Antibiotic prescribing by dentists has increased. Why?
Sammanfattning
Background - Although the overall rate of antibiotic prescribing has been declining in British
Columbia, Canada, the authors conducted a study to explain the increased rate of prescribing by
dentists. Methods - The authors obtained anonymized, line-listed data on outpatient prescriptions
from 1996 to 2013 from a centralized, population-based prescription database, including a variable
coding prescriber licensing body. Analyses used Anatomical Therapeutic Classification standard
codes and defined daily dose (DDD) values. The authors normalized prescribing rates to the
population and expressed the rates in DDDs per 1,000 inhabitants per day (DID). The Canadian
Dental Association released a webinar that invited correspondence from dentists about the drivers of
the trend. Results - From 1996 to 2013, overall antibiotic use declined from 18.24 DID to 15.91 DID,
and physician prescribing declined 18.2%, from 17.25 DID to 14.11 DID. However, dental prescribing
increased 62.2%, from 0.98 DID to 1.59 DID, and its proportionate contribution increased from 6.7% to
11.3% of antibiotic prescriptions. The rate of prescribing increased the most for dental patients 60
years or older. Communication from dentists in Canada and the United States identified the following
explanatory themes: unnecessary prescriptions for periapical abscess and irreversible pulpitis;
increased prescribing associated with dental implants and their complications; slow adoption of
guidelines calling for less perioperative antibiotic coverage for patients with valvular heart disease
and prosthetic joints; emphasis on cosmetic practices reducing the surgical skill set of average
dentists; underinsurance practices driving antibiotics to be a substitute for surgery; the aging
population; and more dental registrants per capita. Conclusions - Emerging themes for dental
prescribing should be explored further in future studies; however, themes already identified may
guide priorities in antibiotic stewardship for continuing dental education sessions.