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Prevalence of unnecessary antibiotic prescriptions among dental visits, 2019

Published online by Cambridge University Press:  20 February 2024

Ashlee M. Murphy ,
Ursula C. Patel Open the ORCID record for Ursula C. Patel [Opens in a new window] ,
Geneva M. Wilson Open the ORCID record for Geneva M. Wilson [Opens in a new window]  and
Katie J. Suda Open the ORCID record for Katie J. Suda [Opens in a new window]
Ashlee M. Murphy
Affiliation:
Department of Veterans’ Affairs, Edward Hines Jr Veterans’ Affairs (VA) Hospital, Hines, Illinois
Ursula C. Patel
Affiliation:
Infectious Disease and Antimicrobial Stewardship, Department of Veterans’ Affairs, Edward Hines Jr VA Hospital, Hines, Illinois
Geneva M. Wilson
Affiliation:
Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr VA Hospital, Hines, Illinois Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
Katie J. Suda*
Affiliation:
Department of Veterans’ Affairs, Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
*
Corresponding author: Katie J. Suda; Email: ksuda@pitt.edu
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Abstract

Objective:

The US National Action Plan for Combating Antibiotic-Resistant Bacteria established a goal to decrease unnecessary outpatient antibiotic use by 50%. However, data to inform this goal have been limited to medical settings and have not included dental prescribing. Thus, we sought to identify the proportion of antibiotics prescribed inappropriately by dentists to inform outpatient stewardship efforts.

Methods:

Cross-sectional analysis of 2019 Veterans’ Affairs (VA) national electronic health record data. Antibiotics prescribed by dentists were evaluated for appropriateness based on 2 definitions: one derived from current guidelines (consensus-based recommendations) and the other based on relevant clinical literature (nonconsensus). A clustered binomial logistic regression model determined factors associated with discordant prescribing.

Results:

In total, 92,224 antibiotic prescriptions (63% amoxicillin; mean supply, 8.0 days) were associated with 88,539 dental visits. Prophylaxis for complications in medically compromised patients was associated with the most (30.9%) antibiotic prescriptions, followed by prevention of postsurgical complications (20.1%) and infective endocarditis (18.0%). At the visit level, 15,476 (17.5%) met the consensus-based definition for appropriate antibiotic usage and 56,946 (64.3%) met the nonconsensus definition.

Conclusions:

More than half of antibiotics prescribed by dentists do not have guidelines supporting their use. Regardless of definition applied, antibiotics prescribed by dentists were commonly unnecessary. Improving prescribing by dentists is critical to reach the national goal to decrease unnecessary antibiotic use.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , First View , pp. 1 - 10
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Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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References

