An audit of antimicrobial prescribing by dental practitioners in the north east of England and Cumbria

Abstract

BackgroundInappropriate prescribing of antimicrobials is a significant threat to global public health. In England, approximately 5% of all antimicrobial items are prescribed by dentists, despite the limited indications for their use in the treatment of oral infections in published clinical guidelines. The objective of this study was to survey antimicrobial prescribing by dental practitioners in North East England and Cumbria, identify educational and training needs and develop a self-assessment tool that can be used for Continued Professional Development by individual practitioners.MethodsDuring October 2016, 275 dental practitioners used a standardised form to record anonymous information about patients who had been prescribed antimicrobials. Clinical information and prescribing details were compared against clinical guidelines published by the Faculty of General Dental Practitioners UK.ResultsDental practitioners provided data on 1893 antimicrobial prescriptions. There was documented evidence of systemic spread, such as pyrexia in 18% of patients. Dentists recorded patients’ pain (91.1% of patients), local lymph gland involvement (41.5%) gross diffuse swelling (55.5%) dysphagia (7.2%) and trismus (13.6%). Reasons for prescribing antimicrobials included patient expectations (25.8%), patient preference (24.8%), time pressures (10.9%), and patients uncooperative with other treatments (10.4%). The most commonly prescribed antimicrobials were amoxicillin, accounting for 61.2% of prescriptions, followed by metronidazole (29.9%). Most prescriptions for amoxicillin were for either 5 days (66.8%) or 7 days (29.6%) and most prescriptions for metronidazole were for a 5-day course (65.2%) or 7-day (18.6%) course.ConclusionIn most cases, when an antimicrobial was prescribed, practitioners used the correct choice of agents and usually prescribed these at the correct dose. However, some evidence of suboptimal prescribing practices when compared to the Faculty of General Dental Practitioner guidelines were identified. The audit has identified training needs across the region and aided the development of Continued Professional Development sessions. Further work to identify barriers and facilitators for improving antimicrobial prescribing and determining appropriate methods to improve clinical practice are required.Electronic supplementary materialThe online version of this article (10.1186/s12903-018-0682-4) contains supplementary material, which is available to authorized users.

Antibiotic Prescribing Habits and Antimicrobial Resistance Awareness of Dental Practitioners in Primorsko-Goranska County, Croatia

“…Antibiotics are also appropriate in cases of necrotizing ulcerative gingivitis or pericoronitis. 11,12,34,35 Large differences in antibiotic prescribing practices were found in European studies in the United Kingdom, Spain, and Croatia, 24,26,28 and similar findings regarding the inappropriate use of antibiotic for endodontic infections and conditions have been found in our study as well. Our results show that implant placement (59.9%) was the third most common situation for which dentists would prescribe antibiotics.…”

“…All dental prescribers need to be aware that antibiotics should be used for support when treating dental infections and not as a replacement for conventional surgical methods. Some European dental practitioners (Croatia, United Kingdom) tend to prescribe antibiotics for nonclinical factors, 24,28 as shown in our study that patients' expectations for antibiotics lead to overprescribing. Some of the possible explanations for this difference in antibiotic prescribing among dental practitioners include dentists' training environment, professional tradition, and cultural expectations.…”

“…[24][25][26] In comparison, British, Swedish, and Norwegian dentists would most frequently prescribe amoxicillin and phenoxymethylpenicillin. 8,27,28 Phenoxymethylpenicillin and amoxicillin are recommended as the antibiotic of choice for the treatment of endodontic infections. Amoxicillin with clavulanic acid with its wide spectrum of action should be reserved for immunocompromised patients or those whose infections have not responded to first-line antibiotics when provided in conjunction with surgical treatment.…”

Determinants of Clinician and Patient to prescription of antimicrobials: case of Mulanje, Southern Malawi

“…The present study confirmed that patient preference is a factor that influences clinicians to give over their prescribing decision power to patients and it determines inappropriate antimicrobial prescription in health care settings. These findings are supported by several studies in developed countries [11,[25][26][27][28]. In the USA, a similar study to the current one found out that parental pressure was influencing clinicians to prescribe antibiotics [12].…”

How did COVID-19 impact on dental antibiotic prescribing across England?

“…Even before COVID-19, there was evidence of significant overprescribing of dental antibiotics internationally. 7,28,29,30 Approaches to address unnecessary and inappropriate antibiotic use are urgently required in dental practices. The FDI World Dental Federation white paper, published in November 2020, advocates three roles for dental teams in tackling antibiotic resistance: 1) raising awareness about antibiotic resistance; 2) preventing dental infections; and 3) antibiotic stewardship to optimise dental antibiotic prescribing in accordance with guidelines.…”