Clinical audit: a study to improve antibiotic prescribing

Abstract

Objective To investigate whether clinical audit can improve general dental practitioners' prescribing of antibiotics. Design An intervention study carried out in general dental practice in the North West of England. Method Information was collected over an initial six-week period from 175 general dental practitioners on their current antibiotic prescribing practices. The information collected was the antibiotic prescribed including dose, frequency and duration, the clinically presenting signs and conditions, the medical history (if for prophylaxis), and any other reasons for prescribing. This was compared to the practitioners' antibiotic prescribing for a further six-week period following an audit, which included an educational component and the issuing of guidelines. Results During the initial period practitioners issued 2316 prescriptions for antibiotics. This was reduced by 42.5% to 1330 during the audit. The majority of the antibiotics (81%) for both periods were prescribed for therapeutic reasons. The most commonly prescribed antibiotics were amoxycillin (57.6%), metronidazole (23.8%), penicillin (9.3%), erythromycin (4.8%) and a combination of amoxycillin and metronidazole (1.7%). The antibiotic regimens used by practitioners were significantly changed by the audit (P < 0.001) and there was a significant reduction in the number of prescriptions (P < 0.05) which did not conform to national guidelines. Conclusions The results from this investigation support the conclusion that clinical audit, with the issuing of guidelines and an educational component, can change prescribing practices leading to a more rational and appropriate use of antibiotics in general dental practice.