US Department of Health and Human Services. National action plan for combating antibiotic-resistant bacteria. White House website. https://obamawhitehouse.archives.gov/sites/default/files/docs/national_action_plan_for_combating_antibotic-resistant_bacteria.pdf. Accessed May 2, 2023.Google Scholar
Hersh, AL, King, LM, Shapiro, DJ, Hicks, LA, Fleming-Dutra, KE. Unnecessary antibiotic prescribing in US ambulatory care settings, 2010–2015. Clin Infect Dis 2021;72:133–137.Google ScholarPubMed
Antibiotic use in the United States, 2019: progress and opportunities. Centers for Disease Control and Prevention website. https://www.cdc.gov/antibiotic-use/data/report-2019.html. Updated November 14, 2019; Accessed August 2, 2021.Google Scholar
Suda, KJ, Calip, GS, Zhou, J, et al. Assessment of the appropriateness of antibiotic prescriptions for infection prophylaxis before dental procedures, 2011 to 2015. JAMA Netw Open 2019;2:e193909.CrossRefGoogle ScholarPubMed
Ramanathan, S, Yan, CH, Hubbard, C, et al. Changes in antibiotic prescribing by dentists in the United States, 2012–2019. Infect Control Hosp Epidemiol 2023;44:1725–1730.CrossRefGoogle ScholarPubMed
Suda, KJ, Fitzpatrick, MA, Gibson, G, et al. Antibiotic prophylaxis prescriptions prior to dental visits in the Veterans’ Health Administration (VHA), 2015–2019. Infect Control Hosp Epidemiol 2022;43:1565–1574.CrossRefGoogle ScholarPubMed
Lockhart, PB, Tampi, MP, Abt, E, et al. Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling: a report from the American Dental Association. J Am Dent Assoc 2019;150:906–921.CrossRefGoogle ScholarPubMed
Tampi, MP, Pilcher, L, Urquhart, O, et al. Antibiotics for the urgent management of symptomatic irreversible pulpitis, symptomatic apical periodontitis, and localized acute apical abscess: systematic review and meta-analysis-a report of the American Dental Association. J Am Dent Assoc 2019;150:e179–e216.CrossRefGoogle ScholarPubMed
Wilson, W, Taubert, KA, Gewitz, M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 2007;116:1736–1754. Erratum in: Circulation 2007;116:e376–e767.CrossRefGoogle Scholar
Khouja, T, Kennedy, E, Suda, KJ. Antibiotic prophylaxis for tooth extractions and dental implants, a narrative review. Curr Infect Dis Rep 2023;25:87–99.CrossRefGoogle Scholar
Lodi, G, Figini, L, Sardella, A, Carrassi, A, Del Fabbro, M, Furness, S. Antibiotics to prevent complications following tooth extractions. Cochrane Database Syst Rev 2012;11:CD003811. Update in: Cochrane Database Syst Rev 2021;2:CD003811.Google ScholarPubMed
Esposito, M, Grusovin, MG, Worthington, HV. Antibiotics at dental implant placement to prevent complications. Cochrane Database Syst Rev 2013;2013:CD004152.Google ScholarPubMed
Thornhill, MH, Gibson, TB, Pack, C, et al. Quantifying the risk of prosthetic joint infections after invasive dental procedures and the effect of antibiotic prophylaxis. J Am Dent Assoc 2023;154:43–52.CrossRefGoogle ScholarPubMed
Carlsen, DB, Durkin, MJ, Gibson, G, et al. Concordance of antibiotic prescribing with the American Dental Association acute oral infection guidelines within Veterans’ Affairs (VA) dentistry. Infect Control Hosp Epidemiol 2021;42:1422–1430.CrossRefGoogle ScholarPubMed
Thornhill, MH, Crum, A, Rex, S, et al. Analysis of prosthetic joint infections following invasive dental procedures in England. JAMA Netw Open 2022;5:e2142987.CrossRefGoogle ScholarPubMed
Sax, OC, Bains, SS, Chen, Z, Delanois, RE, Nace, J. Antibiotic prophylaxis is not necessary for invasive dental procedures in existing total knee arthroplasty implants. Orthopedics 2023;46:76–81.CrossRefGoogle Scholar
Rethman, MP, Watters, W 3d, Abt, E, et al. The American Academy of Orthopaedic Surgeons and the American Dental Association clinical practice guideline on the prevention of orthopedic implant infection in patients undergoing dental procedures. J Bone Joint Surg Am 2013;95:745–747.CrossRefGoogle ScholarPubMed
Sollecito, TP, Abt, E, Lockhart, PB, et al. The use of prophylactic antibiotics prior to dental procedures in patients with prosthetic joints: evidence-based clinical practice guideline for dental practitioners--a report of the American Dental Association Council on Scientific Affairs. J Am Dent Assoc 2015;146:11–16.CrossRefGoogle ScholarPubMed
Hughes, AM, Evans, CT, Fitzpatrick, MA, et al. A qualitative approach to examining antimicrobial prescribing in the outpatient dental setting. Antimicrob Steward Healthc Epidemiol 2022;2:e102.CrossRefGoogle ScholarPubMed
Antibiotic prophylaxis 2017. Update. American Association of Endodontists website. https://www.aae.org/specialty/wp-content/uploads/sites/2/2017/06/aae_antibiotic-prophylaxis-2017update.pdf. Published 2017. Accessed December 22, 2023.Google Scholar
King, LM, Bartoces, M, Fleming-Dutra, KE, Roberts, RM, Hicks, LA. Changes in US outpatient antibiotic prescriptions from 2011–2016. Clin Infect Dis 2020;70:370–377.Google ScholarPubMed
Ioannidou, E, Geurs, N, Lipman, R, et al. Antibiotic prescription patterns among US general dentists and periodontists. J Am Dent Assoc 2022;153:979–988.CrossRefGoogle ScholarPubMed
Pandula, V. Dental Treatments which require antibiotic prophylaxis. JuniorDentist.com website. https://www.juniordentist.com/dental-treatments-which-require-antibiotic-prophylaxis.html. Published September 17, 2016. Accessed August 23, 2021.Google Scholar
Chu, V, Sexton, D. Antimicrobial prophylaxis for the prevention of bacterial endocarditis. In: UpToDate website. https://www.uptodate.com/contents/prevention-of-endocarditis-antibiotic-prophylaxis-and-other-measures. Published 2021. Accessed August 23, 2021.Google Scholar
Nguyen, DH, Martin, JT. Common dental infections in the primary care setting. Am Fam Physician 2008;77:797–802.Google ScholarPubMed
National Action Plan for Combating Antibiotic-Resistant Bacteria, 2020–2025. US Department of Health and Human Services website. https://www.hhs.gov/sites/default/files/carb-national-action-plan-2020-2025.pdf. Accessed May 6, 2023.Google Scholar
Antibiotic stewardship for oral health. Centers for Disease Control and Prevention website. https://www.cdc.gov/oralhealth/infectioncontrol/faqs/antibiotic-stewardship.html. Accessed May 6, 2022.Google Scholar
Goff, DA, Mangino, JE, Trolli, E, Scheetz, R, Goff, D. Private practice dentists improve antibiotic use after dental antibiotic stewardship education from infectious diseases experts. Open Forum Infect Dis 2022;9:ofac361.CrossRefGoogle ScholarPubMed
Gross, AE, Hanna, D, Rowan, SA, Bleasdale, SC, Suda, KJ. Successful implementation of an antibiotic stewardship program in an academic dental practice. Open Forum Infect Dis 2019;6:ofz067.CrossRefGoogle Scholar
Antibiotic stewardship for oral health. Dental Infection Prevention & Safety Association (OSAP) website. https://www.osap.org/antibiotic-stewardship. Accessed May 6, 2023.Google Scholar
Sanchez, GV, Fleming-Dutra, KE, Roberts, RM, Hicks, LA. Core elements of outpatient antibiotic stewardship. MMWR Recomm Rep 2016;65(6):1–12.CrossRefGoogle ScholarPubMed