Methods: ADA members were invited to participate via e-mail in an anonymous web-based survey about preferred antibiotics, prescribing rationale, conditions warranting prescription, utilisation of microbiological diagnostic services, awareness of professional guidelines, and views on antibiotic resistance.
Results: Seventy responses from 1,289 invitations were received for the first month of the survey. The mean age of respondents was 45 years and the majority (84%) were non-specialists. Amoxycillin was the most frequently prescribed antibiotic (65%) with clindamycin (54%) being the preferred alternative for patients with penicillin allergy; dosage varied and duration ranged from 5 to 7 days. Over 80% of clinicians routinely prescribed for facial cellulitis or gross swelling. Other conditions warranting a prescription included acute necrotising ulcerative gingivitis (60%), periodontal abscesses (36%), and bacterial sialadenitis (22%). Some dentists prescribed antibiotics for localised swellings, fungal infections, pericoronitis, dry sockets, and various endodontic conditions. Overall, 11% prescribed antibiotics daily while 8% averaged ≥5 prescriptions/week. Reasons for prescribing were primarily based on presenting symptoms and time pressures. The majority of clinicians (97%) had rarely utilised microbiological diagnostic services with turn-around-time being the main deterrent. While responders were unanimously concerned about inappropriate prescribing, 85% felt that dentists contributed minimally towards antibiotic resistance.
Conclusions: This survey demonstrated moderate adherence to professional guidelines for prescribing antibiotics. There was a heavy reliance on moderate- and broad-spectrum antibiotics, and antibiotics were being prescribed for conditions for which they are contra-indicated. There was little use based on laboratory diagnostics, perceived as impractical; the lack of adherence to guidelines around prophylactic and empirical use led to variance in antibiotic prescription. The main limitation of this study is non-response bias as responders are unlikely to be representative of all survey invitees. Joel Tan was supported by an ADRF Trebitsch Research Grant.