Measuring Antibiotic Stewardship Programmes and Initiatives: An Umbrella Review in Primary Care Medicine and a Systematic Review of Dentistry

Teoh, Leanne; Sloan, Alastair James; McCullough, Michael; Thompson, Wendy

doi:10.3390/antibiotics9090607

Cited by 16 publications

(18 citation statements)

References 41 publications

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“…Convenience sampling of clinicians will be through their membership of relevant societies or organisations (such as national dental associations) or through social media (Twitter). Convenience sampling of academic stakeholders will be through the FDI World Dental Federation early career researcher network [ 6 ], social media (Twitter) and authors with relevant publications in the field of dental antibiotic stewardship [ 10 ]. Adult patients and parent/carer participants will be recruited by convenience sampling through patient representative organisations, social media (Twitter) and via members of the steering group.…”

Section: Methodsmentioning

confidence: 99%

“…A long-list of candidate outcomes for inclusion in the consensus exercise has been produced (see Table 1 ) based on findings of previously published studies [ 10 – 12 ] and structured according to a review evaluating antimicrobial stewardship interventions across healthcare [ 13 ]. Additional items for inclusion in the long-list were identified by the study steering group.…”

Section: Methodsmentioning

confidence: 99%

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Dental antibiotic stewardship: study protocol for developing international consensus on a core outcome set

Thompson

Teoh

Pulcini

et al. 2022

Trials

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Background Antimicrobial resistance is both a global public health and patient safety problem driven by overprescribing of antibiotic and other antimicrobial drugs. To conserve the effectiveness of antibiotics for future generations, antibiotic stewardship approaches to using them only where appropriate and necessary are advocated. Dentistry accounts for about 10% of antibiotic prescriptions across global healthcare, with 80% not in accordance with guidance in some countries. Core outcome sets enable the results of studies to be compared in order to maximise the value which can be derived from them. The aim of this study is to develop an international consensus on a core outcome set for dental antibiotic stewardship. Methods Consensus on outcomes which are critical for inclusion in the core outcome set for dental antibiotic stewardship will be sought through two rounds of a Delphi survey (using the DelphiManager online system) followed by a final online consensus meeting. Thirty participants will be recruited to the Delphi Panel from across three stakeholder groups: ten dentists, ten academics and ten adults experienced with dental antibiotics as either a patient or parent/carer of a patient who has been prescribed them. Consensus will be achieved if more than 70% of the panel agree that an outcome is critical, with at least one from each stakeholder group in agreement. A long-list of candidate core outcomes has been developed from previously published studies with additions recommended by the steering group. The steering group will oversee development of the core outcome set and includes people from around the world with experience of dental antibiotics: clinicians, researchers and people with experience of being prescribed dental antibiotics and/or surviving an antibiotic resistant infection. Discussion To date, few studies of dental antibiotic stewardship have been published. Internationally, dental antibiotic guidelines and patterns of use vary widely, so a core outcome set is particularly important to facilitate meaningful comparisons between studies. This core outcome set will encompass antibiotic prescribing for both therapeutic indications, such as for people with acute infections, and for prophylactic indications, such as the prevention of distant site infections (like infective endocarditis) following dental procedures.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Dental antibiotic stewardship: study protocol for developing international consensus on a core outcome set

Thompson

Teoh

Pulcini

et al. 2022

Trials

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“…[ 18 19 20 21 ] Inadvertent and extravagant use of antibiotics not just leads to substantially added economic burden but also contributes to antimicrobial resistance (AMR). [ 22 23 ]…”

Section: Discussionmentioning

confidence: 99%

Oral pain and infection control strategies for treating children and adolescents in India

Kaul¹,

Hs²,

Talwar³

et al. 2021

Journal of Family Medicine and Primary Care

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Introduction: Oral and dental health form an integral part of complete well being of an individual and society at large. Promoting oral health and societal progression go hand in hand. Aim: To investigate dentists' attitudes about pain and infection control while treating children and adolescents by assessing their recommendations of pre- and postoperative analgesics and antibiotics, and use of local anesthesia (LA) for definitive treatment in different clinical scenarios. Materials and Method: A total of 400 dentists, both general dental practitioners (GDPS) as well as specialist dentists, were surveyed over a period of 2 months by using a pre-tested close-ended questionnaire. The data was statistically analyzed using Pearson's Chi-square test and backward logistic regression analysis for analysis of categorical variables and independent variables, respectively. Level of significance was set at 5%. Results: It was found that there was a gross overuse of antibiotics and analgesics and under use of LA by GDPs compared to specialist dentists. Postoperative antibiotics and analgesics were used more commonly than preoperative antibiotics and analgesics. These strategies were used more often in permanent teeth than primary teeth except the use of LA, which was used with equal frequency in both primary as well as permanent dentition. Conclusion: Dependence on antibiotics and analgesics for achieving pain and infection control in children has to be minimized and focus has to be shifted on judicious definitive treatment involving use of LA, aseptic techniques, and behavior management techniques.

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“…37 A systematic review of metrics for evaluating antibiotic stewardship programs across primary health care revealed that dental studies focused solely on rates of antibiotic prescribing, whereas a wider set of outcomes, such as adverse outcomes and patient satisfaction, were employed in other primary healthcare settings. 38 Further research to develop international consensus for a set of dental antibiotic stewardship core outcomes is needed.…”

Section: Updating and Implementing National Guidelinesmentioning

confidence: 99%

Patterns of dental antibiotic prescribing in 2017: Australia, England, United States, and British Columbia (Canada)

Thompson¹,

Teoh²,

Hubbard³

et al. 2021

Infect. Control Hosp. Epidemiol.

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Objective: Our objective was to compare patterns of dental antibiotic prescribing in Australia, England, and North America (United States and British Columbia, Canada). Design: Population-level analysis of antibiotic prescription. Setting: Outpatient prescribing by dentists in 2017. Participants: Patients receiving an antibiotic dispensed by an outpatient pharmacy. Methods: Prescription-based rates adjusted by population were compared overall and by antibiotic class. Contingency tables assessed differences in the proportion of antibiotic class by country. Results: In 2017, dentists in the United States had the highest antibiotic prescribing rate per 1,000 population and Australia had the lowest rate. The penicillin class, particularly amoxicillin, was the most frequently prescribed for all countries. The second most common agents prescribed were clindamycin in the United States and British Columbia (Canada) and metronidazole in Australia and England. Broad-spectrum agents, amoxicillin-clavulanic acid, and azithromycin were the highest in Australia and the United States, respectively. Conclusion: Extreme differences exist in antibiotics prescribed by dentists in Australia, England, the United States, and British Columbia. The United States had twice the antibiotic prescription rate of Australia and the most frequently prescribed antibiotic in the US was clindamycin. Significant opportunities exist for the global dental community to update their prescribing behavior relating to second-line agents for penicillin allergic patients and to contribute to international efforts addressing antibiotic resistance. Patient safety improvements will result from optimizing dental antibiotic prescribing, especially for antibiotics associated with resistance (broad-spectrum agents) or C. difficile (clindamycin). Dental antibiotic stewardship programs are urgently needed worldwide.

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Measuring Antibiotic Stewardship Programmes and Initiatives: An Umbrella Review in Primary Care Medicine and a Systematic Review of Dentistry

Cited by 16 publications

References 41 publications

Dental antibiotic stewardship: study protocol for developing international consensus on a core outcome set

Dental antibiotic stewardship: study protocol for developing international consensus on a core outcome set

Oral pain and infection control strategies for treating children and adolescents in India

Patterns of dental antibiotic prescribing in 2017: Australia, England, United States, and British Columbia (Canada)

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