BackgroundGuidelines for antibiotics prior to dental procedures for patients with specific cardiac conditions and prosthetic joints have changed, reducing indications for antibiotic prophylaxis. In addition to guidelines focused on patient comorbidities, systematic reviews specific to dental extractions and implants support preprocedure antibiotics for all patients. However, data on dentist adherence to these recommendations are scarce.MethodsThis was a cross-sectional study of veterans undergoing tooth extractions, dental implants, and periodontal procedures. Patients receiving antibiotics for oral or nonoral infections were excluded. Data were collected through manual review of the health record.ResultsOf 183 veterans (mean age, 62 years; 94.5% male) undergoing the included procedures, 82.5% received antibiotic prophylaxis (mean duration, 7.1 ± 1.6 days). Amoxicillin (71.3% of antibiotics) and clindamycin (23.8%) were prescribed most frequently; 44.7% of patients prescribed clindamycin were not labeled as penicillin allergic. Of those who received prophylaxis, 92.1% received postprocedure antibiotics only, 2.6% received preprocedural antibiotics only, and 5.3% received pre- and postprocedure antibiotics. When prophylaxis was indicated, 87.3% of patients received an antibiotic. However, 84.9% received postprocedure antibiotics when preprocedure administration was indicated. While the majority of antibiotics were indicated, only 8.2% of patients received antibiotics appropriately. The primary reason was secondary to prolonged duration. Three months postprocedure, there were no occurrences of Clostridium difficile infection, infective endocarditis, prosthetic joint infections, or postprocedure oral infections.ConclusionThe majority of patients undergoing a dental procedure received antibiotic prophylaxis as indicated. Although patients for whom antibiotic prophylaxis was indicated should have received a single preprocedure dose, most antibiotics were prescribed postprocedure. Dental stewardship efforts should ensure appropriate antibiotic timing, indication, and duration.
BackgroundGuidelines for dental procedure antibiotic prophylaxis have changed significantly, reducing the number of patients indicated to receive antibiotics. The primary objective was to determine the frequency and appropriateness of dental antibiotic prophylaxis at a VA dental clinic.MethodsThis was a cross-sectional study of patients undergoing tooth extractions, dental implants and periodontal procedures in 2015. These procedures are among the most common procedures with the potential for bacteremia post-dental procedure. Patients receiving antibiotics for a separate oral or non-oral infection on the date of the dental procedure were excluded.ResultsOf 183 Veterans undergoing the included dental procedures, 82.5% received antibiotic prophylaxis. Amoxicillin (71.3% of antibiotics) and clindamycin (23.8%) were prescribed most frequently; 44.7% of clindamycin was prescribed to patients not labeled as penicillin allergic. The mean duration of antibiotics was 7.1 +/- 1.6 (1–14) days; 82.5% receiving seven days supply. Of those that received antibiotic prophylaxis, 92.1% received post-procedure antibiotics only, 2.6% pre-procedural antibiotics only and 5.3% received pre- and post-procedure antibiotics. When prophylaxis was indicated (procedure and/or cardiac condition), 85.3% received an antibiotic. However, 72.7% received post-procedure antibiotics when only pre-procedure administration was indicated. When pre-procedure antibiotics were indicated, 11.5% did not receive any antibiotics (pre- or post-procedure). Only 8.2% received antibiotics appropriately based on administration time, procedure and co-morbidities. Three months post-procedure, there were no occurrences of Clostridium difficile, infective endocarditis, prosthetic joint infections or oral infections.ConclusionThe majority of patients undergoing a dental procedure received antibiotic prophylaxis. While the majority of these antibiotics were indicated pre-procedure, prescribing of post-procedure antibiotic for excessive durations was frequent. Dental stewardship efforts should ensure appropriate timing, indications, and duration of antibiotic prophylaxis.Disclosures All authors: No reported disclosures.
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