Antibiotic prescription in emergency dental service in Zagreb, Croatia - a retrospective cohort study

Abstract

Objectives: To analyse prescription of antibodies in emergency dental service according to antibiotic type, working diagnosis, patient visit time and patient demographic characteristics. Additionally, prescription practices among individual dentists were analysed.

Methods: The data in this retrospective cohort study were collected from electronic medical records and analyzed using descriptive statistics. Statistical analyses were conducted using the chi-square test and the Z-test with post-hoc Bonferroni adjustment (α =0.05).

Results: The study covered 20,879 patient visits during a 1.5-year period (from 1 June 2015 to 1 December 2016). Antibiotics were prescribed in 10,188 (48.8%) visits. In 6,202 (29.7%) visits, no dental treatment was performed and only an antibiotic was prescribed. The antibiotics most frequently prescribed were from the penicillin group and also contained clavulanic acid (70.5%); the second most frequently prescribed antibiotic was clindamycin (15.0%). The most common diagnoses for which an antibiotic was prescribed were acute apical abscess, pericoronitis and retained root; for these diagnoses, an antibiotic was prescribed in 79.8%, 64.3% and 63.3% of visits, respectively. Prescription of an antibiotic was significantly more frequent during Sundays and holidays (55.6% of visits) than during working days (33.2% of visits). Prescription of an antibiotic increased from the age of 1 towards the age of 75 and decreased thereafter. Female dentists prescribed antibiotics slightly but significantly (P < 0.001) more frequently than male dentists (50.8% and 46.8% of visits, respectively). High heterogeneity was observed among dentists regarding their criteria for prescribing antibiotics; individual dentists prescribed antibiotics in 15.0%-72.1% of the total number of visits.

Conclusion: Multiple possible issues in the prescription of antibiotics were observed, ranging from administration for inappropriate indications to noncritical and excessive prescription.

Keywords: Antibiotics; acute odontogenic infections; antibiotic resistance; dentistry; emergency dental service.

Figure 1.

Frequency of antibiotic prescribed for an individual diagnosis (thick red bars) and number of patients (thin blue bars) with an individual diagnosis. ABS, acute apical abscess; CAR, caries; GIN, gingivitis; NEC, pulpal necrosis; OTH, other; PAP, periapical periodontitis; PCR, pericoronitis; PER, periodontitis; PUL, pulpitis; RR, retained root.

Figure 2.

Analysis of the number of visits (red bars) and the frequency of antibiotic prescription (blue line) during working days. The same letters denote statistically homogeneous groups.

Figure 3.

Analysis of number of visits (red bars) and the frequency of antibiotic prescription (blue line) during Sundays/holidays. The same letters denote statistically homogeneous groups.

Figure 4.

Distribution of patients according to age (red bars) and the frequency of antibiotic prescription (blue line).

Figure 5.

Frequency of antibiotic prescription among individual dentists. Horizontal lines above bars denote statistically homogeneous groups.

Figure 6.

Percentage of visits in which an antibiotic was prescribed without any dental treatment being performed. ABS, acute apical abscess; CAR, caries; GIN, gingivitis; NEC, pulpal necrosis; OTH, other; PAP, periapical periodontitis; PCR, pericoronitis; PER, periodontitis; PUL, pulpitis; RR, retained root. Horizontal lines above bars denote statistically homogeneous groups.