Dentists Improve Antibiotic Prescribing after Antibiotic Stewardship Education

Antibiotic prescribing improved signifiantly among dentists after infectious diseaseses experts presented dental antibiotic stewardship education, a recent study showed.

The prospective cohort study, published in Open Forum Infectious Diseases, included 15 dentists, including 10 who had been in practice for more than 20 years.

“I think the biggest takeaway is that dentists had no idea they could potentially be harming patients by giving antibiotics for procedures that there really is no evidence that they’re necessary and giving long durations of antibiotics,” lead author Debra Goff, PharmD, FIDSA, FCCP, infectious diseases specialist of global antibiotic stewardship at The Ohio State University Wexner Medical Center and professor of pharmacy practice at The Ohio State University College of Pharmacy, told Contagion. “But once they learned, …they literally changed their antibiotic prescribing overnight.”

Investigators conducted a survey on baseline antibiotic knowledge and collected three months of antibiotic data after which participants attended three evening Zoom education sessions. Prospective audits with weekly feedback sessions were held for three months. The study wrapped up with a final survey and recommendations.

Most participants thought less than 5% of patients taking antibiotics experienced adverse events. The dentists were taught about how their prescribing of antibiotics in the United States contributes to escalating rates of antimicrobial resistance, Clostridioides difficile infections, and other side effects.

During the course of the study, the participants shared their experiences and learned from one another.

“It was really amazing to watch this peer to peer conversation,” Goff said.

Fear of lawsuits, patient requests and lack of definitive guidance were among the nonclincal factors contributing to decisions to prescribe antibiotics.

All participants prescribed clindamycin, which is associated with C diff infections, and none were aware that it is no longer recommended for dental prophylaxis. None of the dentists in the study were aware if their patients had CDI.

“They are never informed if their patient develops C diff because the patient doesn’t run to the dentist with their diarrhea, they run to the emergency room,” Goff said.

Upon completion of dental antibiotic stewardship education, clindamycin prescriptions fell 90% from 183 to 18. The overall number of antibiotics prescribed decreased by 14.5% from 2124 to 1816 while dental procedures increased by 6.3%. Appropriate use of antibiotics increased to 87.8% from 19%. Appropriate prophylaxis rose to 76.7%, up from 46.6%

For treatment, antibiotic appropriateness improved to 90.2%, up from 15% and duration fell to 5.1 days, down from 7.7 days.

Fourteen of 15 participants were unfamiliar with dental stewardship at the onset of the study.

“Do not continue to use the words ‘dental antibiotic stewardship’ with dentists,” Goff said. “The term does not resonate with them. That’s real important to learn. We recommend using verbiage such as ‘new antibiotic guidance for dentists.’ That will catch their attention but dental antibiotic stewardship is not a common term.”

Goff said dental study clubs, which allow dentists to engage with one another and build relationships, are instrumental in spreading awareness of antibiotic stewardship.

“They plugged us in to educate through their dental study clubs and that’s where we were able to educate an additional 2250 dentists across the United States,” she said. “And I continue to do that now.”

Study participants also recommended including antibiotic stewardship in mandatory continuing education currently required for opioid prescriptions.

“I think our paper really provides a roadmap for other antibiotic stewards to follow,” Goff said.