Antibiotic Prescribing Variation by Dental Specialty, Procedure, and Time

Objectives: Appropriate antibiotic prescribing is essential to treat or avoid infection without contributing to the spread of antibiotic resistance. The National Action Plan for Combating Antibiotic-Resistant Bacteria was issued by the Federal Government in March 2015 in response to a September 2014 Presidential Executive Order. This study describes antibiotic prescribing patterns in the dental profession, and evaluates whether these patterns have changed since the National Action Plan was issued.
Methods: The Medical Expenditure Panel Survey (MEPS) provides nationally representative estimates of health care use in the civilian non-institutionalized US population. Antibiotic fills of prescription from dentists by respondents with at least one dental event in 2014-2015 were analyzed by dental specialty, dental procedure, antibiotic, and year, using chi-square tests with alpha set at 0.05.
Results: From 2014 to 2015, the number antibiotics prescriptions from dentists fell 14%, from 11.04 million to 9.47 million (t-test p value <0.001). This 14% decrease change was primarily driven by the significant decrease in antibiotic prescriptions from general dentists, to whom 56.3% of dental visits are made. The proportion of dentists prescribing antibiotics remained statistically similar for most dental specialties. The proportion of procedures associated with an antibiotic prescription decreased or remained statistically similar for all procedure types except periodontal scaling, root planing, or gum surgery, which increased from 38.4% to 55.1% (X² p value <0.001). The antibiotic most commonly prescribed by dentists in both years was amoxicillin (58.9%), followed by azithromycin (11.7%), penicillin (10.3%), and clindamycin (8.7%).
Conclusions: As estimated using MEPS data, dental prescriptions for antibiotics has significantly decreased between 2014 and 2015. Examining infection rates in this same time period may further understanding of the efficacy of antibiotic use in dentistry and support efforts for developing appropriate antibiotic prescribing guidance.