Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-25T08:15:19.908Z Has data issue: false hasContentIssue false
  • English
  • Français

Concordance of antibiotic prescribing with the American Dental Association acute oral infection guidelines within Veterans’ Affairs (VA) dentistry

Published online by Cambridge University Press:  02 March 2021

Daniel B. Carlsen ,
Michael J. Durkin ,
Gretchen Gibson ,
M. Marianne Jurasic ,
Ursula Patel ,
Linda Poggensee ,
Margaret A. Fitzpatrick ,
Kelly Echevarria ,
Jessina McGregor  and
Charlesnika T. Evans
...Show all authors
Daniel B. Carlsen
Affiliation:
Pharmacy Department, Edward Hines Jr, Veterans’ Affairs (VA) Hospital, Hines, Illinois
Michael J. Durkin
Affiliation:
Washington University School of Medicine, St Louis, Missouri
Gretchen Gibson
Affiliation:
Oral Health Quality Group, Veterans’ Health Care System of the Ozarks, Fayetteville, Arkansas
M. Marianne Jurasic
Affiliation:
VA Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans’ Hospital, Bedford, Massachusetts Boston University Henry M Goldman School of Dental Medicine, Boston, Massachusetts
Ursula Patel
Affiliation:
Pharmacy Department, Edward Hines Jr, Veterans’ Affairs (VA) Hospital, Hines, Illinois
Linda Poggensee
Affiliation:
Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr, VA Hospital, Hines, Illinois
Margaret A. Fitzpatrick
Affiliation:
Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr, VA Hospital, Hines, Illinois Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
Kelly Echevarria
Affiliation:
VA Pharmacy Benefits Management Services, San Antonio, Texas
Jessina McGregor
Affiliation:
College of Pharmacy, Oregon State University, Corvallis, Oregon Portland State University School of Public Health, Oregon Health and Science University, Portland, Oregon VA Portland Health Care System, Portland, Oregon
Charlesnika T. Evans
Affiliation:
Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr, VA Hospital, Hines, Illinois Northwestern University Feinberg School of Medicine, Chicago, Illinois
Katie J. Suda*
Affiliation:
Center for Health Equity Research and Promotion, VA Pittsburgh Health Care System, Pittsburgh, Pennsylvania Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
*
Author for correspondence: Katie Suda, PharmD, MS, FCCP, 3609 Forbes Ave, Suite 2, Pittsburgh, PA15213. E-mail: [email protected]; [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

United States dentists prescribe 10% of all outpatient antibiotics. Assessing appropriateness of antibiotic prescribing has been challenging due to a lack of guidelines for oral infections. In 2019, the American Dental Association (ADA) published clinical practice guidelines (CPG) on the management of acute oral infections. Our objective was to describe baseline national antibiotic prescribing for acute oral infections prior to the release of the ADA CPG and to identify patient-level variables associated with an antibiotic prescription.

Design:

Cross-sectional analysis.

Methods:

We performed an analysis of national VA data from January 1, 2017, to December 31, 2017. We identified cases of acute oral infections using International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) codes. Antibiotics prescribed by a dentist within ±7 days of a visit were included. Multivariable logistic regression identified patient-level variables associated with an antibiotic prescription.

Results:

Of the 470,039 VA dental visits with oral infections coded, 12% of patient visits with irreversible pulpitis, 17% with apical periodontitis, and 28% with acute apical abscess received antibiotics. Although the median days’ supply was 7, prolonged use of antibiotics was frequent (≥8 days, 42%–49%). Patients with high-risk cardiac conditions, prosthetic joints, and endodontic, implant, and oral and maxillofacial surgery dental procedures were more likely to receive antibiotics.

