Abstract
BackgroundPrescribing in dental practice has a relatively small but important contribution to the quantity of antibiotics prescribed in primary care. This study aimed to analyse antibiotic prescribing in dentistry over time (2010–2016) in 4 different Northern European countries and their relative contribution to national outpatients consumption.MethodsThis retrospective study evaluated the frequency and number of national antibiotic prescriptions written by dentists in England, Scotland, Norway and Sweden. The consumption of such antibiotics was measured using WHO defined daily doses (DDDs), DDDs per 100,000 inhabitants per day (DIDs100,000).ResultsA total of more than 27 million prescriptions (27,026,599) archived between 2010 and 2016 from the four countries were analysed. The national contribution of Norwegian dentists to the total primary care prescription during this period was 8%. The corresponding figures for Sweden, Scotland and England were 7, 6, and 8%. Dental contribution to National antibiotic use in all four countries has decreased over the study time period for commonly prescribed antibiotics in dentistry, i.e., the beta-lactams (Phenoxymethyl penicillin/Amoxicillin) and metronidazole. There were less numbers of prescriptions by dentists in Norway and Sweden compared to England and Scotland. Marked differences in some classes of antibiotics were noted with Phenoxymethyl penicillin dominating in Sweden/Norway compared to Amoxicillin and Metronidazole in England/Scotland. In England and Scotland, dentists were the largest prescribers of metronidazole in primary care. Clindamycin prescriptions was higher in Norway and Sweden.ConclusionNoticeable differences exist in prescribing patterns for the management of oral infections. High levels of metronidazole use in England and Scotland also require further analysis. All countries over the study period showed a decrease in total numbers of antibiotics prescribed.
Highlights
Prescribing in dental practice has a relatively small but important contribution to the quantity of antibiotics prescribed in primary care
The data included the number of antibiotic prescription items written by dentists dispensed in the community to each antibiotic, total national antibiotic use expressed as Defined daily doses (DDD) in the country in each year and the DDD prescribed by dentists for each respective year
The highest annual rate of antibiotic prescribing per dentist was in England in 2011 (n = 171), by 2016 this had declined to 133 antibiotic prescriptions per year (Fig. 1), this represented the highest number of prescriptions per dentist from all four countries
Summary
Prescribing in dental practice has a relatively small but important contribution to the quantity of antibiotics prescribed in primary care. Dentists prescribe antibiotics to treat acute bacterial intra-oral infections and some cases of chronic periodontitis. The trend of antibiotic prescriptions over time is influenced by many factors, such as disease levels, access to dental services, prescribing guidelines, patients’ attitude toward antibiotic prescribing, and incidence of antimicrobial resistance (AMR) [6, 10]. With increasing trends of antibiotic resistant infections across many bacterial species and clinical specialties, adoption of antimicrobial stewardship principles by all prescribers is vital. It is timely to remember that dental antibiotic use contributes to the selection pressure for development of AMR generally and not just linked to dental infections or oral pathogens [13,14,15]. National data on antibiotic use by dentists can be used to identify priorities for antibiotic stewardship in dentistry and inform management and prescribing guidance. There are some reports of good outcomes following a variety of interventions [17]
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