Division of Hospital Medicine, Department of Medicine, University of California San Francisco, San Francisco, California.
Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, Illinois; Department of Preventive Medicine, Center for Health Services and Outcomes Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Am J Prev Med. 2022 Jun;62(6):943-948. doi: 10.1016/j.amepre.2021.11.004. Epub 2022 Jan 7.
Prescribing antibiotic prophylaxis is common yet unnecessary for many dental visits. In this analysis, our objective was to assess whether the appropriateness of antibiotic prophylaxis has improved over time.
A retrospective cohort study was conducted using dental visits from 2016 to 2018 (data analyzed in 2021) using medical and prescriptions claims data of patients from the U.S. with commercial dental insurance. Antibiotic prophylaxis was defined as a ≤2 days' supply prescription dispensed within 7 days before a dental visit. Appropriateness of prophylaxis was defined on the basis of the manipulation of the gingiva/tooth periapex or oral mucosa perforation in patients with appropriate cardiac diagnoses. Associations between patient and visit characteristics and appropriateness of antibiotic prophylaxis were assessed using multiple Poisson regression.
Unnecessary antibiotic prophylaxis was highly prevalent in this cohort, ranging from 77.0% in 2016 to 78.5% in 2018. In the adjusted analysis, factors associated with unnecessary antibiotic prophylaxis included younger age, female sex, geographic region, rurality, type of antibiotic, and certain dental procedures. The factors associated with the highest risk of unnecessary prophylaxis in the adjusted analysis were orthodontic procedures and having a history of a prosthetic joint. Notably, the risk of unnecessary antibiotic prophylaxis decreased over time in the adjusted analysis.
Unnecessary prescription of antibiotic prophylaxis by dentists continues to be common. Antimicrobial stewardship strategies are needed to improve prescribing by dentists.
在许多牙科就诊中，开具抗生素预防用药很常见，但并非必要。在这项分析中，我们的目的是评估抗生素预防用药的适宜性是否随时间推移而有所改善。
本研究采用回顾性队列研究，利用美国商业医保患者的医疗和处方数据，分析了 2016 年至 2018 年（于 2021 年进行分析）的牙科就诊数据。抗生素预防用药的定义为在牙科就诊前 7 天内配给的 ≤2 天用量的处方。根据适当心脏诊断的患者对牙龈/牙齿根尖或口腔黏膜穿孔的操作，确定预防用药的适宜性。使用多泊松回归评估患者和就诊特征与抗生素预防用药适宜性之间的关联。
在本队列中，不必要的抗生素预防用药非常普遍，从 2016 年的 77.0%到 2018 年的 78.5%不等。在调整分析中，与不必要抗生素预防用药相关的因素包括年龄较小、女性、地理位置、农村地区、抗生素类型和某些牙科手术。在调整分析中，与不必要预防用药风险最高相关的因素是正畸治疗和有假体关节病史。值得注意的是，在调整分析中，不必要抗生素预防用药的风险随时间推移而降低。
牙医开具不必要的抗生素预防用药仍然很常见。需要采取抗菌药物管理策略来改善牙医的处方行为。
