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Quality and consistency of antibiotic prescribing guidelines in dentistry: a worldwide systematic review
Antonio Juárez-Membreño1, Adolfo Figueiras2, Maruxa Zapata-Cachafeiro2
1Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain; Faculty of Medicine, Austral University of Chile, Chile.
Objetive:
To analyse concordance between the antibiotic prescription recommendations for oral diseases made by the various clinical practice guidelines (CPGs) and describe their methodological quality.
Methods:
We conducted a systematic review (SR) of CPGs on antibiotic prescribing in dentistry. We included (i) CPGs on antibiotic prescribing in dentistry; and (ii) CPGs developed by Ministry Health or dental specialist society. We selected the recommendations according to the oral disease and if they were targeted at patients allergic or non-allergic to penicillin. We included CPGs published from July 2012 to Nov 2023 on database MEDLINE, EBSCOB, EMBASE, Scopus, SciELO, Google Scholar and Ministry of Health websites from Europa, America and Oceania. Quality assesment was based on the AGREE II, which classified CPGs as "recommended for use", "recommended with modifications" or "not recommended". (CRD42022367433) RESULTS: : Of the 6147 records identified, this review covered 17 CPGs from 9 countries and 1 issued by the World Health Organisation. Amoxicillin was the antibiotic indicated as first choice for non-allergic patients by16 of CPGs. Consistency was lower when it came to the active ingredients recommended in penicillin-allergic patients. Metronidazole (5/17), to azithromycin (4/17), and clindamycin (4/17) are the main active first-line. Based on our results, 10 of CPGs would be classified as "recommended for use", 5 as "recommended with modifications", and 2 as "not recommended".
Conclusions:
This SR identified a lack of concordance in some of the CPG recommendations in dentistry. Improving aspects such as the rigour of evidence or applicability could serve to enhance the quality of these instruments.
Clinical Significance:
Our study has identified a wide variability among CPG recommendations on antibiotic prescribing in dentistry. Therefore, it would be interesting to know whether high-quality CPGs are a tool associated with better antibiotic prescribing patterns.
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