Antibiotic Prophylaxis Prescribing Practices of Dentists in Singapore

Background: Infective endocarditis (IE), although rare, is a serious complication which results in significant morbidity and mortality in susceptible patients. The guidelines for antibiotic prophylaxis have recently been updated by the American Heart Association (2007) and National Institute for Health and Clinical Excellence (2008). The applicability of these revised recommendations has been evaluated and reported in the United States (US), Canada, Europe and United Kingdom (UK) and there appears to be wide variations in antibiotic prophylaxis administration strategies among health care providers.  Presently, details regarding the antibiotic prophylaxis prescribing practices among dentists in Singapore are unknown. 

Objectives: To determine the specific antibiotic prophylaxis prescribing practices of all dentists in Singapore with regards to the prevention of infective endocarditis.

Methods: Antibiotic prophylaxis prescribing practices of dentists in Singapore were evaluated via a questionnaire which was sent through an email link, as well as by postal mail. Statistical analysis was carried out using SPSS (ver 19).

Results: Responses were received from 458 (35%) dentists, of which 272 were general practitioners. The majority of respondents (40%) followed the AHA 2007 guidelines and 30% followed cardiologists’ recommendations. Majority of dentists were knowledgeable on the type of dental procedures which could cause bacteraemia. The results demonstrated that dentists also prescribed antibiotic prophylaxis for patients with cardiac conditions not known to be at risk from dental procedures. About 37.2% of general dental practitioners versus 54.3% of specialists also additionally consult the cardiologist regarding the patients’ need for antibiotic prophylaxis. 82.8% of respondents felt that developing a local guideline would be beneficial to the local dental community.

Conclusions: There is a lack of uniformity in the antibiotic prophylaxis prescribing practices of dentists in Singapore. It may be helpful to attain a consensus among local cardiologists and dentists to unify the antibiotic prophylaxis prescription practices in Singapore.