02 Jun Majority of Antibiotics Prescribed Before Dental Procedures Are Unnecessary

MedicalResearch.com Interview with:

Dr. Suda

Dr. Katie Suda, PharmD, M.S. 
Associate Professor
College of Pharmacy
University of Illinois at Chicago 

MedicalResearch.com: What is the background for this study?

Response: Dentists prescribe approximately 1 in every 10 antibiotics in the United States and are the top specialty prescriber. Dentists are the primary prescriber of clindamycin in the U.S., which is associated with a high risk of C. difficile infection (an overgrowth of bacteria in the GI tract that can cause a life-threatening infection). Clinical guidelines recommend that patients with specific cardiac conditions receive a dose of antibiotics prior to undergoing invasive dental procedures to prevent infective endocarditis (an infection of the heart values). Taking a dose of antibiotics prior to a dental visit is referred to as antibiotic prophylaxis. Starting in 2007, these guidelines were narrowed secondary to poor evidence on the effectiveness of antibiotic prophylaxis and the risk of antibiotic-related adverse events. Antibiotic adverse events include antibiotic resistance, C. difficile infection, and other general adverse events (nausea, vomiting, diarrhea).

While significant research has been conducted on unnecessary prescribing of antibiotics by medical providers, little work has described appropriateness of prescribing by dentists. We assessed if antibiotics prescribed for prophylaxis prior to dental procedures were consistent with clinical guidelines.

MedicalResearch.com: What are the main findings?

Response: We found that 81% of antibiotics prescribed to adults for prophylaxis prior to dental procedures were unnecessary. The factors associated with unnecessary antibiotic prophylaxis included patients with prosthetic joint devices, dental visits with tooth implant procedures, female patients, prescriptions for clindamycin, and visits occurring in urban areas and in the Western United States. Persons with diabetes, suppressed immune systems, or recent health care use were less likely to receive unnecessary antibiotic prophylaxis. However, unnecessary prescribing decreased over the study period. This may indicate that the guideline changes are being implemented in clinical care. 

MedicalResearch.com: What should readers take away from your report?

Response: These results may seem shocking. Unfortunately, these results are consistent of unnecessary antibiotic prescribing by dentists in other countries. For medical providers, 30% of outpatient antibiotics prescribed in primary care settings are unnecessary. For some specific infections, unnecessary prescribing by medical providers exceeds 70%.

Antibiotics are not safe drugs. While antibiotics are life-saving, they are associated with significant adverse effects. Because antibiotic drug development is limited, we are running out of antibiotics because bacterial resistance is also increasing. Therefore, antibiotics should also be prescribed only when necessary. Therefore, patients should ask their dentist if an antibiotic is really needed for antibiotic prophylaxis.

Providers, including dentists, commonly feel pressured to prescribe antibiotics by their patients. Patients can communicate clearly that they don’t expect an antibiotic; they want to know what to do to feel better.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Future research should assess appropriateness of antibiotic prophylaxis in other populations, especially those without dental insurance. The effectiveness of strategies to improve antibiotic prescribing (or antibiotic stewardship) should also be assessed.

MedicalResearch.com: Is there anything else you would like to add?

Response: No disclosures. The study was funded by the Agency for Healthcare Research and Quality

The limitations are included in the Discussion section of the paper and should be reviewed by the reader. Of note, the dataset only included patients with commercial dental insurance. Therefore, the results may not apply to patients with public insurance (e.g, Medicaid) or persons without dental insurance. Also, other providers (e.g, cardiologists, orthopedists) may have prescribed the antibiotic.

Citation:

Katie J. Suda, Gregory S. Calip, Jifang Zhou, Susan Rowan, Alan E. Gross, Ronald C. Hershow, Rose I. Perez, Jessina C. McGregor, Charlesnika T. Evans. Assessment of the Appropriateness of Antibiotic Prescriptions for Infection Prophylaxis Before Dental Procedures, 2011 to 2015. JAMA Network Open, 2019; 2 (5): e193909 DOI: 10.1001/jamanetworkopen.2019.3909

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Last Updated on June 2, 2019 by Marie Benz MD FAAD