In the Journals Plus

Large dental practice cuts antibiotic prescribing by 73%

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February 17, 2019

A large academic dental practice saw a nearly 73% decrease in antibiotic prescribing after implementing a comprehensive antibiotic stewardship program that is thought to be the first of its kind, researchers said.

“Historically, the focus of [antimicrobial stewardship programs (ASPs)] has been on the inpatient setting, however, the majority of antibiotic use in the United States occurs in the outpatient setting. In the community, 10% of all antibiotics are prescribed by dentists,” Alan E. Gross, PharmD, BCPS, BCIDP, clinical assistant professor of pharmacy practice at the University of Illinois at Chicago College of Pharmacy, and colleagues wrote.

“Dentists frequently prescribe antibiotics for indications including prophylaxis prior to dental procedures, post-surgery, and for the treatment of oral infections. Available data suggest there is significant opportunity for improvement given 30% to 85% of antibiotics prescribed by dentists may be suboptimal or not indicated.”

According to Gross and colleagues, a team of dentists, pharmacists and physicians conducted a baseline needs assessment and literature evaluation to identify opportunities to improve antibiotic prescribing by dentists in the University of Illinois at Chicago College of Dentistry, which provides treatment to more than 30,000 patients each year as Illinois’ largest oral health care provider.

dental surgery 
10% of all antibiotics are prescribed by dentists.
Source: Adobe Stock.

They described a multimodal intervention, which included patient and provider education, clinical guideline development and an assessment of the antibiotic prescribing rate per urgent care visit before and after the educational interventions.

“We identified multiple needs, including standardization of antibiotic prescribing practices for patients with acute oral infections in the urgent care clinics,” Gross and colleagues wrote.

The program led to a 72.9% decrease in antibiotic prescribing between September 2017 and May 2018, Gross and colleagues reported.

“During practice meetings where these data were discussed, clinical providers expressed that anecdotally they had become more conscious of appropriate antibiotic prescribing since the implementation of the educational interventions,” they wrote.

Gross and colleagues said the approach could be adapted to other dental practices to improve antibiotic prescribing.

“Dentists prescribe a significant amount of antibiotics and the implementation of systematic dental practice ASPs can facilitate appropriate antibiotic use to mitigate unintended consequences, such as antibiotic resistance and [Clostridioides difficile infection],” they concluded. “We have presented an approach to implementing a formalized ASP consistent with the CDC Core Elements of Outpatient Antibiotic Stewardship. We have discussed potential opportunities to improve antibiotic use as well as barriers and facilitators to effecting change so that others may potentially adapt lessons learned to implement antibiotic stewardship in their dental practices.”– by Caitlyn Stulpin

Disclosure: Gross reports receiving consulting fees from Paratek Pharmaceuticals outside of the submitted work.

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