An investigation of therapeutic antibiotic prescribing for children referred for dental general anaesthesia in three community national health service trusts.

OBJECTIVE

To investigate antibiotic prescribing for paediatric dental patients requiring general anaesthesia.

DESIGN

A prospective clinical study of children referred for dental treatment under general anaesthesia.

METHOD

Information was collected by way of a two-stage questionnaire for children attending three community NHS trusts for dental extractions under general anaesthesia between July 2001 and January 2003.

RESULTS

A total of 360 questionnaires were analysed. There was wide variation in the waiting times (0-278 days) between referral and treatment under general anaesthesia. Most children (53%) attended with dento-alveolar abscess, 46% with caries only and 1% for orthodontic extractions. Antibiotics were prescribed to 52% of patients with an abscess and 32% with caries only. Only 16% of patients presented with moderate to severe pain, 5.5% with diffuse swelling and 12% with a raised temperature. Antibiotics were prescribed for patients with diffuse swelling (63%) and raised temperature (50%) but also for patients with pain only (39%) and localised swelling (52%). Amoxicillin was the most frequently prescribed antibiotic (82%), with wide variation in all antibiotic regimens.

CONCLUSION

This study provides evidence of inappropriate prescribing of antibiotics to children referred for treatment under general anaesthesia with wide variations in the regimens employed. There was no conclusive evidence that long waiting times for definitive treatment influenced antibiotic prescribing. In some areas the delay for definitive treatment for this group of vulnerable patients was unacceptably long.