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Making a case for dental clinical practice guidelines for elective antibiotic use: an institutional retrospective
Background:
Antibiotic overuse disrupts host-microbiome equilibrium, and increases risks of diarrhea, drug allergies, and multi-drug resistance. Dentists are the third largest prescribers of oral antibiotics in the US. Investigating antibiotic prescribing patterns alongside dental procedures may identify opportunities to reduce antibiotic overuse.
Method:
Institutional antibiotic prescriptions (Abx-Rx) dispensed with dental procedures were retrospectively reviewed from 2017-2022. Augmentin® (USAntibiotics, TN) and clindamycin prescriptions were investigated for nonindicated vs. well-reasoned use, comparing implant-related and extraction-related procedures.
Results:
Over 7,158 Abx-Rx, dispensed with 3,320 (56% of) implant-related, 4,084 (14% of) extraction-related, and 256 overlapping visits, included amoxicillin (79.75%), clindamycin (7.23%), Augmentin® (6.3%), azithromycin (4.2%), and penicillin VK (1.53%). Implant-related procedures were 7.8-fold more likely than extraction-related to involve Abx-Rx [95% CI: 7.392-8.373, p<0.05]. Use of Augmentin® and clindamycin (the two most dispensed broad-spectrum antibiotics) in dental procedures was evaluated further. Over 60% of Augmentin® prescriptions (n=352) were implant-related, of which 88% were nonindicated, versus 48% of dental extractions-related. Implant-related Augmentin® prescriptions were 8-fold more likely to be pre-emptive [95% CI 4.676, 14.47, p<0.05)]. Of 460 clindamycin prescriptions, implant-related prescriptions (30%) were 1.5-fold more likely nonindicated than were extraction-related [95%CI 1.019, 2.443, p<0.05]; 76% occurred in patients reporting penicillin allergy.
Conclusion:
Implant-related procedures more frequently involved nonindicated, broad-spectrum antibiotic use, highlighting the need for evidence-based guidelines to reduce antibiotic overuse. Clindamycin use can further be reduced with the justified use of alternative safer antibiotics and minimizing mislabeling of penicillin allergy. Clinical Practice Guidelines for antibiotic use following dental procedures can promote judicious antibiotic use.
