From knowledge to practice: Antibiotic prescribing behaviors and antimicrobial stewardship awareness among Iraqi dental students

Noor R. Al-Hasani; Ali I. Ibrahim; Nameer Al-Taai; Ali Azeez Al-Jumaili; Mayar Danadneh; Raghad Saleh; Elham Kateeb; Noor R. Al-Hasani; Ali I. Ibrahim; Nameer Al-Taai; Ali Azeez Al-Jumaili; Mayar Danadneh; Raghad Saleh; Elham Kateeb

doi:10.3934/publichealth.2026023

AIMS Public Health

2026, Volume 13, Issue 2: 432-448. doi: 10.3934/publichealth.2026023

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Research article

From knowledge to practice: Antibiotic prescribing behaviors and antimicrobial stewardship awareness among Iraqi dental students

1.
Department of Basic Sciences, College of Dentistry, University of Baghdad, Baghdad, Iraq
2.
Affiliated Researcher, Department of Pharmacy, King's College London, Stamford str., 150, London, SE1 9NH, United Kingdom
3.
Department of Orthodontics, College of Dentistry, University of Baghdad, Baghdad, Iraq
4.
Centre for Oral, Clinical and Translational Sciences, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
5.
Hamdan Bin Mohammed College of Dental Medicine, MBRU University, Dubai, United Arab Emirates
6.
Department of Odontology, Umeå University, Umeå, Sweden
7.
Department of Clinical Pharmacy, College of Pharmacy, University of Baghdad, Baghdad, Iraq
8.
Department of Public Health University of California Davis School of Medicine, CA, USA
9.
Oral Health Research and Promotion Unit, Faculty of Dentistry, Al-Quds University, Jerusalem 51000, Palestine

Received: 23 January 2026 Revised: 12 March 2026 Accepted: 16 March 2026 Published: 09 April 2026

Background
Antimicrobial resistance (AMR) is a growing global health concern, with inappropriate antibiotic use in dentistry significantly contributing to this problem. While regional studies have examined dental students' antibiotic-related knowledge and practices, comprehensive evidence from Iraq remains limited.
Objective
The objective of this study is to evaluate the level of knowledge and awareness of antimicrobial stewardship principles and prescribing practices among Iraqi dental students and interns.
Methods
A cross-sectional, questionnaire-based study was conducted among dental students in the clinical phase of education (fourth and fifth years) and dental interns from multiple Iraqi universities. The survey was distributed from October 2023 to June 2025 to assess the knowledge of antibiotics, awareness of prudent antibiotic use, and self-reported prescribing practices. Correlation analyses were performed to examine associations between knowledge, awareness, and practice domains.
Results
The participants (n = 569) demonstrated strong theoretical knowledge of antibiotics and a high awareness of prudent antibiotic use. However, a consistent gap between knowledge and clinical practice was identified. Knowledge and awareness domains were positively correlated, while both were inversely associated with practice scores, thus indicating a more cautious prescribing behavior among students with higher knowledge levels. A limited access to prescribing guidelines, insufficient practical training, and variability in institutional support were identified as key factors that influence the prescribing behavior. Differences between universities highlighted the significant role of educational environment and curriculum structure (p < 0.05).
Conclusion
Although Iraqi dental students possess adequate knowledge and awareness regarding antibiotic use and AMR, translating this understanding into consistent clinical practice remains challenging. Higher knowledge levels were associated with restrained prescribing, thus reflecting responsible antimicrobial stewardship rather than poor practice. These findings underscore the need to integrate structured antimicrobial stewardship training, standardized prescribing guidelines, and practical decision-making support into dental education. Strengthening these components is essential to bridge the knowledge–practice gap and prepare future dental practitioners to contribute effectively to combating AMR through responsible, evidence-based prescribing.
- antimicrobial stewardship,
- antibiotic resistance,
- Iraq,
- professional practice gaps,
- dental education,
- prescribing practice
Citation: Noor R. Al-Hasani, Ali I. Ibrahim, Nameer Al-Taai, Ali Azeez Al-Jumaili, Mayar Danadneh, Raghad Saleh, Elham Kateeb. From knowledge to practice: Antibiotic prescribing behaviors and antimicrobial stewardship awareness among Iraqi dental students[J]. AIMS Public Health, 2026, 13(2): 432-448. doi: 10.3934/publichealth.2026023

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Abstract

Background

Antimicrobial resistance (AMR) is a growing global health concern, with inappropriate antibiotic use in dentistry significantly contributing to this problem. While regional studies have examined dental students' antibiotic-related knowledge and practices, comprehensive evidence from Iraq remains limited.

Objective

The objective of this study is to evaluate the level of knowledge and awareness of antimicrobial stewardship principles and prescribing practices among Iraqi dental students and interns.

