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SAN FRANCISCO — Prophylactic antibiotic prescriptions prior to dental procedures may not be limited to indicated cardiac diagnoses, as per present guidelines, according to a study presented at IDWeek 2018 in San Francisco, California.
The American Heart Association guidelines, as well as those of the American Dental Association and the American Association of Endodontists, state that only individuals who have a history of prosthetic heart valves, heart valve repaired with prosthetic materials, previous infectious endocarditis, unrepaired cyanotic congenital heart disease, or a cardiac transplant with valve abnormalities should receive antibiotic prophylaxis before dental procedures. 2-4
Through use of a national database of integrated medical, dental and prescription claims, researchers conducted a cross-sectional study of 8.7 million adults in the United States who had a dental appointment in 2015, to assess appropriateness of prescription for antibiotic prophylaxis. Chi square and logistical regression statistical analysis was applied to data accrued from patients who received a prescription for a <3-day supply of prophylactic antibiotics within 7 days before a dental visit, wherein patients with cardiac diagnoses underwent procedures that manipulated the tooth periapex/gingiva.
The researchers found that 30,726 antibiotics were prescribed to 21,986 patients for prophylaxis of dental infection; the most common of such prescriptions were for amoxicillin (68.5%) and clindamycin (14.7%). With respect to present guidelines, 78.0% of prescriptions were inappropriate, with amoxicillin identified as the most likely inappropriate therapy (odds ratio [OR], 1.65; 95% CI, 1.27-1.43). Of note, patients who received orthopedic implants (45.4% of patients) and tooth implant procedures were associated with inappropriate prescriptions (OR, 3.35 [95% CI, 3.14-3.56] and OR, 3.30 [95% CI, 2.48-4.39], respectively). In addition, women (OR, 1.35; 95% CI, 1.27-1.43) and individuals in the western United States (OR, 1.22; 95% CI, 1.09-1.36) were also associated with inappropriate prescriptions of prophylactic antibiotics.
The investigators concluded that the implementation of antimicrobial stewardship protocols in dental practice may be beneficial for the improvement of antibiotic prescribing for infection prophylaxis.
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- Suda K, Adimadhyam S, Calip G, et al. Antibiotics prescribed for infection prophylaxis prior to dental procedures are frequently unnecessary in the United States. Presented at: IDWeek 2018; October 3-7, 2018; San Francisco, CA. Poster 1630.
- American Heart Association. Infective endocarditis. http://www.heart.org/en/health-topics/infective-endocarditis. Accessed September 25, 2018.
- American Dental Association. Antibiotic prophylaxis prior to dental procedures. https://www.ada.org/en/member-center/oral-health-topics/antibiotic-prophylaxis. Accessed September 25, 2018.
- American Association of Endodontists. Antibiotic prophylaxis 2017 update. https://www.aae.org/specialty/wp-content/uploads/sites/2/2017/06/aae_antibiotic-prophylaxis-2017update.pdf. Accessed September 25, 2018.