Appropriateness of Antibiotic Prescription for Emergency Dental Care in Kuwait

Objectives: Systemic antibiotics may be indicated for the management of acute dental conditions, but they must be used judiciously to reduce the chance for undesirable side effects. The aim of this study was to examine the frequency of antibiotic prescription in emergency dental clinics in Kuwait and to assess the appropriateness of such prescription. Methods: For all cases of adult patients presenting for emergency dental care at the three major emergency dental clinics in Kuwait (at Amiri, Adan, and Mubarak hospitals) during a 30-day period, the patient's chief complaint, diagnosis, and treatment provided were recorded, along with antibiotic prescription, if any. The appropriateness of antibiotic use in each clinical situation was assessed by 6 specialists (2 each in oral surgery, endodontics, and periodontics) and was divided into indicated/maybe indicated or not indicated based on their consensus. Descriptive statistics and univariate analyses were used for presentation of the data. Results: Antibiotics were prescribed for 38.8% (500/1291) of all patients. The most commonly prescribed antibiotic was amoxicillin (47.6%), followed by metronidazole alone or in combination with other antibiotics (37.4%). Antibiotic prescription was not indicated for 51% of the cases that received such prescription, and included cases of reversible and irreversible pulpitis or pulp necrosis (17.8%) and chronic periodontits/gingivitis (5.8%). Furthermore, 33.8% of cases where antibiotics were prescribed received no other treatment. Patients receiving antibiotic prescription were significantly older than other patients (32.4±11.1 vs. 30.7±10.1 years; p<0.01), while no significant differences were found in gender. Conclusions: Systemic antibiotics are prescribed inappropriately for a significant portion of dental emergency cases in Kuwait, and in many situations, without the provision of other necessary therapeutic interventions. Review of the guidelines of proper antibiotic use in emergency dental care by the prescribing dentists appears to be needed.