Antibiotic prophylaxis in dentistry: part I. A qualitative study of professionals' views on the NICE guideline

Abstract

Clinicians anticipated difficulties in explaining to patients the change in clinical practice necessitated by adherence to the NICE guidance, most notably for patients with a history of infective endocarditis or where the patient's cardiologist did not agree with the NICE guidance. They placed particular emphasis on the provision of accurate information in order to reassure patients.

Antibiotic’s effectiveness after erupted tooth extractions: A retrospective study

“…Antibiotic resistance driven by antibiotic misuse is considered a world public issue, which is deemed to be among one of the most severe world health problems according to the reports from the Centers for Disease, Control and Prevention (Centers for Disease Control & Prevention, 2019; Dayer, Chambers, Prendergast, Sandoe, & Thornhill, 2013; Fleming‐Dutra et al, 2016; Gutschik & Lippert, 1990; Khouly, Braun, & Chambrone, 2019; Soheilipour et al, 2011). It has been estimated that up to 30% of prescribed antibiotics are unnecessary (Fleming‐Dutra et al, 2016; Khalil, Hultin, Fred, Olsson, & Lund, 2015; Soheilipour et al, 2011). Among dentists, there is a lack of consensus about antibiotic prescription (Khouly et al, 2019); in addition, one of the most recent reviews on the use of antibiotics in dentistry (Marchionni et al, 2017) has pointed out that for simple tooth extractions the use of antibiotics could increase the risks of the medication's adverse effects without significantly preventing postoperative complications.…”

“…Above all, it turned out that dentists frequently prescribed antibiotics in medically compromised patients, who—according to the current guidelines—no longer need antibiotic prophylaxis (Colterjohn, Beer, Petruccelli, Zabtia, & Winemaker, 2014; Dar‐Odeh, Fadel, Abu‐Hammad, Abdeljawad, & Abu‐Hammad, 2018; Dayer et al, 2013; Khouly et al, 2019). What is even more peculiar is that some authors identified non‐clinical factors—such as pressure from the patient or the family physician—that could influence the dentists in prescribing antibiotics (Dayer et al, 2013; Soheilipour et al, 2011). This underlined not only inadequate knowledge among dentists, but also an insufficient awareness or a slow adherence to the guidelines among physicians (Dar‐Odeh et al, 2018; Habib et al, 2015).…”

A not very NICE case of endocarditis

“…Of interest, we note a recent letter in the British Dental Journal highlighting a small qualitative study of dentists within the NHS who felt obliged to follow NICE guidelines, despite over half believing that the American Heart Association guidelines would be more beneficial for their patients 9 10. According to the study, some dentists felt the need to comply with the NICE guidelines, despite their clinical judgement that certain patients warranted antibiotic prophylaxis, out of concern that their actions would be questioned as being against current guidelines.…”

Communicating new policy on antibiotic prophylaxis with patients: a randomised controlled trial

“…Studies investigating attitudes on implementation of the new NICE guideline revealed various levels of concern among patients. 10,11 Clear information concerning the reason for the changes in current practice is necessary to be communicated effectively for patient reassurance.…”

“…Earlier qualitative studies 10,12 by the researchers revealed that cardiologists and dentists were the professional groups who patients would mostly believe. In this study the information about the change in antibiotic prophylaxis based on the NICE guideline and the relevant evidence were communicated with patients through two different methods: leaflet (written information) and leaflet plus videotape (watching a dialogue given by a consultant in special care dentistry about the new guideline).…”