Antimicrobial prescribing by dentists in Wales, UK: findings of the first cycle of a clinical audit

Abstract

Objective To describe the findings of the first cycle of a clinical audit of antimicrobial use by general dental practitioners (GDPs).Setting General dental practices in Wales, UK.Subjects and methods Between April 2012 and March 2015, 279 GDPs completed the audit. Anonymous information about patients prescribed antimicrobials was recorded. Clinical information about the presentation and management of patients was compared to clinical guidelines published by the Scottish Dental Clinical Effectiveness Programme (SDCEP).Results During the data collection period, 5,782 antimicrobials were prescribed in clinical encounters with 5,460 patients. Of these 95.3% were antibiotic preparations, 2.7% were antifungal agents, and 0.6% were antivirals. Of all patients prescribed antibiotics, only 37.2% had signs of spreading infection or systemic involvement recorded, and 31.2% received no dental treatment. In total, 79.2% of antibiotic, 69.4% of antifungal, and 57.6% of antiviral preparations met audit standards for dose, frequency, and duration. GDPs identified that failure of previous local measures, patient unwillingness or inability to receive treatment, patient demand, time pressures, and patients' medical history may influence their prescribing behaviours.Conclusions The findings of the audit indicate a need for interventions to support GDPs so that they may make sustainable improvements to their antimicrobial prescribing practices.

Perceptions, attitudes and factors that influence prescribing by general dentists in Australia: A qualitative study

“…Participants’ choice of amoxicillin as first line for an odontogenic infection is less appropriate than PMP since its wider spectrum will contribute more towards the development of antibiotic resistance . This preferential use of amoxicillin by dentists is a worldwide phenomenon, confirmed from longitudinal studies, surveys, analysis of clinical records and prospective audits . Studies on the susceptibility of bacteria commonly isolated from odontogenic infections show that 85% are susceptible to PMP, with amoxicillin only slightly higher at 91% .…”

An evaluation of dental antibiotic prescribing practices in the United States

“…16, 25 Other important factors include failure of previous operative treatment, shortage of clinical time, and patient pressure. 21, 26 …”

Knowledge and attitudes of recently qualified dentists working in Wales towards antimicrobial prescribing and resistance

“…There is evidence that shorter-regimes, high-doses of dental antimicrobials may result in adequate clinical outcomes yet reduce the pressure of resistance. 21,22 However, a lack of awareness of this amongst newly qualified practitioners may potentially be resulting in longer courses of these agents being prescribed, 10 contributing to the development of antimicrobial resistance.…”

“…However, it has become apparent that these drugs are being issued when they are not always necessary . Even if the prescription of the antimicrobial is justified by the clinical situation, the correct agent, dose and duration prescribed are commonly unsuitable . These inappropriate prescribing behaviours may be due to a poor understanding of the appropriate use of these agents.…”