Methods: All outpatient prescriptions are entered in the BC Pharmanet database. We obtained anonymized, line-listed data on prescriptions from 1996-2013, including a variable coding for licensing body of the prescriber. Analyses were conducted in SAS and Excel using Anatomical Therapeutic Classification (ATC) standard codes and defined daily dose values. Rates of prescribing and utilization were normalized to the BC population and expressed in defined daily doses per 1000 persons per day (DID). To evaluate the reasons for trends, a webinar was held through the Canadian Dental Association, inviting correspondence from dentists about the drivers of antibiotic use in practice.
Results: From 1996-2013, overall community antibiotic use in BC declined from 18.2 to 15.9 DID and physician prescribing for antibiotics declined 18.2% from 17.4 to 14.1 DID. However, dental surgeons increased their rate 62.2% from 0.98 to 1.59 DID and their proportionate contribution of prescriptions from 6.7% to 11.3%. The rate of prescribing increased the most for dental patients aged 60 and over. We had 30 communications from US and Canadian dentists in response to the webinar and the following explanatory themes emerged: Unnecessary prescription for periapical abscess and irreversible pulpitis; increase in use of dental implants and associated complications; slow adoption of newer guidelines calling for less perioperative antibiotic coverage for patients with valvular heart disease and prosthetic joints; emphasis on cosmetic practice reducing the surgical skill-set of the average dentist; under-insurance driving antibiotics as a substitute for surgery; aging population; and more dental registrants per capita.
Conclusion: The above themes should be further validated in other studies but may already guide priorities in antibiotic stewardship for continuing dental education.
D. George, None
M. Chong, None
J. O'keefe, None
E. Blondel-Hill, None
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