Most antibiotics prescribed for dental visits inconsistent with guidelines, study finds

March 06, 2022

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Five out of every six antibiotics prescribed before an appointment with a Veterans Affairs, or VA, dentist were inconsistent with guidelines, researchers found.

“Antibiotic prophylaxis guidelines for dental procedures are lacking,” Katie J. Suda, PharmD, MS, professor of medicine at the University of Pittsburgh, and colleagues wrote in Infection Control & Hospital Epidemiology. “Within dentistry, it is common for prophylaxis to be prescribed in patients with medically complex conditions (eg, immunosuppression) prior to invasive dental procedures, despite a lack of data on the benefit of such practice.”

Suda KJ, et al. Infect Control Hosp Epidemic. 2021;doi:10.1017/ice.2021.521.

Suda and colleagues performed a cross-sectional study of antibiotics prescribed within 7 days before a visit in the absence of an oral infection for all VA dental visits between 2015 and 2019. The primary analysis used a narrow definition of appropriate prophylaxis based on comorbidities — cardiac conditions at the highest risk for an adverse outcome from endocarditis. They performed a secondary analysis that included a broader definition based on comorbidities, including cardiac or immunocompromising condition or tooth extractions and/or implants.

In total, the study included 358,078 visits that were associated with 369,102 antibiotics. When Suda and colleagues used the narrow definition, 15% of prescriptions were appropriate. That increased to 72% under the broader definition.

“Unnecessary prescribing increased over time. Considering that most antibiotics prior to dental visits are for infection prophylaxis, focusing on improving appropriateness may have large implications for stewardship,” the authors wrote. “Focusing on prescribing prophylaxis for prosthetic joints, prescriptions for more than one visit, and just in case antibiotics should be targeted.”

They added that, in addition, evidence to inform prescribing recommendations and guidelines are “urgently needed” to determine whether antibiotic prophylaxis prescriptions are indicated for surgical tooth extractions, dental implant placement surgery and immunocompromising conditions, “which are common reasons dentists prescribe antibiotics.”

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