Evaluation of antibiotic prescribing for ambulatory patients seeking primary dental care services in a public hospital in Ghana: a clinical audit study

Abstract

Background One in 10 of all antibiotic prescriptions globally are for dental conditions with 80% of them being inappropriate, making it a potential driver of antimicrobial resistance. Objectives To evaluate the appropriateness of antibiotic use among ambulatory patients seeking dental care services in a public hospital in Ghana. Methods A retrospective clinical audit was conducted by extracting the medical records of all patients seeking dental care at the ambulatory care clinic of Keta Municipal Hospital (KMH) from January 2020 to December 2020 using the hospital’s electronic database. Descriptive statistics, bivariate and multivariate analysis were performed on the data collected. Results Overall, 1433 patient medical records were extracted from the database within the study period. The mean age of the patients identified was 39.9 years with almost two-thirds being female. The majority (91.1%, n = 1306) of them were attended to by a dental nurse. In total, 88.6% (n = 1269) of the patients received antibiotics and 87.5% (n = 1254) of antibiotics prescribed were non-compliant with Ghana Standard Treatment Guidelines. Three-quarters of the dental conditions were managed with dual antibiotics comprising amoxicillin and metronidazole. Antibiotic prescription was associated with age, gender, type of prescriber and type of dental condition diagnosed. Conclusions There is a high usage of antibiotics for dental conditions managed at the outpatient section of the hospital and most are inappropriate. Development of local guidelines supported by education of dental clinicians on empirical use of antibiotics is a suitable target for the antimicrobial stewardship team to address in KMH.

Exploring the Use of Antibiotics for Dental Patients in a Middle-Income Country: Interviews with Clinicians in Two Ghanaian Hospitals

“…Two hospitals in Ghana were the setting for this study: One is a 100-bed hospital in Accra (Ghana’s capital city), and the other is a 110-bed government hospital in a rural area within the Volta Region. These hospitals were selected due to their involvement in a previous AMS project and previous studies of dental antibiotic use [ 13 , 14 ].…”

“…Whilst dentistry was not included in either of these AMS programmes, recent audits in both hospitals found high rates of dental antibiotic use: dental teams were the highest prescribers of antibiotics, responsible for >20% of antibiotics prescribed in one hospital [ 13 ]. The audits also found high rates of antibiotic misuse: nearly 90% of dental patients in an-other hospital received an antibiotic, of which 88% were non-compliant with national standard treatment guidelines [ 14 ]. This study aimed to explore the antibiotic prescribing behaviour of dental teams and knowledge/beliefs about antibiotic stewardship at these two hospitals in Ghana.…”

Antibiotics in Dentistry: A Narrative Review of the Evidence beyond the Myth

“…Sefah, 2022 JAC-antimicrobial resistance [54] Retrospective "Evaluation of antibiotic prescribing for ambulatory patients seeking primary dental care services in a public hospital in Ghana: a clinical audit study"…”

“…The findings of the various studies about the epidemiology of antibiotic consumption and prescription indicated a lack of adherence to professional guidelines in prescribing antibiotics in dentistry. Only a small percentage of dentists refer to published guidelines for proper antibiotic prescribing, and an even smaller percentage were aware of national action plans on antibiotic resistance [17,18,20,21,28,29,54]. There was still also a lack of knowledge and uniformity in antibiotic prescriptions among dentists in different countries, including Saudi Arabia [18], Pakistan [17], Kuwait [52], Ghana [54], Italy [5], United Kingdom [25], Croatia [30], India [23], Lebanon [39], Northern Ireland [40], and Israel [57].…”

“…Only a small percentage of dentists refer to published guidelines for proper antibiotic prescribing, and an even smaller percentage were aware of national action plans on antibiotic resistance [17,18,20,21,28,29,54]. There was still also a lack of knowledge and uniformity in antibiotic prescriptions among dentists in different countries, including Saudi Arabia [18], Pakistan [17], Kuwait [52], Ghana [54], Italy [5], United Kingdom [25], Croatia [30], India [23], Lebanon [39], Northern Ireland [40], and Israel [57]. The survey results highlighted a divergence in antibiotic prescribing practices also among different dental specialists [18,19,38].…”