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

Abstract

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.

Antibiotic susceptibility patterns of viridans group streptococci isolates in the United States from 2010 to 2020

“…The ∼10% decrease in clindamycin susceptibility we observed between 2010 and 2020 among VGS isolates is also concerning since this agent is sometimes prescribed empirically by dentists to treat odontogenic infections, which can be caused by VGS. 18 There are at least two potential explanations for the change in susceptibility over time: (i) the MICs of these drugs within VGS isolates are increasing (i.e. increased prevalence of resistance mechanisms); and (ii) the prevalence of more resistant VGS species is increasing among VGS isolates tested in VA Medical Centers.…”

Quantifying the Gap between Expected and Actual Rates of Antibiotic Prescribing in British Columbia, Canada

“…The overprescribing reported is not related to dental practitioners but rather physicians treating dental conditions—as further indicated by the reduced number of overall physician visits for dental conditions in comparison to other indications. However, inappropriate antibiotic use in the treatment of dental conditions, in both community and emergency settings, has been well documented across BC, the United States, the United Kingdom, as well as Australia [ 18 , 19 , 20 ]. Patients with inadequate dental insurance coverage might disproportionately seek care from physicians to treat dental conditions, resulting in the overuse of antibiotics offsetting under-pursued surgical interventions.…”

Tackling antimicrobial resistance in practice: dental students’ evaluation of university teaching supplemented by an online course

“…Dentists are responsible for 7.2% of antimicrobial prescribing in primary care in Scotland, 2 which is comparable with other parts of the UK and other high income countries. 3 It has been suggested that as much as 80% of antibiotic prescribing by dentists may be inappropriate, 4 , 5 therefore action to ensure effective antimicrobial stewardship (AMS) in this setting is important. 6 Dental infections are readily amenable to procedures, such as tooth extraction, to remove the source of the infection and antibiotics are only usually necessary as an adjunct in the presence of systemic signs and symptoms of spreading infection.…”

“…Ongoing education is required to ensure optimal management of dental infections (which usually involves a procedure such as extractions or root canal treatment rather than prescription of antibiotics) and prophylactic prescribing in accordance with local guidelines. 3 , 9–12 Studies have demonstrated that targeted education is an effective strategy to tackle AMR by improving dental prescribing, knowledge and confidence. 13 , 14 Universities offering dental training are well positioned to promote positive behaviour in relation to AMS by integrating stewardship training in undergraduate programmes.…”