Antibiotic prescribing in UK general dental practice: a cross-sectional study

Abstract

Objectives: To assess the extent to which antibiotic prescribing in general dental practice conforms to clinical guidelines and to describe factors associated with antibiotic prescription in the absence of spreading infection or systemic involvement.

Methods: A cross-sectional study of the management of adult patients with acute dental conditions by General Dental Practitioners (GDPs) in Wales, UK. Clinical information on the management of patients was compared to clinical and prescribing guidelines published by the Scottish Dental Clinical Effectiveness Programme and the Faculty of General Dental Practice (UK). Multilevel logistic regression was used to identify patient, practitioner and consultation characteristics predictive of antibiotic prescribing in the absence of infection.

Results: Antibiotics were prescribed to 57.4% of 568 patients. Over half of antibiotics (65.6%) were prescribed in situations where there was no evidence of spreading infection, and 70.6% were used without the provision of an operative intervention. Only 19.0% of antibiotics were prescribed in situations where their use was indicated by clinical guidelines. Factors associated (P < 0.05) with antibiotic prescription in the absence of infection were failure of previous operative treatment (Odds Ratio (OR) 13.57), shortage of clinical time to undertake treatment (OR 10.21), patients who were unable or unwilling to accept operative treatment (OR 4.89), patient requests for antibiotics (OR 3.69) and acute periodontal conditions (OR 3.37).

Conclusions: A high level of inappropriate antibiotic prescribing was observed amongst the GDPs studied. Features of the healthcare environment, such as clinical time pressures, and patient-related characteristics, such as expectations for antibiotics and refusal of operative treatment, are associated with antibiotic prescribing in the absence of infection. Individuals responsible for the commissioning and delivery of dental services should seek to develop targeted interventions addressing these issues in order to ensure optimal antimicrobial stewardship within dentistry.

Keywords: antimicrobial resistance; general dental practice; guideline adherence; health services research; pharmacology.