Concordance of antibiotic prescribing with the American Dental Association acute oral infection guidelines within Veterans’ Affairs (VA) dentistry

2021 ◽  
pp. 1-9
Author(s):  
Daniel B. Carlsen ◽  
Michael J. Durkin ◽  
Gretchen Gibson ◽  
M. Marianne Jurasic ◽  
Ursula Patel ◽  
...  
Keyword(s):  
Antibiotic Prescription ◽  
Maxillofacial Surgery ◽  
Apical Periodontitis ◽  
Oral And Maxillofacial Surgery ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Oral Infections ◽  
American Dental Association ◽  
Patient Level ◽  
Irreversible Pulpitis

Abstract Objective: United States dentists prescribe 10% of all outpatient antibiotics. Assessing appropriateness of antibiotic prescribing has been challenging due to a lack of guidelines for oral infections. In 2019, the American Dental Association (ADA) published clinical practice guidelines (CPG) on the management of acute oral infections. Our objective was to describe baseline national antibiotic prescribing for acute oral infections prior to the release of the ADA CPG and to identify patient-level variables associated with an antibiotic prescription. Design: Cross-sectional analysis. Methods: We performed an analysis of national VA data from January 1, 2017, to December 31, 2017. We identified cases of acute oral infections using International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) codes. Antibiotics prescribed by a dentist within ±7 days of a visit were included. Multivariable logistic regression identified patient-level variables associated with an antibiotic prescription. Results: Of the 470,039 VA dental visits with oral infections coded, 12% of patient visits with irreversible pulpitis, 17% with apical periodontitis, and 28% with acute apical abscess received antibiotics. Although the median days’ supply was 7, prolonged use of antibiotics was frequent (≥8 days, 42%–49%). Patients with high-risk cardiac conditions, prosthetic joints, and endodontic, implant, and oral and maxillofacial surgery dental procedures were more likely to receive antibiotics. Conclusions: Most treatments of irreversible pulpitis and apical periodontitis cases were concordant with new ADA guidelines. However, in cases where antibiotics were prescribed, prolonged antibiotic courses >7 days were frequent. These findings demonstrate opportunities for the new ADA guidelines to standardize and improve dental prescribing practices.

scholarly journals 967. Concordance of Antibiotic Prescribing with the Proposed American Dental Association Acute Oral Infection Guidelines within Veterans Affairs (VA) Dentistry

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S31-S32
Author(s):  
Daniel Carlsen ◽  
Katie J Suda ◽  
Ursula C Patel ◽  
Gretchen Gibson ◽  
Marianne M Jurasic ◽  
...  
Keyword(s):  
Dental Treatment ◽  
Apical Periodontitis ◽  
Antibiotic Prescribing ◽  
Cross Sectional ◽  
Oral Infections ◽  
American Dental Association ◽  
Dental Procedures ◽  
Icd 10 ◽  
Future Work ◽  
Irreversible Pulpitis

Abstract Background US dentists prescribe 10% of outpatient antibiotics. However, assessing the appropriateness of dental antibiotic prescribing has been challenging due to a lack of guidelines for common infections. In 2019, the American Dental Association proposed clinical practice guidelines (CPG) on the management of common acute oral infections for the first time. Our objective was to describe national baseline antibiotic prescribing for the treatment of irreversible pulpitis, apical periodontitis, and acute apical abscess prior to the release of the proposed CPG. Methods We performed a cross-sectional analysis of national VA data from January 1, 2017 to December 31, 2017. We identified cases of irreversible pulpitis, apical periodontitis, and acute apical abscess using ICD-10-CM codes. Patient demographics, facility location, medical conditions, dental procedure codes (“CDTs”), and diagnostic (ICD-10-CM) codes were extracted from the VA Corporate Data Warehouse. Antibiotics prescribed by a dentist within 7 days of a visit were included. Multivariable logistic regression identified variables associated with antibiotic prescribing for each infection. Results Of the 470,039 VA dental visits with oral infections coded, 25% of irreversible pulpitis, 41% of apical periodontitis, and 61% of acute apical abscess visits received antibiotics. Amoxicillin was prescribed most frequently. Although the median days’ supply was 7 days, prolonged use of antibiotics was frequent (9.2% of irreversible pulpitis, 17.8% of apical periodontitis, 28.7% of acute apical abscess received antibiotics for ≥8 days). Of the irreversible pulpitis visits with antibiotics prescribed, 20.0% received ≥2 antibiotics. Patients with high-risk cardiac conditions, prosthetic joints, and certain dental procedures were associated with receipt of antibiotics (table). Conclusion Prior to the release of the ADA guidelines, 75.8% and 59.4% of irreversible pulpitis and apical periodontitis were concordant with proposed recommendations. These data identify opportunities to improve prescribing and serve as a benchmark for future outpatient antimicrobial stewardship efforts. Future work should assess definitive dental treatment and populations without access to oral health care. Disclosures All Authors: No reported Disclosures.

