Antibiotic Prophylaxis Before Dental Work Often Unnecessary

Antibiotic prophylaxis before dental procedures is unnecessary more than 80 percent of the time, according to a study published in JAMA Network Open.

Katie J. Suda, Pharm.D., from the University of Illinois in Chicago, and colleagues evaluated the appropriateness of antibiotic prophylaxis before dental procedures using commercial dental visits from 2011 to 2015. This information was linked to medical and prescription claims from 2009 to 2015.

The researchers found that antibiotic prophylaxis was prescribed for 168,420 dental visits for 91,438 patients (median age, 63 years; 57.2 percent female). These dental visits were associated with 287,029 dental procedure codes, with most dental visits classified as diagnostic (70.2 percent) and/or preventive (58.8 percent). The vast majority of dental visits (90.7 percent) involved manipulation of the gingiva or tooth periapex, but only 20.9 percent of patients had a cardiac condition at the highest risk for adverse outcome from infective endocarditis. Therefore, per guidelines, most antibiotic prophylaxis prescriptions before dental visits were unnecessary (80.9 percent). Compared with amoxicillin, clindamycin was more likely to be unnecessary (odds ratio [OR], 1.10). Unnecessary antibiotic prophylaxis was associated with prosthetic joint devices (OR, 2.31), tooth implant procedures (OR, 1.66), female sex (OR, 1.21), and visits occurring in the western United States (OR, 1.15).

"Implementation of antimicrobial stewardship in dental practices is an opportunity to improve antibiotic prescribing for infection prophylaxis," the authors write.

Two authors disclosed financial ties to the pharmaceutical industry.

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