Over-prescription of antibiotics for pulpitis: a systematic review and meta-analysis of cross-sectional surveys

Background: Pulpitis requires operative dental treatment, and antibiotics are not indicated. Nevertheless, inappropriate antibiotic prescribing persists worldwide. This systematic review and meta-analysis evaluated the prevalence of antibiotic prescription for pulpitis among dentists. Methods: A sys...

Descripción completa

Detalles Bibliográficos
Autores: Delgado-Giugni, Vanessa, León-López, María, Crespo Gallardo, Isabel, Sauco Márquez, Juan José, Montero-Miralles, Paloma, Martín González, Jenifer, Cabanillas Balsera, Daniel, Segura Egea, Juan José
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2025
País:España
Institución:Universidad de Sevilla (US)
Repositorio:idUS. Depósito de Investigación de la Universidad de Sevilla
OAI Identifier:oai:idus.us.es:11441/180707
Acceso en línea:https://hdl.handle.net/11441/180707
https://doi.org/10.3390/antibiotics15010013
Access Level:acceso abierto
Palabra clave:Antibiotics
Apical abscess
Apical disease
Apical periodontitis
Endodontic infection
Meta-analysis
Periapical disease
Prescription
Systematic review
id ES_07b19e6a8cd5e17048e4e36d7319a168
oai_identifier_str oai:idus.us.es:11441/180707
network_acronym_str ES
network_name_str España
repository_id_str
spelling Over-prescription of antibiotics for pulpitis: a systematic review and meta-analysis of cross-sectional surveysDelgado-Giugni, VanessaLeón-López, MaríaCrespo Gallardo, IsabelSauco Márquez, Juan JoséMontero-Miralles, PalomaMartín González, JeniferCabanillas Balsera, DanielSegura Egea, Juan JoséAntibioticsApical abscessApical diseaseApical periodontitisEndodontic infectionMeta-analysisPeriapical diseasePrescriptionSystematic reviewBackground: Pulpitis requires operative dental treatment, and antibiotics are not indicated. Nevertheless, inappropriate antibiotic prescribing persists worldwide. This systematic review and meta-analysis evaluated the prevalence of antibiotic prescription for pulpitis among dentists. Methods: A systematic search of MEDLINE/PubMed, Web of Science, Scopus, Embase, and ProQuest (2015–2025) was performed according to PRISMA guidelines. Observational studies reporting the proportion of dentists prescribing systemic antibiotics for pulpitis were included. Random-effects meta-analyses estimated pooled prevalence for all clinicians, general dental practitioners (GDPs), and endodontists (ENs). Risk of bias was assessed using a modified Newcastle–Ottawa Scale, and certainty of evidence was rated with GRADE. Results: Twelve cross-sectional studies met the inclusion criteria, including 3189 dentists. The overall pooled prevalence of antibiotic prescribing for pulpitis was 19.2% (95% CI: 10.4–32.6%), with very high heterogeneity (I2 = 98%). GDPs exhibited significantly higher prescribing rates (26.9%, 95% CI: 14.9–43.5%; I2 = 98%) compared with ENs (5.1%, 95% CI: 1.2–19.2%; I2 = 92%). Sensitivity analysis excluding two high-prevalence studies reduced the pooled estimate to 13.3% (95% CI: 8.0–21.3%) but heterogeneity remained substantial (I2 = 95%). Most studies showed moderate-to-high risk of bias, and the certainty of evidence was graded as very low due to inconsistency, indirectness, imprecision, and potential publication bias. Conclusions: Approximately one in five dentists prescribe antibiotics for pulpitis, despite strong guideline recommendations against their use. However, certainty of evidence was very low. Marked variability across regions and clinical profiles highlights persistent gaps in diagnostic accuracy, access to emergency dental care, and antibiotic stewardship. Targeted education, improved urgent care pathways, and strengthened antimicrobial stewardship programs are needed to reduce unnecessary antibiotic use in pulpitis.MDPIEstomatologíaCTS941: Patología Dentaria, Operatoria Dental y Endodoncia2025info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/pdfhttps://hdl.handle.net/11441/180707https://doi.org/10.3390/antibiotics15010013reponame:idUS. Depósito de Investigación de la Universidad de Sevillainstname:Universidad de Sevilla (US)InglésAntibiotics, 15 (1), 13.https://www.mdpi.com/2079-6382/15/1/13info:eu-repo/semantics/openAccessoai:idus.us.es:11441/1807072026-06-17T12:51:07Z
dc.title.none.fl_str_mv Over-prescription of antibiotics for pulpitis: a systematic review and meta-analysis of cross-sectional surveys
title Over-prescription of antibiotics for pulpitis: a systematic review and meta-analysis of cross-sectional surveys
spellingShingle Over-prescription of antibiotics for pulpitis: a systematic review and meta-analysis of cross-sectional surveys
Delgado-Giugni, Vanessa
Antibiotics
Apical abscess
Apical disease
Apical periodontitis
