Abstract
AIM: Appropriate antibiotic prescribing is a core competency in dental education. This study evaluated dental students' knowledge, antibiotic selection patterns, and adherence to international guidelines for the management of endodontic infections. MATERIALS AND METHODS: An online survey was administered to students in their final two clinical years across 19 countries. Three clinical scenarios were evaluated: first-line antibiotic choice, second-line when the first choice is ineffective, and drug of choice for penicillin-allergic patients. Participants reported drug, dose, frequency, and duration. Guideline adherence was quantified using a 0-5 scoring system based on European Society of Endodontology and American Association of Endodontists recommendations. Mixed-effects linear regression models with country as a random effect were used to identify predictors of guideline-concordant prescribing. RESULTS: A total of 4226 responses were analysed. Amoxicillin was the most frequently selected first-line antibiotic (57.6%), followed by amoxicillin-clavulanic acid (18.4%), with marked between-country variation; adjusted first-choice concordance was highest in Colombia (4.57) and lowest in Bangladesh (2.49). For second-line therapy, amoxicillin-clavulanic acid predominated (33.2%), with the highest adherence in Ecuador (3.40) and the lowest in Switzerland (2.15). In penicillin-allergic patients, clindamycin was most commonly selected (47.8%), but allergy-specific concordance varied widely, ranging from 3.52 in Colombia to 1.06 in India. Age positively predicted second-line concordance, while lower allergy-specific concordance was observed among second-year students and males. CONCLUSIONS: Marked variability and frequent deviations from guideline-recommended prescribing highlight persistent educational gaps. Strengthening antimicrobial stewardship training within undergraduate dental curricula is warranted.