The judicious use of antibiotics in pediatric dentistry is crucial to combat antimicrobial resistance and ensure optimal patient outcomes. Overprescription and inappropriate antibiotic use in children contribute to the global health threat of antibiotic resistance, adverse drug reactions, and disruption of normal microbiota.
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✅ Indications for Antibiotic Use in Pediatric Dentistry
According to the American Academy of Pediatric Dentistry (AAPD) and other professional bodies, antibiotics should be prescribed in pediatric patients only when there is clear evidence of systemic involvement or the risk of spread of odontogenic infections. The primary indications include:
° Acute facial swelling or cellulitis with systemic symptoms (fever, malaise)
° Rapidly progressing infections such as Ludwig’s angina or deep space infections
° Persistent infections not resolved by local measures alone
° Prophylaxis in patients at risk of infective endocarditis or with immunocompromising conditions
Local dental infections like localized abscesses or pulpitis do not typically require systemic antibiotics and are best managed by definitive dental treatment such as extraction or pulpectomy.
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For pediatric patients, the most frequently recommended antibiotics are:
° Amoxicillin: 20–40 mg/kg/day divided every 8 hours, or 25–45 mg/kg/day if given twice daily
° Amoxicillin with Clavulanic Acid: Used when beta-lactamase resistance is suspected
° Clindamycin: 8–20 mg/kg/day in three divided doses (for penicillin-allergic patients)
° Azithromycin: 5–12 mg/kg on the first day followed by lower doses over 4 days
Prescribers must adjust dosages based on weight and age and consider the patient’s medical history, including allergies and hepatic or renal function.
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The AAPD, following the American Heart Association (AHA) guidelines, recommends antibiotic prophylaxis for pediatric patients at high risk of infective endocarditis, especially before procedures likely to cause bleeding (e.g., tooth extractions, periodontal surgery). This includes:
° Children with prosthetic heart valves
° Previous infective endocarditis
° Certain congenital heart conditions
° Cardiac transplant recipients with valvulopathy
The standard prophylactic regimen is amoxicillin 50 mg/kg orally one hour before the procedure.
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Despite clear guidelines, studies reveal frequent antibiotic overprescription in pediatric dentistry. A cross-sectional study by Al-Jundi et al. (2022) indicated that many dentists prescribe antibiotics for non-indicated conditions such as reversible pulpitis, primarily due to parental expectations or time constraints. This inappropriate practice fosters resistance and increases adverse drug reactions, including gastrointestinal issues, allergic reactions, and alterations in the child’s developing microbiome.
Moreover, the COVID-19 pandemic initially led to increased remote consultations and a spike in empirical antibiotic prescriptions, further underscoring the need for robust antimicrobial stewardship programs in dental settings.
Educational interventions, integration of prescribing guidelines into electronic health systems, and continuing professional development can help reduce inappropriate prescribing practices. Collaborative efforts between pediatricians, pharmacists, and pediatric dentists are also essential.
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Antibiotic use in pediatric dentistry should be reserved for cases with systemic involvement or significant risk of progression. Adherence to updated, evidence-based guidelines is critical to minimizing resistance and ensuring patient safety. Dental professionals must prioritize definitive treatment over pharmacologic management when possible and engage in continuous education to refine prescribing practices.
馃摎 References
✔ Al-Jundi, S. H., Mahmoud, S. Y., & Alsafadi, Y. H. (2022). Antibiotic prescribing practices among pediatric dentists in Jordan: A cross-sectional survey. BMC Oral Health, 22(1), 105. https://doi.org/10.1186/s12903-022-02156-3
✔ American Academy of Pediatric Dentistry. (2023). Guideline on Use of Antibiotic Therapy for Pediatric Dental Patients. Retrieved from https://www.aapd.org/research/oral-health-policies--recommendations/antibiotic-therapy/
✔ Wilson, W., Taubert, K. A., Gewitz, M., Lockhart, P. B., Baddour, L. M., Levison, M., ... & Baltimore, R. S. (2007). Prevention of infective endocarditis: guidelines from the American Heart Association. Circulation, 116(15), 1736–1754. https://doi.org/10.1161/CIRCULATIONAHA.106.183095
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