How prescribing habits may hinder antibiotic stewardship
Experts, including Thomas Paumier, D.D.S., who was recently installed as the 163rd president of the ADA, and Erinne Kennedy, D.M.D., commented on a recent study examining the frequency of high-risk antibiotic prescribing in dentistry.
Experts stressed that patients without access to dental care may seek treatment for dental infections at other healthcare providers, according to a news article from the University of Minnesota’s Center for Infectious Disease Research and Policy. With millions of patients receiving care for dental pain outside of dental settings, a high proportion of them are prescribed antibiotics.
Although antibiotics can slow dental infections until patients can receive the necessary dental care, they cannot clear the infections and can carry a risk of harm. For instance, clindamycin is known to increase the likelihood of potentially life-threatening Clostridioides difficile infections and includes a U.S. Food and Drug Administration black box warning. A recent clinical practice statement from the ADA advised dental professionals to opt for safer alternatives to clindamycin whenever possible.
In the retrospective study, published in Open Forum Infectious Diseases, investigators analyzed patterns in antibiotic prescribing and outcomes such as treatment failure among more than 12,000 adult outpatients treated for dental infections. The participants were divided into four groups on the basis of their prescribed antibiotics: amoxicillin/clavulanate, cephalosporins, clindamycin or other antibiotic therapy.
The investigators found that while penicillins — the ADA-recommended first-line treatment options in dental infections — were prescribed in about three-fourths of the cases, clindamycin was prescribed in about one-fifth of the infections. Notably, clindamycin exhibited the highest rate of treatment failure, followed by cephalosporins, amoxicillin/clavulanate and other antibiotics.
In addition, the investigators indicated that clindamycin was sometimes prescribed among patients who reported having penicillin allergies, even though many patients prescribed an antibiotic other than penicillin had no allergy in their records or had a mild allergy or intolerance. More than one-third of those prescribed clindamycin in the study had reported prior mild reactions to penicillin. However, Centers for Disease Control and Prevention data suggested that a very small fraction of individuals in the United States reporting penicillin allergies may have allergies in actuality. Clinicians who ask a set of four questions prior to selecting an antibiotic can quickly determine a patient’s risk of experiencing a penicillin-related allergic reaction.
Dr. Kennedy emphasized the importance of sharing ADA guidelines on antibiotic prescribing with other clinicians across primary care, urgent care and emergency departments to optimize the use of recommended antibiotics over those that pose serious health risks. The ADA recommends prescribing antibiotics if dental pain comes with fever, chills or more widespread infection.
Dental infections can only be cured with dental procedures such as root canals to eliminate the affected tissue, underscored Dr. Paumier. However, many patients may continue to visit primary care, urgent care or emergency departments with ongoing dental infections as a result of limited access to dental care.
Read more: CIDRAP
The article presented here is intended to inform you about the broader media perspective on dentistry, regardless of its alignment with the ADA's stance. It is important to note that publication of an article does not imply the ADA's endorsement, agreement, or promotion of its content.