Use of Antibiotic Prophylaxis for Tooth Extractions, Dental Implants, and Periodontal Surgical Procedures

Abstract

BackgroundGuidelines for antibiotics prior to dental procedures for patients with specific cardiac conditions and prosthetic joints have changed, reducing indications for antibiotic prophylaxis. In addition to guidelines focused on patient comorbidities, systematic reviews specific to dental extractions and implants support preprocedure antibiotics for all patients. However, data on dentist adherence to these recommendations are scarce.MethodsThis was a cross-sectional study of veterans undergoing tooth extractions, dental implants, and periodontal procedures. Patients receiving antibiotics for oral or nonoral infections were excluded. Data were collected through manual review of the health record.ResultsOf 183 veterans (mean age, 62 years; 94.5% male) undergoing the included procedures, 82.5% received antibiotic prophylaxis (mean duration, 7.1 ± 1.6 days). Amoxicillin (71.3% of antibiotics) and clindamycin (23.8%) were prescribed most frequently; 44.7% of patients prescribed clindamycin were not labeled as penicillin allergic. Of those who received prophylaxis, 92.1% received postprocedure antibiotics only, 2.6% received preprocedural antibiotics only, and 5.3% received pre- and postprocedure antibiotics. When prophylaxis was indicated, 87.3% of patients received an antibiotic. However, 84.9% received postprocedure antibiotics when preprocedure administration was indicated. While the majority of antibiotics were indicated, only 8.2% of patients received antibiotics appropriately. The primary reason was secondary to prolonged duration. Three months postprocedure, there were no occurrences of Clostridium difficile infection, infective endocarditis, prosthetic joint infections, or postprocedure oral infections.ConclusionThe majority of patients undergoing a dental procedure received antibiotic prophylaxis as indicated. Although patients for whom antibiotic prophylaxis was indicated should have received a single preprocedure dose, most antibiotics were prescribed postprocedure. Dental stewardship efforts should ensure appropriate antibiotic timing, indication, and duration.

The effect of systemic antibiotics on clinical and patient‐reported outcome measures of oral implant therapy with simultaneous guided bone regeneration

“…The broad-spectrum antibiotic used was amoxicillin (Moxilen ® Medochemie, Cyprus), a well-documented semi-synthetic analogue of ampicillin, derived from the basic penicillin nucleus (6-aminopenicillanic acid) providing a broad spectrum of bactericidal activity against many gram-positive and gram-negative microorganisms (Suda et al, 2017). It is, however, susceptible to degradation by β-lactamases, and therefore, its spectrum of activity does not include organisms producing these enzymes.…”

“…The use of systemic oral antibiotics as prophylaxis against post-surgical infection in implant dentistry has been documented (Esposito, Grusovin, & Worthington, 2013). However, recommendations with regard to antibiotic prophylaxis in guided bone regeneration procedures are often based on personal and anecdotal experience (Deeb, Soung, Best, & Laskin, 2015;Suda, Henschel, Patel, Fitzpatrick, & Evans, 2017). With the increasing worldwide demand for oral implants and oral bone augmentation procedures and the development of antibiotic resistance due to indiscriminate usage, the use of antibiotics with standard oral implant therapy and GBR should be re-evaluated and proper guidelines established (Tan et al, 2014).…”

Are Dentists Prescribing the Antibiotics in Justified Conditions? An Exploratory Study

“…[7][8][9][10] Antimicrobial resistance has been identified as one of the greatest threats to future human health with an increasing number of resistant microbial strains reported each year across both human and animal populations in developed and developing countries. 21,22 Policymakers, health organizations, and research institutes have called for tighter control over their distribution and use in society 5,6 with an emphasis on front-line antibiotic prescribers and dispensers 7 While efforts have been sustained over many years to promote the 'rational use of drugs', for example through the WHO's International Network on the Rational Use of Drugs program (INRUD), the scale of antibiotic use appears to be escalating. [15][16][17] An increase in antibiotic resistance (ABR) worldwide, specifically in developing countries, necessitates the need to pay attention to antibiotics prescription and knowledge and awareness of Antibiotic Resistance among dental practitioners.…”

Prescribing practices for antibiotic prophylaxis in patients with prosthetic joints

“…The findings in this study are consistent with other publications. [28][29][30] Most respondents would still recommend AP for the first years after joint replacement, which shows their level of knowledge does not reflect their current practice behavior. In some countries, the practice of recommending AP before a dental procedure is not even considered due to the lack of support for effectiveness 23 while in others, it is a controversial topic.…”