scholarly journals Antibiotic prescription for febrile outpatients: a health facility-based secondary data analysis for the Greater Accra region of Ghana

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Michael Mireku Opoku ◽  
Harriet Affran Bonful ◽  
Kwadwo Ansah Koram
Keyword(s):  
Antibiotic Prescription ◽  
Secondary Data ◽  
Health Facilities ◽  
Full Blood Count ◽  
Baseline Survey ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Factors Associated ◽  
Laboratory Investigations ◽  
Greater Accra Region

Abstract Background Misguided prescription of antibiotics is an important contributor towards the emergence and spread of antibiotic resistance. The absence of effective interventions to control antibiotic use leads to increased consumption beyond the needed requirements. Antibiotic stewardship interventions must be appropriately targeted and assessed to enhance the controlled use of antibiotics. The objective of this study was to determine the factors associated with antibiotic prescription to febrile outpatients who seek care in health facilities within the Greater Accra region of Ghana. Methods Secondary data obtained from the medical records of 2519 febrile outpatients, consecutively sampled at the outpatient department of 6 health facilities in 3 municipalities during the baseline survey of a quasi-experiment in 2015 was used. The primary outcome was prescription of any antibiotic. Independent variables included patients’ demographics, symptoms, laboratory investigations (blood film microscopy, malaria rapid diagnostic test, full blood count, urine and stool routine examinations), diagnoses, and prescribers’ demographics. Crude and adjusted logistic regression analyses were used to determine the factors associated with antibiotic prescription. Results The prevalence of antibiotic prescription was 70.1% (95% CI: 67.7–72.4). Prescribers with more years of practice (> 5 years) were more likely to prescribe antibiotics compared to those with less than 3 years of practice (p <  0.001). Integrated Management of Neonatal and Childhood Illnesses (IMNCI) training was associated with a 2.3 (95% CI: 1.54, 3.53, p <  0.001) fold odds of antibiotic prescribing. Patients aged 5 years or more were 60% less likely to receive antibiotics compared with those under 5 years (AOR = 0.40, 95% CI: 0.32, 0.51; p <  0.001). Patients referred for laboratory investigations were 29% less likely to be prescribed antibiotics than those not referred. The presence of cough as a presenting symptom was associated with a 3.5 (95% CI: 2.54, 4.92) fold odds of antibiotic prescription. Conclusion Prescription of antibiotics to febrile outpatients was high. Promoting laboratory testing can potentially reduce irrational antibiotic prescription. Prescribing antibiotics for children under five and the prescribing practices of prescribers with longer years of practice should be targeted with interventions to reduce high use of antibiotics.

scholarly journals Antibiotic Prescribing Practices of Endodontic Postgraduate Trainees in Karachi, Pakistan

2021 ◽  
Vol 30 (03) ◽  
pp. 183-188
Author(s):  
Azam Muhammad Aliuddin ◽  
◽  
Sarosh Sadruddin Morani ◽  
Abubakar Sheikh ◽  
Saqib Rashid ◽  
...  
Keyword(s):  
Cross Sectional Study ◽  
Apical Periodontitis ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Duration Of Treatment ◽  
Cross Sectional ◽  
Post Graduate ◽  
Odontogenic Infections ◽  
First Choice ◽  
Graduate Trainees

OBJECTIVE: The aim of this study was to assess the knowledge of Endodontic Postgraduate trainees regarding clinically relevant situations where an antibiotic cover is needed and is focused on the prescription patterns of various antibiotics depending on the clinical evaluation of the patients. METHODOLOGY: A cross sectional study was performed in which data was collected from five different dental institutes offering post-graduate residency in endodontics all over Karachi, Pakistan. Preferred antibiotic for odontogenic infections and the duration for the antibiotic coverage were evaluated amongst postgraduate clinicians. A total of 100 questionnaires were distributed out of which only 82 questionnaires came back with responses. The study was conducted for a period of one month from August 2018- September 2018. The data collected was analyzed by SPSS version 21. RESULTS: A combination of amoxicillin with Clavulanic acid was the first choice of antibiotic in patients with no known allergies to penicillin (40.6%), whereas erythromycin was the first choice of antibiotic in patients having allergic reactions to penicillin (39.3%). The duration of treatment on average was 5 days. In clinical situations of irreversible pulpitis, with or without apical periodontitis, 74.3% and 67% of the respondents prescribed antibiotics. 78 % of respondents have prescribed antibiotics in cases of necrotic pulp with acute apical periodontitis. CONCLUSION: Our study concludes that antibiotic over prescription is very common amongst post graduate trainees and is contributing towards a larger issue of antibiotic resistance. Proper protocols of prescription should be followed by professionals and further refinement is required focusing on need, duration and choice of the antibiotic being used. KEYWORDS: Antibiotics, Odontogenic infections, Endodontics, Microbial resistance

