Systemic antibiotic use in paediatric odontogenic infections: a systematic review of clinical outcomes, prescribing practices, and guideline adherence

Abstract Background Antibiotics are widely prescribed in paediatric dental care, yet inappropriate use remains common and may contribute to adverse events and antimicrobial resistance. This systematic review aimed to synthesize evidence on systemic antibiotic use in paediatric odontogenic and dental infections, focusing on clinical outcomes, prescribing practices, and adherence to current paediatric dental antibiotic guidelines. Methods A systematic literature review was conducted according to a prespecified protocol and reported in accordance with PRISMA 2020. Studies evaluating antibiotic use or prescribing practices in paediatric dental patients were included. Searches were performed in PubMed, Scopus, EBSCOhost, ClinicalKey, and ProQuest for English-language, full-text articles published from April 2016 to April 2026. Risk of bias was assessed using the National Institutes of Health Quality Assessment Tool for cross-sectional studies and the Newcastle–Ottawa Scale for cohort studies. Owing to methodological heterogeneity, results were synthesised narratively. Results Nineteen studies were included, consisting of 10 clinical management studies and 9 prescribing practice studies. Clinical management studies evaluated 1,695 paediatric cases or prescriptions and focused on antibiotic indication, dosing accuracy, route of administration, and necessity of use. Amoxicillin-based regimens were most frequently prescribed. Several studies identified antibiotic overuse, particularly in outpatient and prophylactic settings, while a small number of studies reported underdosing, with one study associating substantial underdosing with treatment failure. Prescribing practice studies showed low to moderate guideline adherence, with antibiotics commonly prescribed for localised infections without systemic involvement. Conclusion The available evidence suggests that systemic antibiotics remain frequently used in paediatric dental care, often beyond guideline-based indications. However, the evidence base is predominantly observational and heterogeneous, precluding quantitative pooling and causal inference. Definitive dental treatment remains the cornerstone of management, while systemic antibiotics should be reserved for selected cases involving systemic signs, spreading infection, or clearly defined medical risk. Trial registration CRD420261367739.