2078. Patterns, Indications, and Appropriateness of Antibiotics Prescribed at a Private Dental Practice

Abstract

BackgroundAlthough dentists prescribe 10% of all outpatient antibiotics in the United States (US), prescribing patterns among dentists in the United States are largely unknown especially in private practice. We aimed to describe the patterns and indications of antibiotics prescribed at a United States private dental practice and evaluate prescription appropriateness.MethodsThis was a retrospective cohort study of all patients who received an antibiotic at a private dental practice in Baytown, TX, between 2017 and 2019. A thorough guideline and literature search was conducted to define the indication-specific appropriateness of antibiotics. The prescribing dentist and an antimicrobial stewardship pharmacist reviewed each patient chart to verify diagnosis and antibiotic indication. Each prescription was categorized as appropriate (evidence supports use), inappropriate (evidence does not support use), indeterminate (insufficient evidence to support or not support use), or not enough information (inadequate patient-specific data to determine appropriateness).ResultsOf 3,700 patient encounters, an antibiotic was prescribed for 230 (6.2%) encounters. Antibiotics prescribed were amoxicillin (52.2%), amoxicillin/clavulanate (27.8%), penicillin VK (7.8%), azithromycin (4.8%), clindamycin (3.5%), cephalexin (2.2%), and metronidazole (1.7%). Excluding antibiotics given as a single pre-operative dose (6% of antibiotics), the mean duration of antibiotics was 5 ± 0.6 days (mean ± SD). Antibiotic indications were symptomatic apical periodontitis or localized acute apical abscess (51.3%), symptomatic irreversible pulpitis (17.8%), prevention of implant failure (11.7%), pericoronitis (4.3%), acute apical abscess with systemic involvement (3.9%), and others (11%). Of the 230 antibiotic prescriptions, 27.8% were appropriate, 3.9% inappropriate, 66.1% indeterminate, and 2.2% not enough information.ConclusionCommonly prescribed antibiotics in this study were amoxicillin or amoxicillin/clavulanate for a mean duration of 5 days. The most common indication was symptomatic apical periodontitis or localized acute apical abscess. Two-thirds of antibiotics were prescribed without sufficient evidence to support or not support use.Disclosures All authors: No reported disclosures.