endodontic

cases among Dentists and Endodontists in Saudi
Arabia
Ahmed Ali Alelyani1, Raid Abdullah Almnea*,1, Rizwan Qureshi2, Ziyad Mohammad Assiri3,
Mansour Hamad Alkorbi3, Khaled Ahmed Almasabi3 & Siraj DAA Khan4
1RestorativeDepartment, Endodontic Division, Faculty of Dentistry, Najran University, Kingdom of Saudi Arabia; 2Faculty of
Dentistry, Najran University, Kingdom of Saudi Arabia; 3Faculty of Dentistry, Najran University, Kingdom of Saudi Arabia;
4Department of Preventive Dental Sciences, Faculty of Dentistry, Najran University, Kingdom of Saudi Arabia; *Corresponding

author

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Author contacts:
Raid Abdullah Almnea – E-mail: [email protected]; Phone: +966-17541-7960
Siraj DAA Khan – E-mail: [email protected]
Ahmed Ali Alelyani – E-mail: [email protected]
Rizwan Qureshi – E-mail: [email protected]
Ziyad Mohammad Assiri – E-mail: [email protected]
Mansour Hamad Alkorbi – E-mail: [email protected]
Khaled Ahmed Almasabi – E-mail: [email protected]

Abstract:
The knowledge of Dentists and Endodontists in Saudi Arabia regarding antibiotic prescriptions during and after endodontic
treatment is of interest. A self-designed questionnaire survey was utilized to assess the knowledge of dentists across various cities in
Saudi Arabia concerning antibiotic usage guidelines for endodontic purposes. A total of 391 participants were included in the study,
and the questionnaire was distributed through social platforms like WhatsApp, Instagram, Facebook Messenger, and email. Results
revealed that over 80% of participants acknowledged the need for antibiotics in cases of acute apical abscess with cellulitis, with
amoxicillin being the most recommended antibiotic by dentists. Interestingly, there was no statistically significant difference in
knowledge based on experience or graduation group. In conclusion, while participants demonstrated adequate knowledge about
antibiotic prescriptions in endodontic cases, continued awareness of updated guidelines, including the WHO's Essential Medicines
List (EML), guidelines by the European Society of Endodontology (ESE) and American Association Endodontists (AAE) is essential
for optimal clinical practice.

Keywords: Endodontics, prescription, antibiotics, acute apical abscess

Background: The systemic antibiotic prescription has become common in

Antibiotics are substances derived from microbial sources or dental practice, increasing significantly in the last two decades.
synthesized with similar properties, exhibiting antimicrobial Dental antibiotic use represents 7-10% of global prescriptions for
effects in low concentrations to impede the growth or eradicate non-dental medical reasons. [7] Antibiotics are recommended
specific microorganisms. The purpose of antibiotic therapy is to based on European Society of Endodontology guidelines for
assist the host's defense mechanisms in managing and pulp and periapical pathology. Prescription is warranted for
eradicating temporarily overwhelming microorganisms. [1] systemic involvement (fever>38ºC, malaise, lymphadenopathies,
Dentists often misuse antibiotics in various clinical situations. trismus), progressing infections (increased inflammation,
The primary approach for treating endodontic infections cellulitis, osteomyelitis), and persistent infections in
involves establishing and sustaining surgical drainage while immunosuppressed individuals. [8] Not every endodontically
eliminating the infection's root cause. Despite the valuable role involved tooth necessitates systemic antibacterial medication;
of antibiotics, successful treatment in most cases can be achieved effective management often involves pulp extirpation and
through mechanical and chemical cleaning of the root canal. [2] thorough mechanical and chemical canal debridement. The use
Clinicians have grappled with the persistent challenge of of antibiotics for immediate pain relief in acute pulpitis lacks
bacterial resistance to antimicrobials since the inception of these proven benefits. [9] To improve this impending problem,
agents. This resistance stems from the inherent capability of scientific guidance based on scientific evidence was established
bacterial species to develop resistance shortly after the by a committee of experts from the European Society of
introduction and widespread use of antibacterial agents. [3] Endodontology (ESE) in 2018. The key feature of ESE is to
Substantial evidence supports a noteworthy correlation between emphasize the appropriate use of antibiotics in endodontics and
the surge in antimicrobial resistance and the utilization of the need to place more emphasis on the performance of root
antimicrobials. Bacteria isolated from regions with elevated canal treatment exclusively. In particular, ESE places value on
antibiotic usage exhibit higher resistance levels compared to the risks associated with the inappropriate use of antibiotics and
those from areas with lower antibiotic utilization. [4] One of the especially antibiotic resistance. [8] Palmer et al. found that 12.5%
various benefits associated with antibiotics is their non-injurious of general dental practitioners (GDPs) prescribed antibiotics for
impact on tissues. Additionally, antibiotics exhibit synergism, acute pulpitis, with 30.3% doing so due to time constraints and
offering the potential to impact a broad spectrum of bacteria. 47.3% in cases where a precise diagnosis was challenging.
They contribute to shortened sterilization duration and facilitate Amoxicillin was the most commonly prescribed antibiotic. [10]
rapid healing. [5] However, it's essential to note that antibiotics Another study revealed that 61.48% of GDPs preferred penicillin
do not alleviate odontogenic pain or swelling arising from teeth V for endodontic infections, while clindamycin (57.3%) and
with symptomatic apical lesions when systemic involvement erythromycin (26.65%) were choices for those allergic to
signs and symptoms are absent. The ineffectiveness of antibiotics penicillin. [11] In Australia, a study showed a generally adequate
in reaching the affected area is attributed to the lack of blood level of antibiotic prescription knowledge among dentists, but
circulation in the root canal, particularly in necrotic teeth. [6] there was a tendency towards over-prescription and a lack of

