Antibiotic prescription in emergency dental service in Zagreb, Croatia – a retrospective cohort study

Abstract

Objectives To analyse prescription of antibodies in emergency dental service according to antibiotic type, working diagnosis, patient visit time and patient demographic characteristics. Additionally, prescription practices among individual dentists were analysed. Methods The data in this retrospective cohort study were collected from electronic medical records and analyzed using descriptive statistics. Statistical analyses were conducted using the chi‐square test and the Z‐test with post‐hoc Bonferroni adjustment (α =0.05). Results The study covered 20,879 patient visits during a 1.5‐year period (from 1 June 2015 to 1 December 2016). Antibiotics were prescribed in 10,188 (48.8%) visits. In 6,202 (29.7%) visits, no dental treatment was performed and only an antibiotic was prescribed. The antibiotics most frequently prescribed were from the penicillin group and also contained clavulanic acid (70.5%); the second most frequently prescribed antibiotic was clindamycin (15.0%). The most common diagnoses for which an antibiotic was prescribed were acute apical abscess, pericoronitis and retained root; for these diagnoses, an antibiotic was prescribed in 79.8%, 64.3% and 63.3% of visits, respectively. Prescription of an antibiotic was significantly more frequent during Sundays and holidays (55.6% of visits) than during working days (33.2% of visits). Prescription of an antibiotic increased from the age of 1 towards the age of 75 and decreased thereafter. Female dentists prescribed antibiotics slightly but significantly (P < 0.001) more frequently than male dentists (50.8% and 46.8% of visits, respectively). High heterogeneity was observed among dentists regarding their criteria for prescribing antibiotics; individual dentists prescribed antibiotics in 15.0%–72.1% of the total number of visits. Conclusion Multiple possible issues in the prescription of antibiotics were observed, ranging from administration for inappropriate indications to noncritical and excessive prescription.

<p>Inappropriate Dental Antibiotic Prescriptions: Potential Driver of the Antimicrobial Resistance in Albaha Region, Saudi Arabia</p>

“…20 In contrast, no gender differences in prescribing dental antibiotics were found among Croatian and British Columbian patients. 8,21 Indeed, it might be a challenge to explain why gender differences in both dentists and patients influence antibiotic prescriptions in the present study. The data obtained in this study might not be sufficient to describe this difference.…”

“…Female dentists prescribed significantly more antibiotics than male dentists (30% and 28%, P = <0.0001, respectively). Likewise, Croatian female dentists prescribed significantly more antibiotics than male dentists (50.8% and 46.8%, P = <0.001, respectively), 8 while dentists' gender did not influence the prescription of antibiotics in the United States. 16 Moreover, our study concluded that male patients received significantly more antibiotics than female patients (36% and 25%, P = <0.0001, respectively).…”

“…Our findings revealed that the most commonly prescribed antibiotic is amoxicillin (56.3%), corroborating other national and international studies conducted in Saudi Arabia, the United States, Turkey, and Croatia, in which Amoxicillin was regarded as the first-choice antibiotic in dental consultations (60%, 61%, 67.8%, and 70.5%, respectively). 8,12,16,17 Moreover, in 32 cases, periodontists and oral surgeons prescribed amoxicillin in combination with amoxicillin/clavulanic acid for treating symptomatic apical periodontitis or acute apical abscess. However, no evidence has demonstrated any superior effectiveness of combining these two antibiotics for treating odontogenic infection.…”

“…3 Many studies have evaluated the prescription trend of dental antibiotics worldwide. [4][5][6][7][8][9] For instance, in the USA, it was found that dental practitioners and dentists prescribed more than 2.9 million antibiotics per year. 5 Moreover, a retrospective study in Croatia showed that antibiotics were prescribed during almost half of the dental emergency visits.…”

“…5 Moreover, a retrospective study in Croatia showed that antibiotics were prescribed during almost half of the dental emergency visits. 8 Similarly, in the UK, a retrospective cohort research revealed that dental antibiotics were prescribed during more than half of dental consultations. 9 These findings indicate a negative contribution of medical practitioners toward AMR and paucity of knowledge among the public over-the-counter availability of antibiotics as well as leftover antibiotic usage, which is the hallmark of low-and middle-income countries.…”