The impact of clinical audit on antibiotic prescribing in general dental practice

Abstract

• Describes an audit undertaken in the East of England on antibiotic prescribing in general dental practice.• The protocols of an original North West of England audit published in 2001 were deliberately replicated, in order to be able to pool the data and obtain a sample size of at least 1% of all UK dentists.• The combined Regional results confi rm that clinical audit reduces both the number of errors made by dental practitioners when writing out a prescription, as well as the number of those which are issued inappropriately, as compared to contemporary prescribing guidelines. I N B R I E FThe impact of clinical audit on antibiotic prescribing in general dental practice Objective To reduce the number of antibiotics inappropriately prescribed by general dental practitioners, and to increase overall prescription accuracy. Design A prospective clinical audit carried out between September and March of 2002-3 and 2003-4. Setting General dental practices in Eastern England. Subjects and methods The pre-audit antibiotic prescribing practices of 212 general dental practitioners were recorded over an initial six week period. On each occasion this included which antibiotic had been chosen, together with its dose, frequency and duration, as well as the clinical condition and reason for which the prescription had been raised. When related to prophylaxis, the patient's medical history was also noted. Following education on contemporary prescribing guidelines, presentations which illustrated the practitioners' previous errors, and the agreement of standards to be achieved, the process was repeated for another six weeks, and the results compared. Results In the pre-audit period, 2,951 antibiotic prescriptions were issued, and during the audit this was reduced by 43.6% to 1,665. The majority were for therapeutic reasons, with only 10.5% and 13.6% for medical prophylaxis during the pre-audit and audit periods respectively. Over both periods, amoxicillin and metronidazole were the two most commonly prescribed antimicrobials (63.4% and 21.2% respectively). In the pre-audit period, only 43% of all prescriptions were error free in dose, frequency, and/or duration of use, but this rose signifi cantly to 78% during the audit. Equally, using contemporary published guidelines, out of all the prescriptions made in the pre-audit period, only 29.2% were deemed to be justifi ed, as compared to 48.5% during the audit. Conclusions Clinical audit, in conjunction with education, and prescribing guidelines can favourably change antibiotic prescribing patterns among general dental practitioners.

Prophylactic and Therapeutic Antibiotic Patterns of Lebanese Dentists for the Management of Dentoalveolar Abscesses

“…These findings indicate a lack of knowledge and a misunderstanding of the involved pathologies, the impairment of the host defenses, the indication of prophylactic antibiotherapy, and the need to educate dentists on current prescription guidelines to favorably change their prescription behavior. 15 However, age is an important factor to consider because the complications associated with adverse effects resulting from the use of antibiotics can be more serious in very young and old patients. At least two previous studies reported that antibiotics were prescribed inappropriately to children most probably in a preventative proactive manner.…”

“…7 , 8 , 15 These results were not surprising because it was previously observed that dentists were reticent on prescribing antibiotics for the management of localized swellings: Despite a course given to dentists on the current prescribing guidelines, the level of unjustifi ed prescriptions after the course increased in the presence of a localized swelling. 15 In this study, a proper decision with regards to prescribing antibiotics or refraining from prescribing them was made for 19 and 22 patients respectively, corresponding to 48.3% of patients with an acute dentoalveolar abscess. Within this context, antibiotics were dispensed inappropriately to 16/42 patients (38.1%) with a chronic dentoalveolar abscess; antibiotics were not administered rightfully to the 26/42 remaining patients with a chronic abscess.…”

“…16 , 21 Continuous educations could help in changing the behavior of dentists in prescribing prophylactic antibiotics. 15 The current recommendations for therapeutic antibiotics also vary among countries. 6,22 In North America, Penicillin V and K are the antibiotics of choice for the management of dental infections.…”

An outcome audit of three day antimicrobial prescribing for the acute dentoalveolar abscess

“…Despite significant reductions in prescribing habits following education, it is still apparent that excessive prescriptions are being issued. 16,[18][19] Note has also been made of the vulnerability of general dental and medical practitioners in relation to such inappropriate prescribing in terms of potential litigation. 21 A study by Kuriyama et al 15 highlights the excellent success rates in achieving stabilisation and improvement in the clinical situation following surgical drainage of the dentoalveolar infection along with rational prescribing.…”

“…7 A number of audits have been carried out looking into the prescribing habits of general dental and general medical practitioners. [15][16][17][18][19][20] Overwhelmingly these show that the antimicrobial prescribing habits are high when managing patients with acute dental pain, whether or not there is frank infection involved, and that there is wide variation in the type of antimicrobial prescribed, its dose and duration. They also highlight the lack of guidelines suggesting appropriateness in prescribing and illustrate how effective education is in reducing unnecessary prescriptions.…”