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awareness regarding adverse reactions, multi-resistant strains, other private information were deliberately omitted from the
and bacterial endocarditis prophylaxis. [12] However, there is no collected data.
data on Saudi dentists and endodontists regarding antibiotic
prescription practices. Evaluating this information is crucial to Statistical analysis:
identifying knowledge gaps, enabling the design of effective The data was analyzed using the SPSS software, and the results
educational campaigns, and addressing the issue of were portrayed using descriptive measures. Correlations among
indiscriminate antibiotic use. Therefore, it is of interest to gather various parameters were determined using χ² tests.
the knowledge of antibiotic prescription during endodontic
treatment among dentists in Saudi Arabia. Ethical approval:
Approval for the ethical considerations of this study was granted
Materials and Methods: by the Deanship of Research, Najran University under the
Study design: reference number 202401-076-017905-040323.
This cross-sectional survey, employing a questionnaire-based
approach, took place from August to December 2023. The survey Results:
aimed to assess the understanding of antibiotic prescriptions for This study encompassed a total of 391 participants, consisting of 55
endodontic cases among dentists and endodontics specialists. females (14.1%) and 336 males (85.9%) who were practicing dentistry.
The majority of participants were distributed across Najran (94), Abha
The questionnaire underwent initial scrutiny in a pilot study,
(68), Jeddah (58), and Riyadh (43). Regarding age distribution, 63.4% fell
with subsequent adjustments made to enhance its validity and within the less than 30 years category, while 36.6% were aged over 30. In
reliability. The questionnaire was prepared based on Antibiotic terms of professional experience, 35% had less than 3 years, 32.5% had 3-
prescription in Endodontic cases according to the ESE 2018 5 years, and more than 5 years of experience. The graduation years 2016-
guidelines. Comprising two segments, Part A encompassed 2020 comprised the majority, accounting for 63.9% of the participants
demographic details such as age, gender, work experience, and (Table 3). The majority of participants across various experience groups,
year of graduation, while Part B focused on queries related to including 123 (89.8%) with less than 3 years of experience, 102 (80.3%)
antibiotic prescription knowledge. These questions were with 3-5 years, and 105 (31.8%) with over 5 years, there was a consensus
that systemic antibiotics were necessary for patients diagnosed with
presented in various formats, including multiple-choice
acute apical abscess with cellulitis in endodontic cases. The preferred
questions, and open-ended questions. The survey delved into first-line antibiotics were Amoxicillin and Metronidazole, with 47.4%,
practitioners' comprehension of the indications for prescribing 53.5%, and 38.4% agreement from those with less than 3 years, 3-5 years,
antibiotics concerning systemic clinical signs associated with and more than 5 years of experience, respectively. This choice was
endodontic cases. Participants were queried about the necessity particularly favoured for patients in good health without documented
of antibiotics for specific clinical conditions, including acute allergies. Only 3 (2.2%) participants with less than 3 years of experience
pulpitis, acute apical abscess, chronic apical abscess with sinus opted for clindamycin in such cases. In instances where patients were
tract, and chronic apical periodontitis, and their preferred allergic to penicillin or amoxicillin, the majority across all experience
groups recommended Clindamycin, comprising 118 (86.1%) with less
treatment choices. Additionally, the survey explored various
than 3 years of experience, 110 (86.6%) with 3-5 years, and 110 (86.6%)
factors influencing antibiotic prescriptions. with more than 5 years of experience. Ciprofloxacin and a combination
of clindamycin and ciprofloxacin were the least preferred antibiotics. For
