The results of a new study show that more than 80% of antibiotics prescribed for infection prophylaxis prior to dental procedures are unnecessary.
The retrospective cohort study, published in JAMA Network Open, examined about 168,000 dental visits from 2011-2015 involving about 91,000 patients who received antibiotic prophylaxis. Appropriate antibiotic prophylaxis was defined as "a prescription dispensed before a dental visit with a procedure that manipulated the gingiva or tooth periapex in patients with an appropriate cardiac diagnosis."
Researchers noted that nearly 91% of the visits had manipulation of the gingiva or tooth periapex, but only about 21% of patients had a cardiac condition at the highest risk of adverse outcome from infective endocarditis. They therefore determined that 80.9% of antibiotic prophylaxis prescriptions were "discordant with guidelines."
Their conclusions include the following: "While antibiotic prophylaxis is appropriately prescribed for indicated dental procedures in patients with cardiac conditions, most antibiotic prophylaxis is prescribed to patients in whom guideline-identified risk factors are not present. Although prescribing is slowly improving, the high proportion of antibiotics that were found to be unnecessary in our study is worrisome. Implementing antimicrobial stewardship efforts in dental practices is an opportunity to improve antibiotic prescribing for infection prophylaxis."
The researchers note that dentists prescribe about 10% of all antibiotic prescriptions in the United States and are also the top prescriber of clindamycin in the United States. Furthermore, they note that antibiotics prescribed by dentists for infection prophylaxis have been associated with community-associated C difficile infection.