Colin C Hubbard1, Charlesnika T Evans2, Gregory S Calip3, Jifang Zhou4, Susan A Rowan5, Katie J Suda6. 1. Division of Hospital Medicine, Department of Medicine, University of California San Francisco, San Francisco, California. 2. Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, Illinois; Department of Preventive Medicine, Center for Health Services and Outcomes Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. 3. College of Pharmacy, University of Illinois Chicago, Chicago, Illinois. 4. School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China. 5. College of Dentistry, University of Illinois Chicago, Chicago, Illinois. 6. Schools of Medicine and Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania. Electronic address: ksuda@pitt.edu.
Abstract
INTRODUCTION: Prescribing antibiotic prophylaxis is common yet unnecessary for many dental visits. In this analysis, our objective was to assess whether the appropriateness of antibiotic prophylaxis has improved over time. METHODS: A retrospective cohort study was conducted using dental visits from 2016 to 2018 (data analyzed in 2021) using medical and prescriptions claims data of patients from the U.S. with commercial dental insurance. Antibiotic prophylaxis was defined as a ≤2 days' supply prescription dispensed within 7 days before a dental visit. Appropriateness of prophylaxis was defined on the basis of the manipulation of the gingiva/tooth periapex or oral mucosa perforation in patients with appropriate cardiac diagnoses. Associations between patient and visit characteristics and appropriateness of antibiotic prophylaxis were assessed using multiple Poisson regression. RESULTS: Unnecessary antibiotic prophylaxis was highly prevalent in this cohort, ranging from 77.0% in 2016 to 78.5% in 2018. In the adjusted analysis, factors associated with unnecessary antibiotic prophylaxis included younger age, female sex, geographic region, rurality, type of antibiotic, and certain dental procedures. The factors associated with the highest risk of unnecessary prophylaxis in the adjusted analysis were orthodontic procedures and having a history of a prosthetic joint. Notably, the risk of unnecessary antibiotic prophylaxis decreased over time in the adjusted analysis. CONCLUSIONS: Unnecessary prescription of antibiotic prophylaxis by dentists continues to be common. Antimicrobial stewardship strategies are needed to improve prescribing by dentists.
INTRODUCTION: Prescribing antibiotic prophylaxis is common yet unnecessary for many dental visits. In this analysis, our objective was to assess whether the appropriateness of antibiotic prophylaxis has improved over time. METHODS: A retrospective cohort study was conducted using dental visits from 2016 to 2018 (data analyzed in 2021) using medical and prescriptions claims data of patients from the U.S. with commercial dental insurance. Antibiotic prophylaxis was defined as a ≤2 days' supply prescription dispensed within 7 days before a dental visit. Appropriateness of prophylaxis was defined on the basis of the manipulation of the gingiva/tooth periapex or oral mucosa perforation in patients with appropriate cardiac diagnoses. Associations between patient and visit characteristics and appropriateness of antibiotic prophylaxis were assessed using multiple Poisson regression. RESULTS: Unnecessary antibiotic prophylaxis was highly prevalent in this cohort, ranging from 77.0% in 2016 to 78.5% in 2018. In the adjusted analysis, factors associated with unnecessary antibiotic prophylaxis included younger age, female sex, geographic region, rurality, type of antibiotic, and certain dental procedures. The factors associated with the highest risk of unnecessary prophylaxis in the adjusted analysis were orthodontic procedures and having a history of a prosthetic joint. Notably, the risk of unnecessary antibiotic prophylaxis decreased over time in the adjusted analysis. CONCLUSIONS: Unnecessary prescription of antibiotic prophylaxis by dentists continues to be common. Antimicrobial stewardship strategies are needed to improve prescribing by dentists.
Authors: Michael P Rethman; William Watters; Elliot Abt; Paul A Anderson; Karen C Carroll; Richard Parker Evans; Harry C Futrell; Kevin Garvin; Stephen O Glenn; Michael J Goldberg; John Hellstein; Angela Hewlett; David Kolessar; Calin Moucha; Richard J O' Donnell; Douglas R Osmon; John O' Toole; Anthony Rinella; Mark J Steinberg; William Robert Martin; Deborah S Cummins; Sharon Song; Patrick Sluka; Kevin Boyer; Anne Woznica; Helen Ristic; Nicholas Buck Hanson Journal: J Bone Joint Surg Am Date: 2013-04-17 Impact factor: 5.284
Authors: Walter Wilson; Kathryn A Taubert; Michael Gewitz; Peter B Lockhart; Larry M Baddour; Matthew Levison; Ann Bolger; Christopher H Cabell; Masato Takahashi; Robert S Baltimore; Jane W Newburger; Brian L Strom; Lloyd Y Tani; Michael Gerber; Robert O Bonow; Thomas Pallasch; Stanford T Shulman; Anne H Rowley; Jane C Burns; Patricia Ferrieri; Timothy Gardner; David Goff; David T Durack Journal: Circulation Date: 2007-04-19 Impact factor: 29.690
Authors: Wendy Thompson; Leanne Teoh; Colin C Hubbard; Fawziah Marra; David M Patrick; Abdullah Mamun; Allen Campbell; Katie J Suda Journal: Infect Control Hosp Epidemiol Date: 2021-04-05 Impact factor: 6.520
Authors: Katie J Suda; Gregory S Calip; Jifang Zhou; Susan Rowan; Alan E Gross; Ronald C Hershow; Rose I Perez; Jessina C McGregor; Charlesnika T Evans Journal: JAMA Netw Open Date: 2019-05-03
Authors: Alan E Gross; Danny Hanna; Susan A Rowan; Susan C Bleasdale; Katie J Suda Journal: Open Forum Infect Dis Date: 2019-02-13 Impact factor: 3.835