Exploring the appropriateness of antibiotic prescribing for dental presentations in Australian general practice-A pilot study.

Abstract

Dental pain is a common presentation in general medical practice for which patients are often prescribed antibiotics. The aim of this pilot study was to assess prescriptions by general medical practitioners (GPs) for dental presentations in Australia. Anonymised electronic medical data relating to antibiotic prescribing across 2 periods (3 August-30 November 2019 and 3 August-30 November 2020) were extracted from 8 general practices in Victoria that contributed data to the University of Melbourne's Data for Decisions programme. Extracted de-identified data included antibiotics prescribed for dental presentations, practice site number, visit date, patient age, sex, reason for prescription, reason for visit and the regimen of the antibiotic. Appropriateness of the prescribed antibiotic was assessed against the Australian national dental guidelines Therapeutic Guidelines Oral and Dental. From 13 641 recorded prescriptions, 178 were recorded for dental presentations, representing 1.3% of all antibiotic prescriptions. When assessed against the guidelines, 23.6% (n= 42) were considered appropriate. The top 3 most commonly prescribed antibiotics were amoxicillin (n =84, 47.2%), amoxicillin/clavulanic acid (n =52, 29.2%) and metronidazole (n =15, 8.4%). The reasons for inappropriate prescribing were as follows: third-line treatment being chosen, inappropriate spectrum, incorrect regimen or prescribing an antibiotic not recommended in the guidelines. These results indicate a need to better understand the potential patient drivers for antibiotic prescription for GPs and patients, and resources GPs need to manage dental presentations. These results will inform the codesign of targeted interventions to address any educational gaps and barriers to accessing dental treatment and thus improving antibiotic prescribing.