Beginning in July 2015, the investigators started collecting dental antibiotic indications in addition to prescriber information. So far, 76 cases of dental antibiotic use have been identified with top indications including tooth infections/abscesses (43%), oral surgery prophylaxis (35%), and dental cleaning prophylaxis (13%).
“Sixty-seven percent of the 76 cases were prescribed antibiotics by dentists,” Dr. Bye drove home.
Following this research, investigators began collecting data related to patients with heart conditions or who have received joint replacements. Of the cases prescribed dental-related antibiotics, 4 had heart conditions (1 had a valve replacement) and 4 had joint replacements. “Of these 8 cases, only the valve replacement potentially warranted antibiotic prophylaxis under current guidelines,” Dr. Bye explained.
The study had 2 notable limitations: the dental records were not reviewed, and the investigators cannot “attribute CDI to dental prescribing when other antibiotics are prescribed for different indications.”
“In conclusion, our analysis suggests that antibiotics prescribed by dentists are contributing to CDI,” Dr. Bye stressed. Although overall antibiotic prescribing has decreased, dental prescribing is actually increasing. She added, “A recent review indicates that taking any antibiotic can increase a person’s chances of getting CDI by 7 times. When taking clindamycin, you increase the chances by 20 times.”
She closed out her presentation by providing conference attendees with the following recommendations:
- Dentists need to be included in stewardship programs
- Dentists need to consider risk for CDI when prescribing antibiotics
- Clarification and consistency is needed across professional associations when it comes to dental prophylaxis for joint replacement
- More research is needed to better understand risk of adverse events linked with dental procedures
“Everybody plays a role in antibiotic stewardship,” Dr. Bye stressed. “Dentists should follow ADA guidelines for antibiotic prophylaxis and treatment, as well as counsel patients about the risk and symptoms of C. diff
and other complications of antibiotic use.”
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