scholarly journals Antibiotic Prescribing Habits of Dental Surgeons in Hyderabad City, India, for Pulpal and Periapical Pathologies: A Survey

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
K. Pavan Kumar ◽  
Mamta Kaushik ◽  
P. Udaya Kumar ◽  
M. Shilpa Reddy ◽  
Neha Prashar
Keyword(s):  
Antibiotic Therapy ◽  
Response Rate ◽  
Apical Periodontitis ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Inferential Statistics ◽  
Prescribing Habits ◽  
Preoperative Symptom ◽  
Educational Initiatives ◽  
History Of

Aim. To determine the antibiotic prescribing habits for pulpal and periapical pathology among dentists in Hyderabad city, India.Methodology. A total of 246 questionnaires were distributed to all the dentists registered with the local dental branch. Demographic details and questions regarding type and dosage of antibiotics prescribed for allergic and nonallergic patients were recorded. Inferential statistics were performed, andP<0.05was considered statistically significant.Results. The response rate for the study was 87.8%. Around 148 (68.5%) of respondents regularly prescribed antibiotics for endodontic management. The first antibiotic of choice for patients with no history of medical allergies was a combination of amoxicillin and metronidazole, followed by amoxicillin alone (29.1%). The first antibiotic of choice in case of allergy to penicillin was erythromycin. Necrotic pulp with acute apical periodontitis with swelling and moderate/severe preoperative symptom was the condition most commonly identified for antibiotic therapy (92.1%).Conclusion. The present study reveals that the overall antibiotic prescribing practices among this group of dentists were quite high, and there is a need for more educational initiatives to rationalize the use of antibiotics in dentistry.

scholarly journals Antibiotics prescription for febrile outpatients: a health facility-based secondary data analysis for the Greater Accra region of Ghana

2020 ◽  
Author(s):  
Michael Mireku Opoku ◽  
Harriet Affran Bonful ◽  
Kwadwo A. Koram
Keyword(s):  
Antibiotic Prescription ◽  
Secondary Data ◽  
Health Facilities ◽  
Full Blood Count ◽  
Baseline Survey ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Factors Associated ◽  
Laboratory Investigations ◽  
Greater Accra Region

Abstract Background: Misguided prescription of antibiotics is an important contributor towards the emergence and spread of antibiotic resistance. The absence of effective interventions to control antibiotic use leads to increased consumption beyond the needed requirements. Antibiotic stewardship interventions must be appropriately targeted and assessed to enhance the controlled use of antibiotics. The objective of this study was to determine the factors associated with antibiotic prescription to febrile outpatients who seek care in health facilities within the Greater Accra region of Ghana.Methods: Secondary data obtained from the medical records of 2,519 febrile outpatients, consecutively sampled at the outpatient department of 6 health facilities in 3 municipalities during the baseline survey of a quasi-experiment in 2016 was used. The primary outcome was prescription of any antibiotic. Independent variables included patients’ demographics, symptoms, laboratory investigations (blood film microscopy, malaria rapid diagnostic test, full blood count, urine and stool routine examinations), diagnoses, and prescribers’ demographics. Crude and adjusted logistic regression analyses were used to determine the factors associated with antibiotic prescription. Results: The prevalence of antibiotic prescription was 70.1% (95% CI: 67.7-72.4). Prescribers with more years of practice (>5years) were more likely to prescribe antibiotics compared to those with less than 3 years of practice (p < 0.001). Integrated Management of Neonatal and Childhood Illnesses (IMNCI) training was associated with a 2.3 (95% CI: 1.54, 3.53, p < 0.001) folds odds of antibiotic prescribing. Patients aged 5 years or more were 60% less likely to receive antibiotics compared with those under 5 years (AOR=0.40, 95% CI: 0.32, 0.51; p<0.001). Patients referred for laboratory investigations were 29% less likely to be prescribed for antibiotics than those not referred. The presence of cough as a presenting symptom was associated with a 3.5 (95% CI: 2.54, 4.92) fold odds of antibiotic prescription. Conclusion: Prescription of antibiotics to febrile outpatients was high. Promoting laboratory testing can potentially reduce irrational antibiotics prescribing. Prescribing antibiotics for children under five and the prescribing practices of prescribers with longer years of practice should be targeted with interventions to reduce high use of antibiotics.

