Evaluation of antibiotic prescribing in dental practices in Mecklenburg-Western Pomerania and a comparison with national and international prescribing practices – a retrospective look at the situation in 2015

Introduction: The aim of this study was to evaluate the antibiotic prescribing practices of dental practitioners and dental clinics in Mecklenburg-Western Pomerania with regard to therapeutic and prophylactic indications, microbiological diagnostics, level of knowledge, and factors influencing prescribing behavior, to draw conclusions for antibiotic stewardship (ABS). Method: The study was conducted as a cross-sectional survey and included all private dental practices which could be contacted via the Mecklenburg-Western Pomerania Dental Association, as well as university and hospital dental clinics. The questionnaire included sociodemographic data, therapeutic and prophylactic antibiotic prescriptions, selection of antibiotics, usage of microbiological diagnostics, knowledge levels, and factors influencing prescribing behavior. Data collection took place in 2015 via post. Results: Of 1,470 dentists contacted, 533 took part in the survey (response rate 36.3%). The majority stated that they prescribed 1–3 antibiotics per week. Clindamycin was the most commonly used antibiotic for odontogenic abscesses, apical periodontitis, peri-implantitis and osteomyelitis, followed by amoxicillin. For acute necrotizing ulcerative periodontitis and acute necrotizing ulcerative gingivitis, metronidazole was the preferred choice, followed by amoxicillin and clindamycin. 58.1% of participants recommended antibiotic therapy for 5 days, 34.5% for 3–5 days, and 7.4% for 1–3 days. 71% of participants stated that they did not request microbiological testing prior to antibiotic therapy, and only 28.3% would order an antibiogram if the antibiotic had no effect. Personal experience and the current resistance profile were named as the most important factors influencing prescribing behavior. 91.2% of dentists were not influenced by patient expectations. For 71.5%, price was not a factor. There was a significant correlation between the number of years in practice and prescribing frequency, in which younger and more experienced dentists tending to be more cautious in their prescribing. 44.8% of respondents rated their knowledge of antibiotic stewardship (ABS) as satisfactory, 33.8% as good and 6.2% as very good. 90.0% of participants stated that their last training course on ABS had taken place 1–3 years ago. 91.9% would attend a training course (again). The indication for endocarditis prophylaxis was largely restricted to high-risk patients, whereas antibiotic prophylaxis in patients with large-joint prostheses was not limited to risk-based indications. Discussion: The prescribing patterns did not align with current guidelines. The low usage of microbiological diagnostics indicates further room for improvement in the implementation of ABS. The importance of personal experience as a key influencing factor in antibiotic prescribing underscores the need to regularly organize targeted training initiatives to implement regional ABS programs. Conclusion: The rational prescribing of antibiotics in dentistry is not merely a technical challenge in its own right, but part of global efforts to combat antibiotic resistance. Every prescribing decision should contribute to preserving efficacy for future generations. The key to responsible and sustainable antimicrobial therapy in dentistry lies in combining scientific evidence, clinical expertise, and an understanding of regional specificities.