Thornhill, M. orcid.org/0000-0003-0681-4083, Gibson, T., Durkin, M. et al. (4 more authors) (2020) Prescribing of antibiotic prophylaxis to prevent infective endocarditis. Journal of the American Dental Association, 151 (11). 835-845.e31. ISSN 0002-8177
Abstract
Background In 2007, the American Heart Association recommended that antibiotic prophylaxis (AP) be restricted to those at high risk of developing complications due to infective endocarditis (IE) undergoing invasive dental procedures. The authors aimed to estimate the appropriateness of AP prescribing according to type of dental procedure performed in patients at high risk, moderate risk, or low or unknown risk of developing IE complications.
Methods Eighty patients at high risk, 40 patients at moderate risk, and 40 patients at low or unknown risk of developing IE complications were randomly selected from patients with linked dental care, health care, and prescription benefits data in the IBM MarketScan Databases, one of the largest US health care convenience data samples. Two clinicians independently analyzed prescription and dental procedure data to determine whether AP prescribing was likely, possible, or unlikely for each dental visit.
Results In patients at high risk of developing IE complications, 64% were unlikely to have received AP for invasive dental procedures, and in 32 of 80 high-risk patients (40%) there was no evidence of AP for any dental visit. When AP was prescribed, several different strategies were used to provide coverage for multiple dental visits, including multiday courses, multidose prescriptions, and refills, which sometimes led to an oversupply of antibiotics.
Conclusions AP prescribing practices were inconsistent, did not always meet the highest antibiotic stewardship standards, and made retrospective evaluation difficult. For those at high risk of developing IE complications, there appears to be a concerning level of underprescribing of AP for invasive dental procedures.
Practical Implications Some dentists might be failing to fully comply with American Heart Association recommendations to provide AP cover for all invasive dental procedures in those at high risk of developing IE complications.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2020 American Dental Association. This is an author produced version of a paper subsequently published in Journal of the American Dental Association. Uploaded in accordance with the publisher's self-archiving policy. Article available under the terms of the CC-BY-NC-ND licence (https://creativecommons.org/licenses/by-nc-nd/4.0/). |
Keywords: | Infective endocarditis; antibiotic prophylaxis; dental procedures; guidelines; prevention; antibiotic stewardship; risk |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Clinical Dentistry (Sheffield) |
Funding Information: | Funder Grant number DELTA DENTAL UNSPECIFIED |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 27 Jul 2020 15:04 |
Last Modified: | 26 Oct 2021 00:38 |
Status: | Published |
Publisher: | Elsevier |
Refereed: | Yes |
Identification Number: | 10.1016/j.adaj.2020.07.021 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:163770 |
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Filename: Endocarditis Prophylaxis Manuscript - Final (with Figs) June-12-2020.pdf
Licence: CC-BY-NC-ND 4.0