scholarly journals The impact of pulse oximetry and Integrated Management of Childhood Illness (IMCI) training on antibiotic prescribing practices in rural Malawi: a mixed-methods study

2020 ◽  
Author(s):  
Fiona Sylvies ◽  
Lucy Nyirenda ◽  
Alden Blair ◽  
Kimberly Baltzell
Keyword(s):  
Pulse Oximeter ◽  
Antibiotic Prescription ◽  
Integrated Management ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Continued Education ◽  
Pediatric Pneumonia ◽  
Prescription Rates ◽  
The Impact ◽  
Pulse Oximeters

Abstract Background. The misdiagnosis of non-malarial fever in sub-Saharan Africa has contributed to the significant burden of pediatric pneumonia and the inappropriate use of antibiotics in this region. This study aims to assess the impact of 1) portable pulse oximeters and 2) Integrated Management of Childhood Illness (IMCI) continued education training on the diagnosis and treatment of non-malarial fever amongst pediatric patients being treated by the Global AIDS Interfaith Alliance (GAIA) in rural Malawi. Methods. This study involved a logbook review to compare treatment patterns between five GAIA mobile clinics in Mulanje, Malawi during April-June 2019. An intervention study design was employed with four study groups: 1) 2016 control, 2) 2019 control, 3) IMCI-only, and 4) IMCI and pulse oximeter. A total of 3,504 patient logbook records were included based on these inclusion criteria: age under five years, febrile, malaria-negative, and treated during the dry season. A qualitative questionnaire was distributed to the participating GAIA providers. Fisher’s Exact Testing and odds ratios were calculated to compare the prescriptive practices between each study group and reported with 95% confidence intervals. Results. The pre- and post-exam scores for the providers who participated in the IMCI training showed an increase in content knowledge and understanding (p<0.01). The antibiotic prescription rates in each study group were 75% (2016 control), 85% (2019 control), 84% (IMCI only), and 42% (IMCI + pulse oximeter) (p<0.01). An increase in pneumonia diagnoses was detected for patients who received pulse oximeter evaluation with an oxygen saturation <95% (p<0.01). No significant changes in antibiotic prescribing practices were detected in the IMCI-only group (p>0.05). However, provider responses to the qualitative questionnaires indicated alternative benefits of the training including improved illness classification and increased provider confidence. Conclusion. Clinics that implemented both the IMCI course and pulse oximeters exhibited a significant decrease in antibiotic prescription rates, thus highlighting the potential of this tool in combatting antibiotic overconsumption in low-resource settings. Additionally, the pulse oximeters demonstrated the capacity to improve detection of pediatric pneumonia. GAIA staff appreciated the IMCI continued education training, however it did not appear to significantly impact antibiotic prescription rates and/or pneumonia diagnosis.

scholarly journals Antibiotic prescription for febrile outpatients: a health facility-based secondary data analysis for the Greater Accra region of Ghana

2020 ◽  
Author(s):  
Michael Mireku Opoku ◽  
Harriet Affran Bonful ◽  
Kwadwo A. Koram
Keyword(s):  
Antibiotic Prescription ◽  
Secondary Data ◽  
Health Facilities ◽  
Full Blood Count ◽  
Baseline Survey ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Factors Associated ◽  
Laboratory Investigations ◽  
Greater Accra Region