Methods

A cross-sectional, questionnaire-based study was conducted among dental students in the clinical phase of education (fourth and fifth years) and dental interns from multiple Iraqi universities. The survey was distributed from October 2023 to June 2025 to assess the knowledge of antibiotics, awareness of prudent antibiotic use, and self-reported prescribing practices. Correlation analyses were performed to examine associations between knowledge, awareness, and practice domains.

Results

The participants (n = 569) demonstrated strong theoretical knowledge of antibiotics and a high awareness of prudent antibiotic use. However, a consistent gap between knowledge and clinical practice was identified. Knowledge and awareness domains were positively correlated, while both were inversely associated with practice scores, thus indicating a more cautious prescribing behavior among students with higher knowledge levels. A limited access to prescribing guidelines, insufficient practical training, and variability in institutional support were identified as key factors that influence the prescribing behavior. Differences between universities highlighted the significant role of educational environment and curriculum structure (p < 0.05).

Conclusion

Although Iraqi dental students possess adequate knowledge and awareness regarding antibiotic use and AMR, translating this understanding into consistent clinical practice remains challenging. Higher knowledge levels were associated with restrained prescribing, thus reflecting responsible antimicrobial stewardship rather than poor practice. These findings underscore the need to integrate structured antimicrobial stewardship training, standardized prescribing guidelines, and practical decision-making support into dental education. Strengthening these components is essential to bridge the knowledge–practice gap and prepare future dental practitioners to contribute effectively to combating AMR through responsible, evidence-based prescribing.

Acknowledgments

We are grateful to the dental students in their final clinical years and internships across Iraq. Their involvement in this study between October 2023 and June 2025 was essential to our findings.

Funding

The authors declare that this study received no financial support for the research and/or publication.

Authors' contributions

Noor R. Al-Hasani: Conceptualization; Data curation; Formal analysis; Methodology; Project administration; Writing – original draft; Writing – review & editing. Ali I. Ibrahim: Project administration; Data curation; Formal analysis; Visualization; Writing – original draft. Nameer Al-Taai: Methodology; Formal analysis; Visualization; Writing – original draft., Ali Azeez Al-Jumaili: Data curation; statistical analysis; Visualization; Writing – original draft. Mayar Danadneh: Conceptualization; Data curation; Formal analysis; Methodology; Project administration; Writing – original draft; Writing – review & editing. Raghad Saleh: Data curation; Investigation; Writing – original draft. Elham Kateeb: Supervision; Conceptualization; Methodology; Formal analysis; Writing – original draft; Writing – review & editing. All authors have read and agreed to the published version of the manuscript.

Conflict of interest

The authors declare no conflict of interest.

