More than 80 percent of antibiotics prescribed before dental procedures to prevent infection are unnecessary, according to a study published in JAMA Network Open.
Overuse of antibiotics is a significant and growing public health concern, explained senior author Charlesnika Evans, PhD, MPH, associate professor of Preventive Medicine in the Division of Epidemiology.
“While antibiotics are life-saving, they are not safe drugs and can cause many adverse effects in patients. We are also running out of antibiotics that work because bacterial resistance is increasing,” Evans said. “Therefore, antibiotics should be prescribed only when necessary.”
Dentists are responsible for prescribing about 1 in 10 of all antibiotics and are among the top outpatient antibiotic prescribers in the United States.
A wealth of previous research, including studies led by Jeffrey Linder, ’97 MD, MPH, chief of General Internal Medicine and Geriatrics in the Department of Medicine, has demonstrated the high rate of unnecessary antibiotic prescriptions in the outpatient primary medical care setting. The current study, however, is one of the first to evaluate antibiotic prescribing by dentists in a large commercially-insured population.
In the study, the investigators focused on the appropriateness of antibiotic prophylaxis, when antibiotics are prescribed to prevent infection before a procedure.
Currently, guidelines only recommend antibiotic prophylaxis for patients with specific high-risk heart conditions before they undergo invasive dental procedures, in order to prevent an infection of the heart called infective endocarditis.
The investigators analyzed insurance claims data from more than 91,000 patients who received antibiotic prophylaxis for 168,420 dental visits between 2011 and 2015. They found that 90.7 percent of the dental visits were considered invasive, indicated by manipulation of the gingiva or tooth periapex. However, only 20.9 percent of those patients had a cardiac condition that called for antibiotic prophylaxis under current guidelines.
As such, 80.9 percent of the antibiotics prescribed were considered unnecessary.
“Patients should ask their dentist if an antibiotic is really needed for antibiotic prophylaxis. Providers, including dentists, commonly feel pressured to prescribe antibiotics by their patients. Patients can communicate clearly that they don’t expect an antibiotic,” Evans said.
The current analysis is part of a larger study to evaluate prescribing by dentists. “We are planning to conduct interviews with dental providers to identify barriers to appropriate antibiotic prescribing,” Evans explained. “We will use the information from this analysis and the interviews to develop a pilot intervention to support improved prescribing by dentists.”
The study, led by Katie Suda, PharmD, MS, at the University of Illinois at Chicago, was supported by the Agency for Healthcare Research and Quality under award R01 HS25177.
Listen to an episode of the Breakthroughs Podcast with Linder, who has developed effective ways to reduce the number of inappropriate prescriptions.
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