Greater than 80% of antibiotics prescribed for infection prophylaxis prior to dental visits were found to be unnecessary, according to a recent retrospective cohort study.
The aim of the study was to evaluate the “appropriateness” of antibiotic prophylaxis prior to dental procedures. In order to do this, the study authors utilized Truven MarketScan, a national health claims database, to link dental visits between 2011 and 2015 to medical and prescription claims processed between 2009 and 2015.
“Participants were US patients with commercial dental insurance without a hospitalization or extraoral infection 14 days before antibiotic prophylaxis (defined as a prescription with 2 days’ supply dispensed within 7 days before a dental visit),” the study authors explained. They added, “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.”
A total of 91,438 patients (median age: 63 years; 57.2% female) were prescribed antibiotic prophylaxis for 168,420 dental visits between 2011 and 2015. The study authors reported that 90.7% of these visits involved gingival manipulation and/or mucosal incision, but only 20.9% of patients had a cardiac diagnosis that would put them at increased risk for infective endocarditis.
Of these prescriptions, the authors found that only 19.1% were prescribed appropriately, resulting in 80.9% of prescriptions for antibiotic prophylaxis prior to dental visits being unnecessary and not in accordance with current guidelines.
Findings of the study also revealed several factors that were found to be associated with unnecessary antibiotic prophylaxis including: clindamycin use (compared to amoxicillin; odds ratio [OR]: 1.10; 95% CI: 1.05, 1.15), the presence of prosthetic joint devices (OR: 2.31; 95% CI: 2.22, 2.41), tooth implant procedures (OR: 1.66; 95% CI: 1.45, 1.89), female gender (OR: 1.21; 95% CI: 1.17, 1.25), and the occurrence of dental visits in the western US (OR: 1.15; 95% CI: 1.06, 1.25).
Based on their findings, the authors concluded that “Implementing antimicrobial stewardship efforts in dental practices is an opportunity to improve antibiotic prescribing for infection prophylaxis.”
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