Sample size: patients with a localized swelling and draining sinus, the majority across
In total, 500 dentists were enlisted for this investigation, and a experience groups (56.2%, 55.9%, and 66.9% for less than 3 years, 3-5
questionnaire was distributed to them. Out of the total, 410 years, and more than 5 years of experience, respectively) recommended a
participants actively responded and submitted their completed combination of antibiotics (Table 2). The recommended dosage which
questionnaires. To maintain data quality, questionnaires with is chose by 50% participants was Penicillin VKa loading dose 1000
mg with a maintenance dose of 500 mg q4-6h 5-7 days followed by
less than 30% of questions answered were excluded, resulting in
Amoxicillin loading dose 1000 mg with a maintenance dose of 500
391 questionnaires being available for subsequent analysis. mg q4-6h 5-7 days by 32% participants (Figure 1). A total of 36%
participants were agreed that Patients with previous history of
Inclusion and exclusion criteria: Infective Endocarditis need antibiotic prescription while only 5%
The inclusion criteria for this study involved general dentists agree that Patients with primary Endodontic lesions with secondary
and endo-dontists practicing in Saudi Arabia. Exclusions periodontal involvement need prescription of antibiotics (Figure 2). A
comprised practitioners who declined participation and those large number of dentists across different graduation groups, including
not involved in performing endodontic procedures. Participation 57 (83.8%) from the 1st group (before 2015), 209 (83.6%) from the 2nd
group (2016-2020), and 64 (87.7%) from the 3rd group (after 2020), there
was entirely voluntary, with participants retaining the right to
was consensus that systemic antibiotics were necessary for patients
withdraw from the study at any point without facing any diagnosed with acute apical abscess with cellulitis in endodontic cases.
consequences. The questionnaire's outset included a cover letter Notably, 10.3% of participants from the 1st group opted for irreversible
elucidating the survey's purpose and guaranteeing data pulpitis, and 9.6% from the 3rd group chose symptomatic apical
confidentiality. Respondents signalled their consent to periodontitis instead. Amoxicillin and Metronidazole were considered
participate and were subsequently directed to complete the the primary antibiotics by most participants (55.9%, 58.8%, and 42.5%
questionnaire. Personal identifiers such as names, emails, or any from the 1st, 2nd, and 3rd groups, respectively) for prescribing in
endodontic cases requiring antibiotic treatment, particularly for patients
in good health without documented allergies. Amoxicillin and
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Clavulanic acid emerged as the second most preferred antibiotics for suggested that their members forward this information to
these patients. For individuals allergic to penicillin or amoxicillin, dentists in their respective countries. [8] In the investigation
Clindamycin was the top-recommended antibiotic by the majority of conducted by Abdulhai et al. a significant majority of
participants across all groups (58 (85.3%), 218 (87.2%), and 62 (85.0%)
participants (75.3%) selected amoxicillin 500 mg, three times a
from the 1st, 2nd, and 3rd groups, respectively). In cases involving
localized swelling with a draining sinus, a combination of antibiotics was day, as their primary choice for therapeutic antibiotics. [19]
recommended by most participants (67.6%, 59.2%, and 53.4% from each Similarly, in our study, Amoxicillin and Metronidazole were the
group, respectively) (Table 3). The recommended dosage and regimen first choice by 216 (55.2%) dentists. This percentage stands
for patients requiring prophylactic antibiotics in the context of notably higher than what was reported in a prior local study
endodontic treatment in an adult according to the 56% participants was (18.3% and 33.7%) and various international studies (34-47%).
Amoxicillin, oral route, 1 g , 1 hour before procedure (Figure 3). For the [13, 21, 22] However, it is lower than the reported preferences of
