Rethinking Antibiotic Prescribing Practices in Dental Clinics

Antibiotic prescribing in the dental setting requires updated guidelines and patient management strategies, according to research¹ presented at IDWeek 2022, held October 19 to 23 in Washington, D.C.

Dentists are the third highest prescribers of antibiotics in the outpatient setting in the country, with “suboptimal” prescribing rates between 30% and 85%. Current American Dental Association guidelines, published in 2019, provide guidance for antibiotic use based on the presence of dental pain or swelling, and “whether definitive conservative dental treatment is immediately available.”

Researchers from Cleveland, Ohio, evaluated antibiotic prescribing data from January through December 2021. The primary study goal was to evaluate the appropriateness of antibiotic use based on ADA guidelines; secondary goals were to describe dentists’ antibiotic choices, the duration of therapy, and the use of non-first line antibiotics, with first line antibiotics defined as penicillin, amoxicillin, and amoxicillin-clavulanate.

A total of 14,381 dental clinic encounters were identified, 16% of which resulted in 1 or more antibiotic prescriptions for a total of 2788 prescriptions. Of these prescriptions, 14% were non-first line antibiotics, including clindamycin, azithromycin, metronidazole, ciprofloxacin, trimethoprim-sulfamethoxazole, tetracyclines, and cephalexin; 17% were prescribed to patients who had no documented beta-lactam allergy.

Among the non-first line antibiotic prescriptions prescribed for patients with a documented allergy (n=333), a first-line antibiotic or cephalexin could have been prescribed in 36% of cases.

Within the 120 cases randomly selected by investigators for more detailed review, antibiotics were prescribed for treatment, rather than prophylaxis, in 96% of cases. Antibiotics were indicated in only 14% of patients, and mean therapy duration was 7.2 days.

“At our institution, most antibiotics prescribed from our dental clinics were for treatment, were not commonly indicated, and were usually prescribed for 7 days or more,” the researchers concluded. “Developing a clinical pathway incorporating updated guidelines and management of patients with beta-lactam ‘allergies’ may improve patient care.”

Reference

1. Son AH, Boland BP, Harsh NC, Hecker MT. Drilling down on antibiotic use in dental clinics. Presented at: IDWeek 2022; October 19-23, 2022; Washington, D.C. Poster 1745.