Quality indicators for the use of systemic antibiotics in dentistry

Risks resulted from using systemic antibiotics such as increasing rates of bacterial resistance, allergy and side effects should be always weighed individually for each patient against any potential benefits. Routine antibiotic prescribing must be therefore discouraged. The Federal Joint Committee ("Gemeinsamer Bundesauschuss", G-BA) commissioned the AQUA-Institute with the development of an external quality assurance procedure, examining systemic antibiotic use in periodontal, conservative and surgical treatments in ambulatory dental health care. The aim of the procedure was to increase patient safety through rational use of systemic antibiotics and increasing the use of first line medications.

The process of developing the quality indicators included searching for relevant literature and quality indicators, analyzing dental claims data (2013) and antibiotic prescriptions, and finally evaluating the proposed quality indicators in an expert panel. The analysis examined patients who received dental treatments and a prescription for systemic antibiotics. The indicator set consisted of three indicators: usage of systemic antibiotics in dental treatments without indication for antibiotics, the percentage of penicillin prescriptions in dental treatments and the percentage of clindamycin prescriptions in dental treatments.

The analysis showed that about 574 million claims on conservative and surgical treatments were made for about 60 million patients. In total, about 4.7 million systemic antibiotics prescriptions were issued for 3.5 million patients with dental treatments. The percentage of patients given a systemic antibiotic as an adjunct to dental treatments, usually without indication, was 3.4 %. The percentage of penicillin prescriptions (as a whole therapeutic/pharmacological subgroup) of the total systemic antibiotic use in dental treatments was 46.3 %; for clindamycin it was 47.0 %.

Clindamycin is preferred by German dentists, and its overprescription represents an inappropriate use of antibiotics. Optimizing antibiotics prescriptions in dental care through rational use decreases bacterial resistance, increases patient safety and the overall quality of dental care. Future analysis and reporting of the indicators will draw a clear picture of dental antibiotic use, i.e. using a risk adjustment for the first indicator and the implementation of a consistent identification system for dentists in the statutory health insurance (SHI). This will enable a direct connection between dentists and their respective antibiotic prescriptions (causal relationship) and thus highlight areas of need for quality improvement. As such targeted educational activities can be developed on an individual basis.