1592 An Audit on Prophylactic Prescribing for Third Molar Surgery

Abstract

Abstract Introduction Over-prescription of antibiotics gives rise to problems including increased risk of adverse antimicrobial reaction and antimicrobial resistance. Despite this, the ‘routine’ prescription of prophylactic antibiotics following lower third molar removal (LTMR) remains common practice. The current body of evidence shows minimal to no statistically significant difference in the incidence of postoperative infection between prescribing and withholding prophylactic antibiotics for LTMR in healthy individuals. There is currently no published guidance on appropriate antibiotic usage following LTMR. Method A single centred, retrospective review of 100 successive patients undergoing LTMR. In the absence of current guidance, standards of specific criteria to justify antibiotic prophylaxis were formed. Primary outcome measures included appropriate prescription of prophylactic antibiotics, and record of clinical indication for antibiotic prescription. Following dissemination of results and implementation of suggested improvements, a 2nd audit cycle has commenced. Results Cycle 1 (n = 100) (Nov 2019 - April 2020) 52% of patients received prophylactic antibiotics following LTMR. Only 9% had a clear appropriate justification for use. 27% of antibiotics were not prescribed in accordance with BNF or SDCEP guidance. There were 0 postoperative infections within this cohort. Conclusions Over-prescription of antibiotic prophylaxis with inadequate documented justification for use is clear. All clinicians have a duty to consider the rising incidence of antimicrobial resistance and reflect this in their practice. The use of prophylactic systemic antibiotics in LTMR should be limited to cases where it may be deemed to show clinical benefit in patient best interest on both an individual and community scale.