More Than 80 Percent of Antibiotics Prescribed Before Dental Procedures Are Unnecessary, Analysis Concludes

An AHRQ-funded study found that about 81 percent of nearly 169,000 antibiotic prescriptions given to patients before a dental procedure to prevent cardiac infections were considered unnecessary by current guidelines. Preventive antibiotics are recommended for dental patients with a number of serious conditions to prevent secondary infections, such as infective endocarditis. Researchers reviewed dental procedure records between 2011 and 2015 using a national health claims database to find patients who had been given antibiotics. Of those who had received a prescription, more than 80 percent did not have a qualifying, high-risk cardiac diagnosis and no risk of further infection, making those prescriptions unnecessary. The researchers noted that orthopedic implants, tooth implant procedures and procedures completed in the western United States were significantly associated with antibiotic overuse. The risk of overuse was also higher for female patients. Researchers recommended using antibiotic stewardship in dental offices to reduce misuse. Access the abstract of the article published in JAMA Network Open.

2019 May 3;2(5):e193909. doi: 10.1001/jamanetworkopen.2019.3909.

Assessment of the Appropriateness of Antibiotic Prescriptions for Infection Prophylaxis Before Dental Procedures, 2011 to 2015.

Suda KJ1,2, Calip GS1, Zhou J1, Rowan S3, Gross AE1, Hershow RC4,5, Perez RI5, McGregor JC6,7, Evans CT2,8.

Author information

Abstract

IMPORTANCE:

Antibiotics are recommended before certain dental procedures in patients with select comorbidities to prevent serious distant site infections.

OBJECTIVE:

To assess the appropriateness of antibiotic prophylaxis before dental procedures using Truven, a national integrated health claims database.

DESIGN, SETTING, AND PARTICIPANTS:

Retrospective cohort study. Dental visits from 2011 to 2015 were linked to medical and prescription claims from 2009 to 2015. The dates of analysis were August 2018 to January 2019. 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).

EXPOSURES:

Presence or absence of cardiac diagnoses and dental procedures that manipulated the gingiva or tooth periapex.

MAIN OUTCOMES AND MEASURES:

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. To assess associations between patient or dental visit characteristics and appropriate antibiotic prophylaxis, multivariable logistic regression was used. A priori hypothesis tests were performed with an α level of .05.

RESULTS:

From 2011 to 2015, antibiotic prophylaxis was prescribed for 168 420 dental visits for 91 438 patients (median age, 63 years; interquartile range, 55-72 years; 57.2% female). Overall, these 168 420 dental visits were associated with 287 029 dental procedure codes (range, 1-14 per visit). Most dental visits were classified as diagnostic (70.2%) and/or preventive (58.8%). In 90.7% of dental visits, a procedure was performed that would necessitate antibiotic prophylaxis in high-risk cardiac patients. Prevalent comorbidities include prosthetic joint devices (42.5%) and cardiac conditions at the highest risk of adverse outcome from infective endocarditis (20.9%). Per guidelines, 80.9% of antibiotic prophylaxis prescriptions before dental visits were unnecessary. Clindamycin was more likely to be unnecessary relative to amoxicillin (odds ratio [OR], 1.10; 95% CI, 1.05-1.15). 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 sex (OR, 1.21; 95% CI, 1.17-1.25), and visits occurring in the western United States (OR, 1.15; 95% CI, 1.06-1.25) were associated with unnecessary antibiotic prophylaxis.

CONCLUSION AND RELEVANCE:

More than 80% of antibiotics prescribed for infection prophylaxis before dental visits were unnecessary. Implementation of antimicrobial stewardship in dental practices is an opportunity to improve antibiotic prescribing for infection prophylaxis.