Content Dam De Print Articles Volume 106 Issue 8 Prophy Antibiotics Thumb

An update on prophylactic antibiotics

Aug. 25, 2016
Aside from primary-care physicians, dentists are the leading prescribers of antibiotics and are in a unique position to mitigate their overuse. Read more about current prophylactic antibiotic use in dentistry here.

A 2013 study by the Centers for Disease Control and Prevention reported that an estimated 2 million antibiotic-resistant illnesses and 23,000 deaths occur annually in the United States. (1)

The American Dental Association (ADA) and other health professions have begun addressing the problem, working to improve judicious antibiotic use and cut inappropriate prescribing-a commonly cited goal being a reduction of 50% in practices and 20% in hospitals.

While primary-care providers understandably prescribe the most antibiotics, among other health-care providers, dentists are the leading prescribers. Therefore, dentists are in a unique position to help mitigate the problem of overprescribing.

While previous recommendations called for prophylactic antibiotics (PAs) to be prescribed prior to dental procedures for millions of Americans, we know now that PAs are necessary for only very select groups of patients. They should be used only when necessary, since antibiotics carry individual risks to the patients using them and also risks to the population by increasing the incidence of antibiotic-resistant bacteria. In an effort to decrease antibiotic-resistant bacteria and prevent multidrug-resistant infections, the ADA has provided guidance to its members on the appropriate use of antibiotics, as well as a number of published articles on the topic, to change the way they look at PA regimens.

READ MORE | Insufficient evidence to premedicate patients with joint replacements prior to dental procedures: Great, but what should I do in my office?

For infective endocarditis prophylaxis, the ADA has continued its efforts to promulgate the 2007 American Heart Association guidelines. It supports premedication only for the much smaller group of patients who are at the highest risk of adverse outcomes from infective endocarditis. This effort has had the effect of more appropriate use of PAs with the result of decreasing antibiotic prescription.

The ADA also recommends more judicious uses of antibiotics for people who have had joint replacements. As stated in the ADA chairside guide, in general, PAs "are not recommended prior to dental procedures to prevent prosthetic joint infection." (2) The practitioner and patient should consider the individual circumstances that may suggest if there is a significant medical risk associated with providing dental care without antibiotic prophylaxis, as well as the risks of frequent antibiotic use. To assess a patient's medical status, a complete medical history is always recommended when making final decisions regarding the need for antibiotic prophylaxis.

All decisions regarding PAs should be made using professional judgment and patient- specific data, needs, and preferences. We should not prescribe antibiotics without a clear medical reason to do so. Dentists and physicians must work together to be stewards of these life-saving medications.

READ MORE | Stop premedicating! ADA review examines treatment of patients with prosthetic joints

For more information on PAs prior to dental procedures, visit ADA.org.

References
1. Antibiotic Resistance Threats in the United States, 2013. Centers for Disease Control and Prevention website. http://www.cdc.gov/drugresistance/threat-report-2013/. Published 2013. Accessed June 3, 2016.
2. Management of patients with prosthetic joints undergoing dental procedures. ADA website. http://www.ada.org/~/media/EBD/Files/ADA_Chairside_Guide_Prosthetics.pdf?la=en. Accessed July 20, 2016.

Thomas P. Sollecito, DMD, is professor and chair of Oral Medicine at the University of Pennsylvania School of Dental Medicine. He is an attending in oral medicine at the Hospital of the University of Pennsylvania and a clinical associate at the Children's Hospital of Philadelphia. He completed his DMD degree program at the University of Pennsylvania. He is a diplomate in oral medicine and a fellow and diplomate in hospital dentistry of the Special Care in Dentistry Organization.

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