1745. Drilling Down on Antibiotic Use in Dental Clinics

Abstract

Abstract Background Dentists are the third highest prescribers of antibiotics in outpatient settings in the US with reported suboptimal prescribing rates between 30 and 85%. The 2019 American Dental Association guidelines provide guidance for antibiotic use based on the presence of dental pain and/or swelling and whether definitive conservative dental treatment is immediately available. Our primary objective was to assess the appropriateness of systemic antibiotic use in our institution’s dental clinics based on these guidelines. Our secondary objectives were to describe antibiotic choice, duration of therapy, and use of non-first line antibiotics. Methods From January 2021 through December 2021 data on antibiotics prescribed during all patient encounters in our institution’s dental clinics were abstracted from the electronic medical record. Detailed review was performed on a randomly generated sample of 120 unique patient encounters (10 each month). First line antibiotics included penicillin, amoxicillin, and amoxicillin-clavulanate. Results Of 14,381 dental clinic encounters, 2,413 (16%) resulted in one or more antibiotic prescriptions (total of 2788 prescriptions). Non-first line antibiotics accounted for 402 (14%) of all antibiotic prescriptions (Table). Sixty-nine (17%) of non-first line antibiotics were prescribed for patients with no documented beta-lactam allergy. Of the 333 non-first line antibiotics prescribed for patients with a documented beta-lactam “allergy”, a first line antibiotic or cephalexin could have been used in 120 (36%). Of 120 patient encounters undergoing detailed review, antibiotics were prescribed for treatment (not prophylaxis) in 115 (96%). Antibiotics were indicated in only 16 of 108 (14%) evaluable patients. The mean duration of therapy was 7.2 days. Eleven percent of prescriptions were longer than 7 days. Conclusion At our institution most antibiotics prescribed from our dental clinics were for treatment, were commonly not indicated, and were usually prescribed for 7 days or more. First line antibiotics and cephalexin could have replaced nearly half of the non-first line antibiotics prescribed. Developing a clinical pathway incorporating updated guidelines and management of patients with beta-lactam “allergies” may improve patient care. Disclosures All Authors: No reported disclosures.