A survey of antibiotic use in dentistry

Background. Antibiotics are important in the management and prophylaxis of infection in patients at risk of experiencing microbial disease. As a resul t of the increase in antimicrobial resistance, the authors conducted a surv ey to assess current antibiotic use in dental practice. Methods. The authors mailed a two-page, pretested survey to all licensed de ntal practitioners in British Columbia, Canada. A total of 2,542 suveys wer e mailed; 19.9 percent were returned by fax or mail. The authors examined a n association between factors analyzed using a chi (2) test. Results. Respondents were demographically consistent with all registered de ntists in British Columbia. They reported writing an average of 4.45 prescr iptions per week. Antibiotics prescribed after treatment primarily were pen icillin and its derivatives. Recommended adult doses of penicillin were pre scribed by 59.2 percent of respondents; recommended daily doses of amoxicil lin were prescribed by 72.2 percent of respondents. The average prescriptio n duration was 6.92 days. Respondents prescribed prophylactic antibiotics a n average of 1.15 times per week for prophylaxis of bacterial endocarditis; 17.5 percent reported postoperative dosing for prophylaxis, ranging from a one-to seven-day prescription with an average of 6.91 postoperative doses. Preoperative antibiotics were prescribed for patients with a history of rh eumatic fever or any heart murmur or prosthetic hip. Antibiotics were presc ribed more frequently for surgical procedures and patients with acquired im munodeficiency syndrome than for other circumstances. Conclusions. More than 80 percent of respondents reported that they followe d current American Heart Association prophylaxis guidelines. The authors, h owever, noted discrepancies in prophylactic use of antibiotics for bacteria l endocarditis and for patients with large joint prostheses, as well as in prescribing antibiotics in the presence of clinical infection. In therapeut ic use, approximately 85 percent of respondents followed appropriate prescr iption guidelines for dosing and duration of therapy. Clinical Implications. Appropriate and correct use of antibiotics is essent ial to ensure that effective and safe treatment is available and that pract ices that may enhance microbial resistance are avoided. To improve standard s of care, dentists need up-to-date pharmacology in dental education, as we ll as continuing education, further outcome studies and continuous assessme nt of dental practices.