Methods: This was a cross-sectional study of patients undergoing tooth extractions, dental implants and periodontal procedures in 2015. These procedures are among the most common procedures with the potential for bacteremia post-dental procedure. Patients receiving antibiotics for a separate oral or non-oral infection on the date of the dental procedure were excluded.
Results: Of 183 Veterans undergoing the included dental procedures, 82.5% received antibiotic prophylaxis. Amoxicillin (71.3% of antibiotics) and clindamycin (23.8%) were prescribed most frequently; 44.7% of clindamycin was prescribed to patients not labeled as penicillin allergic. The mean duration of antibiotics was 7.1 +/- 1.6 (1-14) days; 82.5% receiving seven days supply. Of those that received antibiotic prophylaxis, 92.1% received post-procedure antibiotics only, 2.6% pre-procedural antibiotics only and 5.3% received pre- and post-procedure antibiotics. When prophylaxis was indicated (procedure and/or cardiac condition), 85.3% received an antibiotic. However, 72.7% received post-procedure antibiotics when only pre-procedure administration was indicated. When pre-procedure antibiotics were indicated, 11.5% did not receive any antibiotics (pre- or post-procedure). Only 8.2% received antibiotics appropriately based on administration time, procedure and co-morbidities. Three months post-procedure, there were no occurrences of Clostridium difficile, infective endocarditis, prosthetic joint infections or oral infections.
Conclusion: The majority of patients undergoing a dental procedure received antibiotic prophylaxis. While the majority of these antibiotics were indicated pre-procedure, prescribing of post-procedure antibiotic for excessive durations was frequent. Dental stewardship efforts should ensure appropriate timing, indications, and duration of antibiotic prophylaxis.
H. Henschel, None
M. Fitzpatrick, None
C. Evans, None