patients who have allergy to amoxicillin in endodontic cases, the Brazilian endodontists (90.2%) and Spanish dental students
recommended dosage according to 63% participants was Clindamycin,
(100%). [23] According to ESE antibiotics guidelines in
oral route, 600 mg ,1 h before procedure (Figure 4).
endodontics, Beta-lactam antibiotics (penicillin V and
amoxicillin) are recommended for the treatment of endodontic
Discussion:
infections. Recommended loading doses are 1000 mg of
This cross-sectional study, conducted through a questionnaire,
penicillin V administered orally followed by 500 mg every 4–6 h
aimed to evaluate the knowledge of antibiotic prescription
or 1000 mg of amoxicillin, with or without clavulanic acid,
practices among dentists and endodontists in Saudi Arabia
followed by 500 mg every 8 h. [8, 24] Penicillin VK, being
during endodontic treatments. The findings revealed sufficient
bactericidal, exhibits high effectiveness, low toxicity, and cost-
knowledge among participants regarding the prescription of
effectiveness. [25] Notably, penicillin has a relatively narrow
antibiotics in endodontic therapy. It is worth noting that the
spectrum, while amoxicillin boasts a broader spectrum of
present survey boasted a larger sample size (n=319) compared to
antibiotic activity. [24, 25]
a 2015 local study by Iqbal (n=157), demonstrating a notable
strength. [13] Furthermore, the current study included
Table 1: Demographic Details of Participants
participants from various cities and institutes in Saudi Arabia, Gender
distinguishing it from the single-institute study conducted by Female 55 14.1
Iqbal et al. in 2015, which adds another layer of strength. [13] Male 336 85.9
Total 391 100.0
According to the British Society for Antimicrobial
Area of Practice
Chemotherapy, improper prescription of antibacterial drugs by Abha 68 17.4
dental practitioners significantly contributes to the emergence of Al Madina 33 8.4
drug-resistant strains. Factors such as inappropriate dosing, Al-Ahsa 2 0.5
Aljouf 3 0.8
duration, and prophylaxis play a role in the development of Bisha 3 0.8
resistant strains. [14] Various factors, including the improper Buraidah 2 0.5
prescription of antibiotics by medical or dental practitioners, Dammam 7 1.8
Hail 5 1.3
contribute to Antimicrobial Resistance (AMR). [8] Once
Jazan 23 5.9
resistance occurs, reversing it becomes impossible, emphasizing Jeddah 58 14.8
the importance of minimizing the development of new resistant Khamis Mushait 5 1.3
strains through the judicious use of antibiotics. [15] As per a Khobar 4 1.0
Makkah 18 4.6
systematic review conducted by James et al. antibiotics were Najran 94 24.0
deemed non-essential for providing relief in cases of irreversible Riyadh 43 11.0
pulpitis. [16,17] Consistent with this, the research conducted by Sharurah 11 2.8
Tabuk 7 1.8
Vengidesh et al. identified a certain degree of antibiotic misuse,
Taif 5 1.3
with prescriptions given for pain relief, reversible pulpitis, Total 391 100.0
irreversible pulpitis, and endodontic flare-ups (84.1%). [18] In Age
the current study, 330 (84.4%) dentists agreed that the Less than 30 years 248 63.4
More than 30 years 143 36.6
prescription of antibiotics was deemed necessary in the Total 391 100.0
condition of acute apical abscess with Cellulitis. Similarly, Experience
another study indicated that the highest percentage of antibiotic Less than 3 years 137 35.0
3 to 5 years 127 32.5
prescriptions was observed in cases of acute apical abscess with
More than 5 years 127 32.5
diffuse intraoral swelling, accompanied by fever and trismus Total 391 100.0
(83.4%), as well as in cases of acute apical abscess with diffuse Graduation Group
intra- and extra-oral swelling, fever, and trismus (81%). [19] Before 2015 68 17.4
2016-2020 250 63.9
These percentages align with the findings of a Brazilian survey, After 2020 73 18.7
reporting figures of 88.1% and 90.1%, respectively. [20] To Total 391 100.0
prevent antibiotic overuse, in 2018, the European Society of
Endodontology (ESE) issued the most recent recommendations
for prescribing practices related to endodontic infections and
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Table 2: Correlation between working experience and awareness