Abstract Background: Misguided prescription of antibiotics is an important contributor towards the emergence and spread of antibiotic resistance. The absence of effective interventions to control antibiotic use leads to increased consumption beyond the needed requirements. Antibiotic stewardship interventions must be appropriately targeted and assessed to enhance the controlled use of antibiotics. The objective of this study was to determine the factors associated with antibiotic prescription to febrile outpatients who seek care in health facilities within the Greater Accra region of Ghana.Methods: Secondary data obtained from the medical records of 2,519 febrile outpatients, consecutively sampled at the outpatient department of 6 health facilities in 3 municipalities during the baseline survey of a quasi-experiment in 2016 was used. The primary outcome was prescription of any antibiotic. Independent variables included patients’ demographics, symptoms, laboratory investigations (blood film microscopy, malaria rapid diagnostic test, full blood count, urine and stool routine examinations), diagnoses, and prescribers’ demographics. Crude and adjusted logistic regression analyses were used to determine the factors associated with antibiotic prescription. Results: The prevalence of antibiotic prescription was 70.1% (95% CI: 67.7-72.4). Prescribers with more years of practice (>5years) were more likely to prescribe antibiotics compared to those with less than 3 years of practice (p < 0.001). Integrated Management of Neonatal and Childhood Illnesses (IMNCI) training was associated with a 2.3 (95% CI: 1.54, 3.53, p < 0.001) fold odds of antibiotic prescribing. Patients aged 5 years or more were 60% less likely to receive antibiotics compared with those under 5 years (AOR=0.40, 95% CI: 0.32, 0.51; p<0.001). Patients referred for laboratory investigations were 29% less likely to be prescribed antibiotics than those not referred. The presence of cough as a presenting symptom was associated with a 3.5 (95% CI: 2.54, 4.92) fold odds of antibiotic prescription. Conclusion: Prescription of antibiotics to febrile outpatients was high. Promoting laboratory testing can potentially reduce irrational antibiotic prescription. Prescribing antibiotics for children under five and the prescribing practices of prescribers with longer years of practice should be targeted with interventions to reduce high use of antibiotics.

scholarly journals Molar Position and Surgical Time in Lower Third Molar Extraction

2018 ◽  
Vol 1 (1) ◽  
pp. 17-20
Author(s):  
Sergio Olate ◽  
Juan Alister ◽  
David Thomas ◽  
Ricardo Alveal ◽  
Alejandro Unibazo
Keyword(s):  
Maxillofacial Surgery ◽  
Third Molar ◽  
Aggressive Periodontitis ◽  
Oral And Maxillofacial Surgery ◽  
Oral Diseases ◽  
Surgical Time ◽  
Oral Infections ◽  
Third Molar Extraction ◽  
Time Required ◽  
A Prospective Study

The aim of this research was to find the influence of lower third molar position in surgical time required for extraction of this molar. A prospective study was designed in patients at the Division of Oral and Maxillofacial Surgery at Universidad de La Frontera. Patients with ASA I and II and without oral diseases as aggressive periodontitis and oral infections were included. The third molar position was established in relation to Pedersen scale, Winter scale and Pell and Gregory scale, considering surgical time between the start of surgery and finalization of the procedure; data analyses was carried out with t test with statisticaldifferences when p<0.05. Surgical time of 12±9 minutes was registered, and this was statistically associated to dental position and difficulty observed. It is therefore concluded that the position of the molar has an influence on surgical time.

Antibiotic prescriptions by medical interns in Hong Kong: influence of the hospital settings and prescription culture

2020 ◽  
pp. postgradmedj-2020-138414
Author(s):  
Tai Pong Lam ◽  
Tak Hon Chan ◽  
Kai Sing Sun ◽  
Kwok Fai Lam ◽  
Kit Wing Kwok ◽  
...  
Keyword(s):  
Hong Kong ◽  
Focus Group ◽  
Antibiotic Prescription ◽  
Antibiotic Use ◽  
Public Hospitals ◽  
Antibiotic Prescribing ◽  
Close Monitoring ◽  
Prescribing Practices ◽  
Inadequate Knowledge ◽  
Medical Interns

BackgroundInappropriate antibiotic prescribing practices predispose to resistance emergence. Despite the inclusion of the topic in medical school curricula worldwide, it is uncertain whether newly graduated medical interns have confidence in proper antibiotic prescription.ObjectivesThis study aimed to explore the antibiotic prescribing behaviours of the medical interns in Hong Kong and their barriers to appropriate antibiotic prescription.MethodsTwo focus groups were conducted among medical interns with training experiences in different public hospitals. Their prescribing behaviours and barriers were further examined with a questionnaire survey just before completion of internship.ResultsFocus group interviews identified a variety of hospital workplace cultures, including inappropriate empirical prescriptions and dosages, interns’ passive roles in prescribing antibiotics and varied guidelines between different departments. Defensive medicine and lack of clinical experience were other barriers encountered. The interns believed that the incorrect practice learnt would perpetuate in their minds and affect their future practice. The top barriers reported by the survey respondents were adaptation to prescription culture of different hospitals (93.5%), lack of experience in antibiotic prescription (88.3%), inadequate knowledge in the choice of antibiotics (85.7%) and compliance with the seniors’ instructions (80.6%). However, some focus group participants perceived weaker barriers in paediatric departments which provided close monitoring of antibiotic use.ConclusionsInadequate knowledge and low confidence in antibiotic prescription led to the passive role of medical interns in antibiotic prescription, predisposing to future inappropriate practice. Inconsistent guidelines and prescription cultures between different hospitals and departments might further exacerbate their barriers.

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