Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 May 3;2(5):e193909.
doi: 10.1001/jamanetworkopen.2019.3909.

Assessment of the Appropriateness of Antibiotic Prescriptions for Infection Prophylaxis Before Dental Procedures, 2011 to 2015

Katie J Suda  1   2 , Gregory S Calip  1 , Jifang Zhou  1 , Susan Rowan  3 , Alan E Gross  1 , Ronald C Hershow  4   5 , Rose I Perez  5 , Jessina C McGregor  6   7 , Charlesnika T Evans  2   8
Affiliations

Assessment of the Appropriateness of Antibiotic Prescriptions for Infection Prophylaxis Before Dental Procedures, 2011 to 2015

Katie J Suda et al. JAMA Netw Open. .

Abstract

Importance: Antibiotics are recommended before certain dental procedures in patients with select comorbidities to prevent serious distant site infections.

Objective: To assess the appropriateness of antibiotic prophylaxis before dental procedures using Truven, a national integrated health claims database.

Design, setting, and participants: Retrospective cohort study. Dental visits from 2011 to 2015 were linked to medical and prescription claims from 2009 to 2015. The dates of analysis were August 2018 to January 2019. Participants were US patients with commercial dental insurance without a hospitalization or extraoral infection 14 days before antibiotic prophylaxis (defined as a prescription with ≤2 days' supply dispensed within 7 days before a dental visit).

Exposures: Presence or absence of cardiac diagnoses and dental procedures that manipulated the gingiva or tooth periapex.

Main outcomes and measures: Appropriate antibiotic prophylaxis was defined as a prescription dispensed before a dental visit with a procedure that manipulated the gingiva or tooth periapex in patients with an appropriate cardiac diagnosis. To assess associations between patient or dental visit characteristics and appropriate antibiotic prophylaxis, multivariable logistic regression was used. A priori hypothesis tests were performed with an α level of .05.

Results: From 2011 to 2015, antibiotic prophylaxis was prescribed for 168 420 dental visits for 91 438 patients (median age, 63 years; interquartile range, 55-72 years; 57.2% female). Overall, these 168 420 dental visits were associated with 287 029 dental procedure codes (range, 1-14 per visit). Most dental visits were classified as diagnostic (70.2%) and/or preventive (58.8%). In 90.7% of dental visits, a procedure was performed that would necessitate antibiotic prophylaxis in high-risk cardiac patients. Prevalent comorbidities include prosthetic joint devices (42.5%) and cardiac conditions at the highest risk of adverse outcome from infective endocarditis (20.9%). Per guidelines, 80.9% of antibiotic prophylaxis prescriptions before dental visits were unnecessary. Clindamycin was more likely to be unnecessary relative to amoxicillin (odds ratio [OR], 1.10; 95% CI, 1.05-1.15). Prosthetic joint devices (OR, 2.31; 95% CI, 2.22-2.41), tooth implant procedures (OR, 1.66; 95% CI, 1.45-1.89), female sex (OR, 1.21; 95% CI, 1.17-1.25), and visits occurring in the western United States (OR, 1.15; 95% CI, 1.06-1.25) were associated with unnecessary antibiotic prophylaxis.

Conclusion and relevance: More than 80% of antibiotics prescribed for infection prophylaxis before dental visits were unnecessary. Implementation of antimicrobial stewardship in dental practices is an opportunity to improve antibiotic prescribing for infection prophylaxis.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Suda reported receiving funding from the Agency for Healthcare Research and Quality (AHRQ), US Department of Veterans Affairs Health Services Research & Development (VA HSR&D), VA Quality Enhancement Research Initiative, Centers for Disease Control and Prevention, and Roybal Foundation. Dr Rowan reported receiving grants from the AHRQ. Dr Gross reported receiving personal fees from Paratek. Dr McGregor reported receiving grants from the AHRQ, VA HSR&D, and Merck. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Study Flowchart
Derivation of the study population is shown.
Figure 2.
Figure 2.. Geographic Variation in Unnecessary Antibiotic Prophylaxis, 2011-2015
Results from the unadjusted analysis are shown.
See this image and copyright information in PMC

Comment in

References

    1. 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(9):-. doi:10.1093/cid/civ076 - DOI - PubMed
    1. Koppen L, Suda KJ, Rowan S, McGregor J, Evans CT. Dentists’ prescribing of antibiotics and opioids to Medicare Part D beneficiaries: Medications of high impact to public health. J Am Dent Assoc. 2018;149(8):721-730. doi:10.1016/j.adaj.2018.04.027 - DOI - PubMed
    1. Durkin MJ, Feng Q, Warren K, et al. ; Centers for Disease Control and Prevention Epicenters . Assessment of inappropriate antibiotic prescribing among a large cohort of general dentists in the United States. J Am Dent Assoc. 2018;149(5):372-381.e1. doi:10.1016/j.adaj.2017.11.034 - DOI - PMC - PubMed
    1. Allen U. Infective endocarditis: updated guidelines. Can J Infect Dis Med Microbiol. 2010;21(2):74-77. doi:10.1155/2010/760276 - DOI - PMC - PubMed
    1. Wilson W, Taubert KA, Gewitz M, et al. ; American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee; American Heart Association Council on Cardiovascular Disease in the Young; American Heart Association Council on Clinical Cardiology; American Heart Association Council on Cardiovascular Surgery and Anesthesia; Quality of Care and Outcomes Research Interdisciplinary Working Group . 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(15):1736-1754. doi:10.1161/CIRCULATIONAHA.106.183095 - DOI - PubMed

Publication types

Substances