255. Evaluation of Antibiotic Prescribing at University-Affiliated Dental Clinics

Abstract

BackgroundDentists prescribe 10% of outpatient antibiotics, yet aside from guidelines for infective endocarditis prophylaxis and against prosthetic joint infection prophylaxis, little is known about appropriate antibiotic use in dentistry. We aimed to describe antibiotic prescribing in dentistry to identify targets for improving prescribing.MethodsWe performed a cross-sectional study of patients receiving antibiotics between October 1, 2014 and September 30, 2016 at one of three University of Utah (UU) Dentistry clinics. Antibiotic prescriptions entered through the dental practice management software (Dentrix) were pulled from the UU data warehouse and linked with medical records. We assessed antibiotic prescribing rates, most commonly prescribed agents, frequency of documented β-lactam allergies, and duration of therapy. Prescriptions were categorized as for prophylaxis based on administration directions or antibiotics administered as one-time doses in the clinic. Finally, we measured the frequency of cardiac indications for preprocedure antibiotic prophylaxis and indicators that may be drivers of unnecessary antibiotic use (e.g., prosthetic joint).ResultsA total of 1,718 antibiotic prescriptions occurred in the study period, with a prescribing rate of 48/1,000 dental visits. Penicillins were the most commonly prescribed class [81% (1,399/1,718)]. Six percent (96/1,718) of prescriptions were consistent with infection prophylaxis. Thirty percent (29/96) of those receiving prophylaxis had a cardiac indication for dental prophylaxis, and 23% (22/96) had prosthetic joints. Mean nonprophylactic antibiotic duration was 8 days (standard deviation 3.9 days). Ten percent (180/1,718) of prescriptions were in patients with a documented β-lactam allergy. The majority of these patients [62% (111/180)] received clindamycin.ConclusionThe majority of prescriptions evaluated were not consistent with preprocedure prophylaxis. Prophylaxis was frequently prescribed in patients without prophylactic indications. While improving prophylactic use of antibiotics for dental procedures is an important antibiotic stewardship target, a better understanding of the use of treatment courses could have more significant implications for dental antibiotic stewardship efforts.Disclosures All authors: No reported disclosures.