Knowledge and Practices of Dentists Regarding Antibiotic Prescription During Endodontic Treatment in Nepal

Abstract

Introduction: Inappropriate use of antibiotics in endodontics plays a substantial role in the development of antimicrobial resistance. Despite the availability of established guidelines, antibiotics are frequently prescribed in situations where local treatment alone would be adequate. This study aimed to evaluate the knowledge and prescribing practices of Nepalese dentists regarding antibiotic use in endodontic therapy.

Methods: A cross-sectional online survey was conducted among dentists registered under the Nepal Dental Association from December 2025 to January 2026. A structured questionnaire comprising 14 close-ended questions was distributed to 500 participants via social media platforms, with 410 responses received. Data were analyzed descriptively using frequencies and percentages.

Results: Antibiotics were appropriately prescribed by most respondents for acute apical abscess with systemic involvement (94.9%), progressive infections (93.2%), and persistent infections (78.3%). However, a considerable proportion still prescribed antibiotics for non-indicated conditions, such as chronic apical abscess (39.3%) and acute apical abscess without systemic involvement (37.8%). Amoxicillin with metronidazole (65.1%) and clindamycin (57.8%) were the most frequently prescribed regimens for non-allergic and penicillin-allergic patients, respectively. Most dentists prescribed antibiotics for 5 days (87.8%), while only 33.2% used a loading dose. About half (51.2%) reported having antibiotic prescribing guidelines. Prophylactic antibiotics were widely used for patients at risk of infective endocarditis (96.1%), with majority of dentists (72%) following the recommended regimen.

Conclusion: Although antibiotic prescribing practices were appropriate in certain clinical scenarios, inappropriate use persists in non-indicated conditions. There is a need for improved adherence to evidence-based guidelines to promote rational antibiotic use and combat antimicrobial resistance.