Response Experience Total Chi- p-
Less than 3 3-5 More than 5 square value
years years years
In which conditions is the prescription of systemic antibiotics deemed Acute Apical Abscess 123 102 105 330 19.098 0.014
necessary for with Cellulitis 89.8% 80.3% 31.8% 84.4%
patients with an endodontic diagnosis of Chronic Apical Abscess 1 0 0 1
0.7% 0.0% 0.0% 0.3%
Irreversible Pulpitis 1 10 15 26
0.7% 7.9% 11.8% 6.6%
Necrotic Pulp with 5 5 4 14
Asymptomatic Apical 3.6% 3.9% 3.1% 3.6%
Periodontitis
Symptomatic Apical 7 10 3 20
Periodontitis 1.8% 2.6% 2.4% 5.1%
What is the recommended primary/ first line antibiotic for prescription in Amoxicillin and 42 35 28 105 14.068 0.080
cases of Clavulanic acid 30.7% 27.6% 22.0% 26.9%
endodontically related conditions necessitating antibiotic treatment, for Amoxicillin and 65 68 83 216
patients Metronidazole 47.4% 53.5% 38.4% 55.2%
who are in good health and have no documented allergies Clindamycin 3 0 0 3
2.2% 0.0% 0.0% 0.8%
Erythromycin 5 3 3 11
3.6% 2.4% 2.4% 2.8%
Penicillin VK 22 21 13 56
16.1% 16.5% 10.2% 14.3%
Which antibiotic is the optimal choice when a patient exhibits an allergy to Ciprofloxacin 5 2 2 9 11.457 0.489
penicillin 3.6% 1.6% 1.6% 2.3%
Or amoxicillin in the context of endodontic treatment? Clarithromycin 5 7 4 16
3.6% 5.5% 3.1% 4.1%
Clindamycin 118 110 110 338
86.1% 86.6% 86.6% 86.5%
Clindamycin, 4 3 2 9
Ciprofloxacin 2.9% 2.4% 1.6% 2.3%
Minocycline 3 1 7 11
2.2% 0.8% 5.5% 2.8%
Minocycline, 2 4 2 8
Clindamycin 1.5% 3.1% 1.6% 2.0%
Under what circumstances should a combination of antibiotics, such as Patients having a 77 71 85 233 5.296 0.506
amoxicillin and localised swelling 56.2% 55.9% 66.9% 59.6%
Metronidazole, be considered in endodontic treatment? with draining sinus
Patients showing 41 36 27 104
no improvement in 29.9% 28.3% 21.3% 26.6%
symptoms with
previous medication
of Amoxicillin alone
Patients with allergy 7 10 6 23
to Penicillin VK 5.1% 7.9% 4.7% 5.9%
Patients with sharp 12 10 9 31
and shooting pain and 8.8% 7.9% 7.1% 7.9%
tooth tender on percussion
In which clinical scenario antibiotic prescription is a consideration for Acute Apical Abscess 99 97 105 301 10.734 0.097
preventing with localised fluctuant 72.3% 76.4% 82.7% 77.0%
Post-treatment flare-ups / Post treatment pain in endodontic cases? swellings, elevated
body temperature >38°C,
malaise, lymphadenopathy,
trismus
Irreversible Pulpitis with 14 15 6 35
Condensing Osteitis 10.2% 11.8% 4.7% 9.0%
Necrotic pulp with 21 9 13 43
Periapical Radiolucency 15.3% 7.1% 10.2% 11.0%
Patients with tooth fractures, 3 6 3 12
concussion, subluxation, 2.2% 4.7% 2.4% 3.1%
luxation injuries and extrusion injury
Is antibiotic prescription advisable in cases where a radiograph reveals a No , not indicated in healthy patients 71 64 73 208 4.382 0.357
substantial 51.8% 50.4% 57.5% 53.2%
periapical radiolucency associated with a draining sinus/ purulent discharge Yes , in retreatment cases to 10 6 3 19
in prevent post-operative pain 7.3% 4.7% 2.4% 4.9%
Endodontic patients? Yes, for better treatment outcomes 56 57 51 164
40.9% 44.9% 40.2% 41.9%
Should antibiotics be prescribed for patients who present with severe pain in No , not indicated in healthy patients 86 76 80 242 9.109 0.058
response 62.8% 59.8% 63.0% 61.9%
to hot and cold stimuli, along with clinical signs of percussion tenderness, to Yes , in retreatment cases to prevent 31 17 18 66

