A study of prophylactic antibiotic prescribing in National Health Service general dental practice in England

Objective To study the use of prophylactic antibiotics by general dental pr actitioners. Design A postal questionnaire of National Health Service (NHS) general dent al practitioners in ten English Health Authorities. Subjects General dental practitioners (GDPs) (1544) contracted to provide N HS treatment in the Health Authorities of Liverpool, Wirral, Oxfordshire, B uckinghamshire, Nottingham, North Nottinghamshire, Sheffield, Newcastle, No rthumberland and North Tyneside. Main outcome measures The questionnaires were analysed and the responses to each question expressed as absolute frequencies. Results Responses to the questionnaires were received from 929 (60.1%) prac titioners. Over 40% of general dental practitioners would prescribe prophyl actic antibiotics for patients with no relevant medical history for minor o ral surgery to prevent postoperative infection. Amoxicillin was the predomi nant choice of antibiotic in this situation. Between 15-67% of GDPs failed to prescribe prophylactic antibiotics for at risk medically compromised pat ients. GDPs also prescribed for patients with a medical history not known t o be at risk from dental procedures, Over 50% of GDPs however, would seek s pecialist advice about prophylaxis if they were unsure of the indications a nd over 90% of GDPs indicated they would use the current recommended regime for antibiotic prophylaxis for patients at risk of infective endocarditis. Conclusions The evidence from this study suggests that a significant number of the practitioners surveyed prescribe prophylactic antibiotics inappropr iately, both for surgical procedures and for patients at risk from endocard itis. There is also evidence that practitioners prescribe antibiotic prophy laxis for clinical procedures and medical conditions for which there is lit tle evidence. The results suggest that there is a need for the development of guidelines for practitioners on the appropriate prophylactic use of anti biotics.