IDWeek 2019 — Unnecessary dental prophylaxis can lead to serious antibiotic-related AEs


  • Marielle Fares, Pharm.D.
  • Conference Reports
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Takeaway

  • Unnecessary dental prophylaxis can lead to serious antibiotic-related adverse events (AEs).
  • Even ≤2 days of antibiotic usage can result in AEs.

Why this matters

  • Dentists prescribe 10% of antibiotics annually, and this percentage has remained stable.
  • 80% of prophylactic antibiotics prescribed by dentists are unnecessary.
  • Antibiotics are no longer recommended in prosthetic joint replacements or with cardiac conditions, except for those at high risk for endocarditis.
  • Antibiotic stewardship programs must include dentists, who may be unaware of reactions treated outside the dental setting.
  • Dentists are the top prescribers of clindamycin, which is linked to increased risk for Clostridium difficile infection.

Study design

  • Retrospective cohort of dental visits, 2011-2015.
  • Included patients with unnecessary prophylaxis (prophylaxis in patients who did not have manipulation of the gingiva/tooth periapex or an appropriate cardiac diagnosis).
  • Primary endpoint: cumulative incidence of AEs within 14 days postprescription, a composite of allergy, anaphylaxis, C difficile infection, and emergency department visit.

Key results

  • Of all unnecessary prophylactic antibiotics, 3.8% were associated with AEs.
  • Most frequent events were emergency department visits (1.2%) and new allergies (2.9%).
  • Clindamycin was linked to more AEs than amoxicillin (322/1000 person-years; 95% CI, 238-406).

Limitations

  • Presented at a conference without peer review.