Conclusions:

Most treatments of irreversible pulpitis and apical periodontitis cases were concordant with new ADA guidelines. However, in cases where antibiotics were prescribed, prolonged antibiotic courses >7 days were frequent. These findings demonstrate opportunities for the new ADA guidelines to standardize and improve dental prescribing practices.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 12 , December 2021 , pp. 1422 - 1430
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Suda, KJ, Hicks, LA, Roberts, RM, Hunkler, RJ, Matusiak, LM, Schumock, GT. Antibiotic expenditures by medication, class, and healthcare setting in the United States, 2010–2015. Clin Infect Dis 2018;66:185–190.CrossRefGoogle ScholarPubMed
Hicks, LA, Bartoces, MG, Roberts, RM, et al. US outpatient antibiotic prescribing variation according to geography, patient population, and provider specialty in 2011. Clin Infect Dis 2015;60:1308–1316.Google ScholarPubMed
Suda, KJ, Roberts, RM, Hunkler, RJ, Taylor, TH. Antibiotic prescriptions in the community by type of provider in the United States, 2005–2010. J Am Pharm Assoc (2003) 2016;56:621–621.e1.CrossRefGoogle ScholarPubMed
Durkin, MJ, Hsueh, K, Sallah, YH, et al. An evaluation of dental antibiotic prescribing practices in the United States. J Am Dent Assoc 2017;148:878–886.e1.CrossRefGoogle ScholarPubMed
Antibiotic resistance threats in the United States, 2013. Centers for Disease Control and Prevention website. https://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf. Published 2013. Accessed September 24, 2018.Google Scholar
Antibiotic resistance: Global report on surveillance, 2014. World Health Organization website. http://www.who.int/drugresistance/documents/surveillancereport/en/. Published 2014. Accessed September 1, 2018.Google Scholar
Dantes, R, Mu, Y, Hicks, LA, et al. Association between outpatient antibiotic prescribing practices and community-associated Clostridium difficile infection. Open Forum Infect Dis 2015;2:ofv113.CrossRefGoogle ScholarPubMed
Antibiotic use for the emergency management of dental pain and swelling clinical practice guideline, 2019. American Dental Association website. https://ebd.ada.org/en/evidence/guidelines/antibiotics-for-dental-pain-and-swelling. Published 2019. Accessed June 23, 2019.Google Scholar
Chow, AW. Infections of the oral cavity, neck, and head. In: Bennett, JE, Dolin, R, Blaser, MJ. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, eighth edition. Philadelphia, PA: Saunders; 2015:789–800.CrossRefGoogle Scholar
Wilson, W, Taubert, KA, Gewitz, M, et al. Prevention of infective endocarditis: Guidelines from the American Heart Association: A guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 2007;116:1736–1754.CrossRefGoogle Scholar
American Dental Association. Clinical practice guideline on the use of antibiotics for the emergency management of symptomatic irreversible pulpitis, symptomatic apical periodontitis, and localized acute apical abscess. JADA 2019;150:906–921.Google Scholar
Fleming-Dutra, KE, Hersh, AL, Shapiro, DJ, et al. Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010–2011. JAMA 2016;315:1864–1873.CrossRefGoogle ScholarPubMed
Suda, KJ, Calip, GS, Zhou, J, et al. Assessment of the appropriateness of antibiotic prescription for infection prophylaxis before dental procedures, 2011 to 2015. JAMA Netw Open 2019;2:e193090.CrossRefGoogle ScholarPubMed
Thornhill, MH, Dayer, MJ, Prendergast, B, Baddour, LM, Jones, S, Lockhart, PB. Incidence and nature of adverse reactions to antibiotics used as endocarditis prophylaxis. J Antimicrob Chemother 2015;70:2382–2388.CrossRefGoogle ScholarPubMed
