Majority of antibiotics prescribed by dentists inconsistent with guidelines

United States dentists prescribe 10% of all outpatient antibiotics. Assessing appropriateness of antibiotic prescribing has been challenging due to a lack of guidelines for oral infections. In 2019, the American Dental Association (ADA) published clinical practice guidelines (CPG) on the management of acute oral infections. Our objective was to describe baseline national antibiotic prescribing for acute oral infections prior to the release of the ADA CPG and to identify patient-level variables associated with an antibiotic prescription. It was a Cross-sectional analysis.

Researchers performed an analysis of national VA data from January 1, 2017, to December 31, 2017. Researchers identified cases of acute oral infections using International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) codes. Antibiotics prescribed by a dentist within ±7 days of a visit were included. Multivariable logistic regression identified patient-level variables associated with an antibiotic prescription.

The Results of the study are:

Of the 470,039 VA dental visits with oral infections coded, 12% of patient visits with irreversible pulpitis, 17% with apical periodontitis, and 28% with acute apical abscess received antibiotics. Although the median days' supply was 7, prolonged use of antibiotics was frequent (≥8 days, 42%-49%). Patients with high-risk cardiac conditions, prosthetic joints, and endodontic, implant, and oral and maxillofacial surgery dental procedures were more likely to receive antibiotics.

Thus, the researchers concluded that most treatments of irreversible pulpitis and apical periodontitis cases were concordant with new ADA guidelines. However, in cases where antibiotics were prescribed, prolonged antibiotic courses >7 days were frequent. These findings demonstrate opportunities for the new ADA guidelines to standardize and improve dental prescribing practices.

Reference:

Concordance of antibiotic prescribing with the American Dental Association acute oral infection guidelines within Veterans' Affairs (VA) dentistry by Daniel B Carlsen et al. published in the Infection Control & Hospital Epidemiology.

https://pubmed.ncbi.nlm.nih.gov/33650474/

Keywords: Infection Control & Hospital Epidemiology, dental visits and antibiotics, antibiotics, dentist and antibiotics, prescribed antibiotics use in dentistry, antibiotics and guidelines in dentistry, guidelines followed by dentists for antibiotics, acute oral infection guidelines latest article, Daniel B Carlsen, Michael J Durkin, Gretchen Gibson, M Marianne Jurasic , Ursula Patel 1, Linda Poggensee, Margaret A Fitzpatrick, Kelly Echevarria, Jessina McGregor, Charlesnika T Evans, Katie J Suda, ADA guidelines for oral antibiotics, veterans' Affairs (VA) dentistry