Comparison of guideline concordant antibiotic prophylaxis in Veterans Affairs and non-Veterans Affairs dental settings among those with cardiac conditions or prosthetic joints

Outpatient antibiotic prescribing by general dentists in the United States from 2018 through 2022

BACKGROUND

Dentists play a role in combatting antimicrobial resistance. This analysis characterizes antibiotic prescribing changes by dentists after the American Dental Association's dental infection treatment guideline was released in 2019.

METHODS

The Xponent (IQVIA) database was used to extract antibiotic prescriptions dispensed from 2018 through 2022. General dentist prescriptions were compared with total outpatient oral antibiotics and summarized by patient and provider characteristics. Census denominators were used to calculate prescribing rates per 1,000 people.

RESULTS

Dentists prescribed 24.65 million antibiotics in 2018 compared with 25.17 million in 2022, resulting in 75.5 prescriptions per 1,000 people for both years. From 2018 through 2022, dentists prescribed 9.8% through 12.1% of all outpatient antibiotics. Females, patients 65 years and older, and patients in the Northeast received the most antibiotic prescriptions.

CONCLUSIONS

Prescribing by general dentists remained stable from 2018 through 2022 despite guideline recommendations to limit antibiotic use for dental infections. Variation by patient and provider characteristics may represent unnecessary antibiotic use.

PRACTICAL IMPLICATIONS

Antibiotic stewardship is needed to optimize prescribing in the dental care setting. The Centers for Disease Control and Prevention's Core Elements of Outpatient Antibiotic Stewardship framework can be adapted for dental stewardship implementation.

Barriers and facilitators to guideline concordant dental antibiotic prescribing in the United States: A qualitative study of the National Dental PBRN

OBJECTIVES

While factors contributing to dental antibiotic overprescribing have previously been described, previous work has lacked any theoretical behavior change framework that could guide future intervention development. The purpose of this study was to use an evidence-based conceptual model to identify barriers and facilitators of appropriate antibiotic prescribing by dentists as a guide for future interventions aimed at modifying antibiotic prescribing.

METHODS

Semi-structured interviews were conducted with dentists from the National Dental Practice Based Research Network (PBRN) exploring patient and practice factors perceived to impact antibiotic prescribing. Audio-recorded telephone interviews were transcribed and independently coded by three researchers. Themes were organized around the COM-B model to inform prospective interventions.

RESULTS

73 of 104 dentists (70.1%) were interviewed. Most were general dentists (86.3%), male (65.7%), and white (69.9%). Coding identified three broad targets to support appropriate dental antibiotic prescribing among dentists: (1) increasing visibility and accessibility of guidelines, (2) providing additional guidance on antibiotic prescribing in dental scenarios without clear guidelines, and (3) education and communication skills-building focused on discussing appropriate antibiotic use with patients and physicians.

CONCLUSIONS

The findings from our study are consistent with other studies focusing on antibiotic prescribing behavior in dentists. Understanding facilitators and barriers to dental antibiotic prescribing is necessary to inform targeted interventions to improve appropriate antibiotic prescribing. Future interventions should focus on implementing multimodal strategies to provide the necessary support for dentists to judiciously prescribe antibiotics.

Guideline concordance and antibiotic-associated adverse events between Veterans administration and non-Veterans administration dental settings: a retrospective cohort study

Background: Antibiotics prescribed as infection prophylaxis prior to dental procedures have the potential for serious adverse drug events (ADEs). However, the extent to which guideline concordance and different dental settings are associated with ADEs from antibiotic prophylaxis is unknown. Aim: The purpose was to assess guideline concordance and antibiotic-associated ADEs and whether it differs by VA and non-VA settings. Methods: Retrospective cohort study of antibiotic prophylaxis prescribed to adults with cardiac conditions or prosthetic joints from 2015 to 2017. Multivariable logistic regression models were fit to assess the impact of ADEs, guideline concordance and dental setting. An interaction term of concordance and dental setting evaluated whether the relationship between ADEs and concordance differed by setting. Results: From 2015 to 2017, 61,124 patients with antibiotic prophylaxis were identified with 62 (0.1%) having an ADE. Of those with guideline concordance, 18 (0.09%) had an ADE while 44 (0.1%) of those with a discordant antibiotic had an ADE (unadjusted OR: 0.84, 95% CI: 0.49-1.45). Adjusted analyses showed that guideline concordance was not associated with ADEs (OR: 0.78, 95% CI: 0.25-2.46), and this relationship did not differ by dental setting (Wald χ^2 p-value for interaction = 0.601). Conclusion: Antibiotic-associated ADEs did not differ by setting or guideline concordance.