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expedite post-operative painYes , in 22.6% 13.4% 14.2% 16.9%

Symptom relief in endodontic cases? retreatment cases to prevent post-operative
pain
Yes, for better treatment outcomes 20 34 29 83
14.6% 26.8% 22.8% 21.2%
Table 3: Correlation between graduation group and awareness
Response Graduation group Total Chi- p-
Before 2016- After square value
2015 2020 2020
1.In which conditions is the prescription of systemic Acute Apical Abscess with Cellulitis 57 209 64 330 12.177 0.143
antibiotics deemed necessary for patients with an 83.8% 83.6% 87.7% 84.4%
endodontic diagnosis of Chronic Apical Abscess 0 1 0 1
0.0% 0.4% 0.0% 0.3%
Irreversible Pulpitis 7 19 0 26
10.3% 7.6% 0.0% 6.6%
Necrotic Pulp with Asymptomatic Apical Periodontitis 3 9 2 14
4.4% 3.6% 2.7% 3.6%

Symptomatic Apical Periodontitis 1 12 7 20

1.5% 4.8% 9.6% 5.1%
What is the recommended primary/ first line Amoxicillin and Clavulanic acid 18 60 27 105 15.114 0.057
antibiotic for prescription in 26.5% 24.0% 37.0% 26.9%
cases of endodontically related conditions Amoxicillin and Metronidazole 38 147 31 216
necessitating antibiotic treatment, 55.9% 58.8% 42.5% 55.2%
for patients who are in good health and have no Clindamycin 0 1 2 3
documented allergies 0.0% 0.4% 2.7% 0.8%
Erythromycin 3 4 4 11
4.4% 1.0% 5.5% 2.8%
Penicillin VK 9 38 9 56
13.2% 15.2% 12.3% 14.3%

