US Trends In Antibiotic Prescription By Dentists, 2002-2017
Objectives: Overuse or misuse of antibiotics can lead to antibiotic resistance. Improving prescription practices in terms of antibiotic type or duration is vital, and assessing current trends in antibiotic prescriptions is one component of improving dental prescription practices.
Methods: Dental-visit-associated antibiotic prescription rates were calculated from all years available (2002 – 2017) using Medical Expenditure Panel Survey data (n=531,415). Duration data was available from 2010-17 for 66.1% of prescriptions, and was categorized as ≤1 day, 2-4 days, or ≥5 days. Those aged <18 years were excluded to avoid confusion due to pediatric weight-based antibiotic dosing. SAS 9.4 was used to adjust rates and standard errors for the complex survey design. Joinpoint 188.8.131.52 was used to calculate time trends in rates of dental-associated antibiotic prescription and test whether there were statistically significant (α=0.05) change points in trends.
Results: From 2002-17, total annual dental antibiotic prescribing rate decreased 1.06 prescriptions/1,000 adults (slope t-test p-value<0.001) with no significant breaks in the trend (permutation test p-value: 0.2), from a high of 44.0/1,000 adults in 2003 to 17.9/1,000 in 2017. From 2010 to 2014 there was a non-significant increase from 2010-14 (slope: 0.85, p-value: 0.4), a significant change in slope (permutation test p-value: 0.04), then a non-significant decrease (slope: -3.52, p-value: 0.09) in the average rate of antibiotics prescribed for ≥5 days by dentists. In contrast, the rates of antibiotics prescribed for ≤1 days (slope: 0.07, p-value<0.0001), or 2-4 days (slope: 0.03, p-value: 0.1) trended upward between 2010-17.
Conclusions: Based on this sample designed to be nationally representative of the US, antibiotic prescribing by dentists has significantly declined in the last 15 years. Prescriptions for <5 days are a minority of dental antibiotic prescriptions, but increased since 2010. Further evaluation of temporal trends in prescribing by dentists should continue as antibiotic prescribing policies and recommendations evolve.