Endodontic infection
Meta-analysis
Periapical disease
Prescription
Systematic review
title_short Over-prescription of antibiotics for pulpitis: a systematic review and meta-analysis of cross-sectional surveys
title_full Over-prescription of antibiotics for pulpitis: a systematic review and meta-analysis of cross-sectional surveys
title_fullStr Over-prescription of antibiotics for pulpitis: a systematic review and meta-analysis of cross-sectional surveys
title_full_unstemmed Over-prescription of antibiotics for pulpitis: a systematic review and meta-analysis of cross-sectional surveys
title_sort Over-prescription of antibiotics for pulpitis: a systematic review and meta-analysis of cross-sectional surveys
dc.creator.none.fl_str_mv Delgado-Giugni, Vanessa
León-López, María
Crespo Gallardo, Isabel
Sauco Márquez, Juan José
Montero-Miralles, Paloma
Martín González, Jenifer
Cabanillas Balsera, Daniel
Segura Egea, Juan José
author Delgado-Giugni, Vanessa
author_facet Delgado-Giugni, Vanessa
León-López, María
Crespo Gallardo, Isabel
Sauco Márquez, Juan José
Montero-Miralles, Paloma
Martín González, Jenifer
Cabanillas Balsera, Daniel
Segura Egea, Juan José
author_role author
author2 León-López, María
Crespo Gallardo, Isabel
Sauco Márquez, Juan José
Montero-Miralles, Paloma
Martín González, Jenifer
Cabanillas Balsera, Daniel
Segura Egea, Juan José
author2_role author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Estomatología
CTS941: Patología Dentaria, Operatoria Dental y Endodoncia
dc.subject.none.fl_str_mv Antibiotics
Apical abscess
Apical disease
Apical periodontitis
Endodontic infection
Meta-analysis
Periapical disease
Prescription
Systematic review
topic Antibiotics
Apical abscess
Apical disease
Apical periodontitis
Endodontic infection
Meta-analysis
Periapical disease
Prescription
Systematic review
description Background: Pulpitis requires operative dental treatment, and antibiotics are not indicated. Nevertheless, inappropriate antibiotic prescribing persists worldwide. This systematic review and meta-analysis evaluated the prevalence of antibiotic prescription for pulpitis among dentists. Methods: A systematic search of MEDLINE/PubMed, Web of Science, Scopus, Embase, and ProQuest (2015–2025) was performed according to PRISMA guidelines. Observational studies reporting the proportion of dentists prescribing systemic antibiotics for pulpitis were included. Random-effects meta-analyses estimated pooled prevalence for all clinicians, general dental practitioners (GDPs), and endodontists (ENs). Risk of bias was assessed using a modified Newcastle–Ottawa Scale, and certainty of evidence was rated with GRADE. Results: Twelve cross-sectional studies met the inclusion criteria, including 3189 dentists. The overall pooled prevalence of antibiotic prescribing for pulpitis was 19.2% (95% CI: 10.4–32.6%), with very high heterogeneity (I2 = 98%). GDPs exhibited significantly higher prescribing rates (26.9%, 95% CI: 14.9–43.5%; I2 = 98%) compared with ENs (5.1%, 95% CI: 1.2–19.2%; I2 = 92%). Sensitivity analysis excluding two high-prevalence studies reduced the pooled estimate to 13.3% (95% CI: 8.0–21.3%) but heterogeneity remained substantial (I2 = 95%). Most studies showed moderate-to-high risk of bias, and the certainty of evidence was graded as very low due to inconsistency, indirectness, imprecision, and potential publication bias. Conclusions: Approximately one in five dentists prescribe antibiotics for pulpitis, despite strong guideline recommendations against their use. However, certainty of evidence was very low. Marked variability across regions and clinical profiles highlights persistent gaps in diagnostic accuracy, access to emergency dental care, and antibiotic stewardship. Targeted education, improved urgent care pathways, and strengthened antimicrobial stewardship programs are needed to reduce unnecessary antibiotic use in pulpitis.
publishDate 2025
dc.date.none.fl_str_mv 2025
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/11441/180707
https://doi.org/10.3390/antibiotics15010013
url https://hdl.handle.net/11441/180707
https://doi.org/10.3390/antibiotics15010013
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Antibiotics, 15 (1), 13.
https://www.mdpi.com/2079-6382/15/1/13
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv MDPI
publisher.none.fl_str_mv MDPI
dc.source.none.fl_str_mv reponame:idUS. Depósito de Investigación de la Universidad de Sevilla
instname:Universidad de Sevilla (US)
instname_str Universidad de Sevilla (US)
reponame_str idUS. Depósito de Investigación de la Universidad de Sevilla
collection idUS. Depósito de Investigación de la Universidad de Sevilla
repository.name.fl_str_mv
repository.mail.fl_str_mv
_version_ 1869402998026797056
score 15,811543

Similares en LA Referencia