Which antibiotic is the optimal choice when a patient Ciprofloxacin 1 7 1 9 8.081 0.779
exhibits an allergy 1.5% 2.8% 1.4% 2.3%
to penicillin or amoxicillin in the context of Clarithromycin 2 11 3 16
endodontic treatment? 2.9% 4.4% 4.1% 4.1%
Clindamycin 58 218 62 338
85.3% 87.2% 85.0% 86.5%
Clindamycin, Ciprofloxacin 2 5 2 9
2.9% 2.0% 2.7% 2.3%
Minocycline 3 5 3 11
4.4% 2.0% 4.1% 2.8%
Minocycline, Clindamycin 2 4 2 8
0.5% 1.6% 2.7% 2.0%
Under what circumstances should a combination of Patients having a localised swelling with draining sinus 46 148 39 233 6.709 0.349
antibiotics, such as 67.6% 59.2% 53.4% 59.6%
Amoxicillin and metronidazole, be considered in Patients showing no improvement in symptoms with previous medication of 16 68 20 104
endodontic treatment? Amoxicillin alone 23.5% 27.2% 27.4% 26.6%
Patients with allergy to Penicillin VK 2 17 4 23
2.9% 6.8% 5.5% 5.9%
Patients with sharp and shooting pain and tooth tender on percussion 4 17 10 31
5.9% 6.8% 13.7% 7.9%
In which clinical scenario antibiotic prescription is a Acute Apical Abscess with localised fluctuant swellings, elevated body temperature 58 200 43 301 24.359 0.000
consideration for >38°C, malaise, lymphadenopathy, trismu 85.3% 80.0% 58.9% 77.0%
Preventing post-treatment flare-ups / Post treatment Irreversible Pulpitis with Condensing Osteitis 5 20 10 35
pain in endodontic cases? 7.4% 8.0% 13.7% 9.0%
Necrotic pulp with Periapical Radiolucency 5 20 18 43
7.4% 8.0% 24.7% 11.0%
Patients with tooth fractures, concussion, subluxation, luxation injuries and extrusion 0 10 2 12
injury 0.0% 4.0% 2.7% 3.1%
Is antibiotic prescription advisable in cases where a No , not indicated in healthy patients 37 137 34 208 3.678 0.451
radiograph reveals a 54.4% 54.8% 46.6% 53.2%
Substantial periapical radiolucency associated with a Yes , in retreatment cases to prevent post operative pain 1 13 5 19
draining sinus/ 1.5% 5.2% 6.8% 4.9%
purulent discharge in endodontic patients? Yes, for better treatment outcomes 30 100 34 164
44.1% 40.0% 46.6% 41.9%
Should antibiotics be prescribed for patients who No , not indicated in healthy patients 39 156 47 242 0.869 0.929
present with severe pain 57.4% 64.5% 64.4% 61.9%
in response to hot and cold stimuli, along with Yes , in retreatment cases to prevent post operative painYes , in retreatment cases to 13 41 12 66
clinical signs of percussion prevent post operative pain 19.1% 16.4% 16.4% 16.9%
Tenderness, to expedite symptom relief in endodontic Yes, for better treatment outcomes 16 53 14 83
cases? 23.5% 21.2% 19.2% 21.2%

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Figure 1: Recommended dosage and prescription for penicillin VKa /Amoxicillin in endodontic cases

Figure 2: In what clinical scenario is the prophylactic prescription of antibiotics deemed necessary in endodontics?

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Figure 3: Recommended dosage and regimen for patients requiring prophylactic antibiotics in the context of endodontic treatment in
an adult.

Figure 4: What is the recommended dosage and regimen for patients requiring prophylactic antibiotics who have and allergy to
amoxicillin in endodontic cases?

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Amoxicillin, a synthetic improvement of the penicillin molecule, Conclusion:

is easily absorbed with food and remains resistant to stomach Data shows that participants had an adequate knowledge about
acid damage. [26] The combination of amoxicillin with the prescription of antibiotics in endodontic cases but it
metronidazole has been recommended due to metronidazole's highlighted the tendency among dentists, to prescribe
excellent activity against anaerobes. [11] In a separate study by antibiotics, deviating from established guidelines. It is
Vengidesh et al. approximately 87% of participants chose imperative to place greater emphasis on instilling a proper
amoxicillin as their primary drug, followed by metronidazole antibiotic prescription approach at the undergraduate level.
(11%), a pattern consistent with the findings of Maslamani et al. Additionally, dental practitioners should stay abreast of recent
[18,27] In the research conducted by Mawra et al., clindamycin guidelines for antibiotic prescription, including the WHO's
emerged as a less commonly prescribed option. [28] Essential Medicines List (EML) and the AWaRe classification.
Clindamycin was also the least chosen antibiotic in the present Continuous Dental Education (CDE) programs can play a
study. These findings align with studies by Fahad et al. and Jain pivotal role in this regard, ensuring practitioners are well-
A et al., where clindamycin was infrequently prescribed, while informed. Following precise endodontic diagnosis and treatment
amoxicillin was the more prevalent choice. [29,30] A protocols is essential to mitigate endodontic flare-ups,
combination of antibiotics is favored by over 70% of dentists, subsequently diminishing the necessity for antibiotics. Educating
and amoxicillin + clavulanic acid is one such combination patients about the potential adverse effects of self-prescribing
recommended for severe oral infections and situations where antibiotics is crucial in promoting responsible antibiotic use.
resistant species are suspected, unresponsive to standard
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