By Emma Yasinksi
Eighty percent of antibiotics prescribed before dental procedures are unnecessary under the most recent guidelines, and may be contributing to increasing antibiotic resistance and C. diff infections, according to a recent study in JAMA Network Open.
Dentists write 10 percent of all antibiotic prescriptions in the United States, more than any other specialist doctor. In 2007, the American Heart Association released guidelines that narrowed the indications for using prophylactic antibiotics to only patients with cardiac conditions that put them at high risk for contracting endocarditis.
Dentists are most likely to prescribe the antibiotic clindamycin, which increases the risk of a patient contracting C. difficile, a dangerous and potentially fatal gastrointestinal infection that causes diarrhea, fever, pain, and nausea.
The researchers knew from previous work that about 30 percent of the antibiotics primary care doctors prescribe is unnecessary. Katie J. Suda, PharmD, M.S, an associate professor in the College of Pharmacy at the University of Illinois at Chicago, and lead author of the study, observed that there had been very little research looking at the appropriateness of dentists’ antibiotic prescriptions.
She and her team used data from 91,438 patients who received antibiotic prophylaxis before dental procedures between 2011 and 2015. Some patients visited the dentist multiple times, making a total of 168,420 visits during the period.
Linking this data to medical insurance claims, the researchers found that while 90.7 percent of the visits were for procedures that could require antibiotic prophylaxis if the patient had a high-risk cardiac condition, only 20.9 percent of patients had one of these conditions, according to the most recent guidelines. “Therefore,” the researchers wrote, “80.9 percent of antibiotic prophylaxis prescriptions were discordant with guidelines.”
Some characteristics increased the likelihood of being prescribed antibiotics, such as prosthetic joint devices, being female, being located in the Western portion of the US, and receiving a tooth implant.
“These results may seem shocking. Unfortunately, these results are consistent with unnecessary antibiotic prescribing by dentists in other countries,” said Dr. Suda. “However, our results should initiate a call to action to professional organizations, public health, and advocacy groups to improve prescribing of antibiotic prophylaxis prior to dental procedures.”
The ADA is working to develop new guidelines for prescribing antibiotics in dental practices. Additionally, an antibiotic stewardship program – usually confined to medical practices – was successfully implemented in a dental practice in Chicago.
“Antibiotics are not safe drugs,” added Dr. Suda. “While antibiotics are life-saving, they are associated with significant adverse effects.”
Author: Contributing writer Emma Yasinski received her Master of Science (MS) in science and medical journalism from Boston University. Her articles have also appeared at TheAtlantic.com, Kaiser Health News, NPR Shots, and Genetic Engineering and Biotechnology News.
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