Gross, AE, Hanna, D, Rowan, SA, Bleasdale, SC, Suda, KJ. Successful implementation of an antibiotic stewardship program in an academic dental practice. Open Forum Infect Dis 2019;6:ofz067.CrossRefGoogle Scholar
Gross, AE, Suda, KJ, Zhou, Z, et al. Serious antibiotic-related adverse effects following unnecessary dental prophylaxis in the United States. Infect Control Hosp Epidemiol 2021;42:110–112.CrossRefGoogle ScholarPubMed
Deshpande, A, Pasupuleti, V, Thota, P, et al. Community-associated Clostridium difficile infection and antibiotics: a meta-analysis. J Antimicrob Chemother 2013;68:1951–1961.CrossRefGoogle ScholarPubMed
Thornhill, MH, Dayer, MJ, Durkin, MJ, Lockhart, PB, Baddour, LM. Risk of adverse reactions to oral antibiotics prescribed by dentists. J Dent Res 2019;98:1081–1087.CrossRefGoogle ScholarPubMed
Teng, C, Reveles, KR, Obodozie-Ofoegbu, OO, Frei, CR. Infection risk with important antibiotic classes: an analysis of the FDA Adverse Event Reporting System. Int J Med Sci 2019;16:630–635.CrossRefGoogle ScholarPubMed
Cruz-Rodríguez, NC, Hernández-García, R, Salinas-Caballero, AG, Pérez-Rodríguez, E, Garza-González, E, Camacho-Ortiz, A. The effect of pharmacy restriction of clindamycin on Clostridium difficile infection rates in an orthopedics ward. Am J Infect Control 2014;42:e71–e73.Google Scholar
Climo, MW, Israel, DS, Wong, ES, Williams, D, Coudron, P, Markowitz, SM. Hospital-wide restriction of clindamycin: effect on the incidence of Clostridium difficile–associated diarrhea and cost. Ann Intern Med 1998;128:989–995.CrossRefGoogle ScholarPubMed
Suda, KJ, Roberts, RM, Hunkler, RJ, Taylor, TH. Antibiotic prescriptions in the community by type of provider in the United States, 2005–2010. J Am Pharm Assoc (2003) 2016;56:621–626.CrossRefGoogle ScholarPubMed
Tamma, PD, Avdic, E, Li, DX, Dzintars, K, Cosgrove, SE. Association of adverse events with antibiotic use in hospitalized patients. JAMA Intern Med 2017;177:1308–1315.CrossRefGoogle ScholarPubMed
Vaughn, VM, Flanders, SA, Snyder, A, et al. Excess antibiotic treatment duration and adverse events in patients hospitalized with pneumonia: a multihospital cohort study. Ann Intern Med 2019;171:153–163.CrossRefGoogle ScholarPubMed
Spellberg, B. The maturing antibiotic mantra: “shorter is still better.” J Hosp Med 2018;13:361–362.Google Scholar
Royer, S, Demerle, KM, Dickson, RP, Prescott, HC. Shorter versus longer courses of antibiotics for infection in hospitalized patients: a systematic review and meta-analysis. J Hosp Med 2018;13:336–342.Google ScholarPubMed
Jurasic, MM, Gibson, G, Wehler, CJ, Orner, MB, Jones, JA. Caries prevalence and associations with medications and medical comorbidities. J Public Health Dent 2019;79:34–43.CrossRefGoogle ScholarPubMed
Chate, RA, White, S, Hale, LR, et al. The impact of clinical audit on antibiotic prescribing in general dental practice. Br Dent J 2006;201:635–641.CrossRefGoogle ScholarPubMed
Seager, JM, Howell-jones, RS, Dunstan, FD, Lewis, MA, Richmond, S, Thomas, DW. A randomised controlled trial of clinical outreach education to rationalise antibiotic prescribing for acute dental pain in the primary care setting. Br Dent J 2006;201:217–222.CrossRefGoogle ScholarPubMed
Tampi, MP, Pilcher, L, Urquhart, O, et al. Antibiotics for the urgent management of symptomatic irreversible pulpitis, symptomatic apical periodontitis, and localized acute apical abscess: systematic review and meta-analysis-a report of the American Dental Association. J Am Dent Assoc 2019;150:e179–e216.CrossRefGoogle ScholarPubMed
Supplementary material: File

Carlsen et al. supplementary material

Tables S1-S5

Download Carlsen et al. supplementary material(File)
File 27.9 KB