References

[1]	Singier A, Noize P, Berdai D, et al. (2021) Medicine misuse: A systematic review and proposed hierarchical terminology. Br J Clin Pharmacol 87: 1695-1704. https://doi.org/10.1111/bcp.14604
[2]	Malik UR (2024) Misuse of antibiotics in the community and its implications for the healthcare sector–a narrative review. Health 1: 100001. https://doi.org/10.70389/PJPH.100001
[3]	WHOGlobal action plan on antimicrobial resistance (2015). [cited 2026 March 16]. Available from: https://www.amcra.be/swfiles/files/WHO%20actieplan_90.pdf
[4]	Klein EY, Van Boeckel TP, Martinez EM, et al. (2018) Global increase and geographic convergence in antibiotic consumption between 2000 and 2015. Proc Natl Acad Sci U S A 115: E3463-E3470. https://doi.org/10.1073/pnas.1717295115
[5]	Licata F, Di Gennaro G, Cautela V, et al. (2021) Endodontic infections and the extent of antibiotic overprescription among Italian dental practitioners. Antimicrob Agents Chemother 65: 10.1128/aac.00914-00921. https://doi.org/10.1128/aac.00914-21
[6]	Hicks LA, Bartoces MG, Roberts RM, et al. (2015) US outpatient antibiotic prescribing variation according to geography, patient population, and provider specialty in 2011. Clin Infect Dis 60: 1308-1316. https://doi.org/10.1093/cid/civ076
[7]	Cope AL, Francis NA, Wood F, et al. (2016) Antibiotic prescribing in UK general dental practice: a cross-sectional study. Community Dent Oral Epidemiol 44: 145-153. https://doi.org/10.1111/cdoe.12199
[8]	Suda KJ, Calip GS, Zhou J, et al. (2019) Assessment of the appropriateness of antibiotic prescriptions for infection prophylaxis before dental procedures, 2011 to 2015. JAMA Network Open 2: e193909-e193909. https://doi.org/10.1001/jamanetworkopen.2019.3909
[9]	D'Ambrosio F, Di Spirito F, Amato A, et al. (2022) Attitudes towards antibiotic prescription and antimicrobial resistance awareness among Italian dentists: what are the milestones?. Healthcare 10: 1585. https://www.mdpi.com/2227-9032/10/8/1585
[10]	Danadneh M, Saleh R, Kwaik A, et al. (2025) Antibiotic resistance: knowledge, attitudes, and behaviours regarding prescription among dental students: a cross-sectional study. Front Oral Health 6: 1638336. https://doi.org/10.3389/froh.2025.1638336
[11]	Wilson GM, Evans CT, Fitzpatrick MA, et al. (2023) Clostridioides difficile infection following dental antibiotic prescriptions in a cohort of US veterans. Infect Control Hosp Epidemiol 44: 494-496. https://doi.org/10.1017/ice.2021.516
[12]	Karasneh RA, Al-Azzam SI, Ababneh M, et al. (2021) Prescribers' knowledge, attitudes and behaviors on antibiotics, antibiotic use and antibiotic resistance in Jordan. Antibiotics 10: 858. https://doi.org/10.3390/antibiotics10070858
[13]	Al Marah ZA, Abdulkareem AA, Gul SS, et al. (2021) A survey of systemic antibiotic prescription patterns amongst Iraqi dentists. Int Dent J 72: 338. https://doi.org/10.1016/j.identj.2021.06.002
[14]	Mahdi ZA, Ibrahim JA (2023) Dentists' attitudes and prescription practices for analgesics and antibiotics in Kirkuk Governorate, Iraq. J Med Life 16: 1818. https://doi.org/10.25122/jml-2023-0405
[15]	Othman ZY, Noaman BR, Muhammed RA (2023) Knowledge, attitude, and practice of antibiotics usage and resistance among dental students. Eurasian J Sci Eng : 208-216. https://doi.org/10.23918/eajse.v9i2p16
[16]	Al-Obaidi MMJ, Hadi EA, al-Talib ZN, et al. (2023) Antibiotic prescription in the management of endodontic infections amongst Iraqi final-year undergraduate dental students. Braz J Oral Sci 22: e230171. https://doi.org/10.20396/bjos.v22i00.8670171
[17]	AboAlSamh A, Alhussain A, Alanazi N, et al. (2018) Dental students' knowledge and attitudes towards antibiotic prescribing guidelines in Riyadh, Saudi Arabia. Pharmacy 6: 42. https://doi.org/10.3390/pharmacy6020042
[18]	Tariq K, Hassan M, Wajahat M, et al. (2021) Awareness of antibiotic use and antibiotic resistance amongst dental students. Braz Dent Sci 2021: 1-6. https://doi.org/10.14295/bds.2021.v24i3.2470
[19]	Jairoun A, Hassan N, Ali A, et al. (2019) Knowledge, attitude and practice of antibiotic use among university students: a cross sectional study in UAE. BMC Public Health 19: 518. https://doi.org/10.1186/s12889-019-6878-y
[20]	Thompson W, Tonkin-Crine S, Pavitt S, et al. (2019) Factors associated with antibiotic prescribing for adults with acute conditions: an umbrella review across primary care and a systematic review focusing on primary dental care. J Antimicrob Chemother 74: 2139-2152. https://doi.org/10.1093/jac/dkz152
[21]	Teoh L, Löffler C, Mun M, et al. (2025) A systematic review of dental antibiotic stewardship interventions. Community Dent Oral Epidemiol 53: 245-255. https://doi.org/10.1111/cdoe.13009
[22]	Vázquez-Cancela O, Zapata-Cachafeiro M, Herdeiro MT, et al. (2024) Dentists' knowledge, attitudes and perceptions of antibiotic prescribing: A systematic review. Prev Med 185: 108043. https://doi.org/10.1016/j.ypmed.2024.108043
[23]	Thompson W, Sandoe J, Pavitt S, et al. (2021) Co-developing an antibiotic stewardship tool for dentistry: shared decision-making for adults with toothache or infection. Antibiotics 10: 1345. https://doi.org/10.3390/antibiotics10111345
[24]	Constant ML, Kimmoun A, Baudet A, et al. (2026) Knowledge in oral infectiology and antibiotic stewardship of french dental students: a national cross-sectional survey. Eur J Dent Educ 30: 54-62. https://doi.org/10.1111/eje.13092
[25]	Zhuraviksva K, Troiano G, Caponio VCA (2025) Balancing individual and community risk: role of dentists in antimicrobial stewardship. Lancet Microbe 6: 101185. https://doi.org/10.1016/j.lanmic.2025.101185

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