Appropriateness of antibiotic prescribing in dental practice: results of two clinical audits conducted at a university hospital

Antimicrobial resistance (AMR) is a major global public health threat, and dentistry contributes substantially to unnecessary antibiotic use. Despite the publication of clear prescribing recommendations by the European Society of Endodontology (ESE) in 2018, inappropriate antibiotic prescribing remains common, particularly in dental emergency settings. This study aimed to evaluate the appropriateness of antibiotic prescribing in a university dental emergency department and to assess the impact of an audit-and-feedback intervention. A prospective two-phase clinical audit was conducted in 2025 at the University Hospital of Marseille. Two consecutive two-week audit periods were conducted before and after individualized feedback and educational workshops. Prescriptions were classified according to ESE guidelines as appropriate (A1, A2) or inappropriate (I1, I2). A secondary analysis evaluated the appropriateness of treatment modalities (A1C, A1NC). Statistical analyses were performed using Chi-squared or Fisher's exact tests. A total of 640 patients were included. Antibiotics were prescribed in 30.3% of consultations. The proportion of appropriate prescriptions did not improve significantly between audits (A1 + A2: 71.9% vs. 77.6%, p  = 0.822). Among the 193 patients who received antibiotics, inappropriate prescriptions remained common (I2, 72.5%), particularly among patients presenting with pulpal or periapical diseases and among those consulting primarily because of pain. Among patients with a pulpal or periapical diagnosis who received antibiotics, 112 of 113 prescriptions (99.1%) were inappropriate, compared with 28 of 80 (35.0%) among other diagnoses. This pattern was consistent across the individual pulpal and periapical diagnostic subgroups. Inappropriate antibiotic prescribing remains frequent in dental emergency care. A single audit-and-feedback intervention was insufficient to significantly modify prescribing practices, highlighting the need for sustained and multifaceted antimicrobial stewardship strategies focused on improving diagnostic accuracy and ensuring timely operative management.