Evaluation of Antibiotic Prescribing Practices at University-Affiliated Dental Clinics.

Objectives: Evaluate antibiotic prescribing in dental clinics as part of a multi-center CDC stewardship
study with the goal of improving antibiotic prescribing practices in dentistry.
Methods: Cross-sectional study of patients (10/1/2014 to 9/30/2016) at 3 University of Utah (UU)
Dental clinics. Antibiotic prescriptions (ABX) and Current Dental Terminology (CDT) codes were linked
with UU medical records. ABX defined as prescriptions written the same day as the dental procedure.
Prophylaxis prescriptions defined as ABX with directions consistent with pre-procedure one-time doses.
CDT codes included those entered on or within 60 days after the dental encounter. Allergy, comorbidity
and outcome data were extracted from linked medical records defined as those receiving medical care
at UU within the past two years. We assessed ABX rates, commonly prescribed agents, frequency of
documented beta-lactam allergies, duration of therapy and procedure-associated ABX based on CDT
codes. Frequency of prescriptions written as prophylaxis and frequency of cardiac indications for preprocedure
antibiotic prophylaxis and other potential indicators of prophylaxis (e.g., prosthetic
joint/immunosuppression), Clostridioides difficile infection (CDI), hospital admission, ED/urgent care
visits, and allergic adverse events were evaluated.
Results: 1683 (6.1%) encounters included ABX with a prescribing rate of 61.3/1000 visits.
Aminopenicillins were the most commonly prescribed ABX class [70.8% (1212/1712)]. 10% (168/1683) of
ABX were consistent with pre-procedure prophylaxis, of which 13.7% (23/168) had cardiac indications
for endocarditis prophylaxis. The average duration of non-prophylactic prescriptions was 8.3 days.
Antibiotic prescribing was common with implants and highest in oral surgery procedures. Subsequent
CDI was more common after ABX.
Conclusions: The majority of ABX with dental encounters were not consistent with pre-procedure
prophylaxis and were for long durations. Given complications associated with dental ABX, a better
understanding of ABX indications and the non-standard use of infection prophylaxis are needed to drive
antibiotic stewardship in dentistry.