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Concordance of antibiotic prescribing with the American Dental Association acute oral infection guidelines within Veterans’ Affairs (VA) dentistry

Published online by Cambridge University Press:  02 March 2021

Daniel B. Carlsen ,
Michael J. Durkin ,
Gretchen Gibson ,
M. Marianne Jurasic ,
Ursula Patel ,
Linda Poggensee ,
Margaret A. Fitzpatrick ,
Kelly Echevarria ,
Jessina McGregor  and
Charlesnika T. Evans
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Daniel B. Carlsen
Affiliation:
Pharmacy Department, Edward Hines Jr, Veterans’ Affairs (VA) Hospital, Hines, Illinois
Michael J. Durkin
Affiliation:
Washington University School of Medicine, St Louis, Missouri
Gretchen Gibson
Affiliation:
Oral Health Quality Group, Veterans’ Health Care System of the Ozarks, Fayetteville, Arkansas
M. Marianne Jurasic
Affiliation:
VA Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans’ Hospital, Bedford, Massachusetts Boston University Henry M Goldman School of Dental Medicine, Boston, Massachusetts
Ursula Patel
Affiliation:
Pharmacy Department, Edward Hines Jr, Veterans’ Affairs (VA) Hospital, Hines, Illinois
Linda Poggensee
Affiliation:
Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr, VA Hospital, Hines, Illinois
Margaret A. Fitzpatrick
Affiliation:
Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr, VA Hospital, Hines, Illinois Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
Kelly Echevarria
Affiliation:
VA Pharmacy Benefits Management Services, San Antonio, Texas
Jessina McGregor
Affiliation:
College of Pharmacy, Oregon State University, Corvallis, Oregon Portland State University School of Public Health, Oregon Health and Science University, Portland, Oregon VA Portland Health Care System, Portland, Oregon
Charlesnika T. Evans
Affiliation:
Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr, VA Hospital, Hines, Illinois Northwestern University Feinberg School of Medicine, Chicago, Illinois
Katie J. Suda*
Affiliation:
Center for Health Equity Research and Promotion, VA Pittsburgh Health Care System, Pittsburgh, Pennsylvania Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
*
Author for correspondence: Katie Suda, PharmD, MS, FCCP, 3609 Forbes Ave, Suite 2, Pittsburgh, PA15213. E-mail: ksuda@pitt.edu; katie.suda@va.gov
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Abstract

Objective:

United States dentists prescribe 10% of all outpatient antibiotics. Assessing appropriateness of antibiotic prescribing has been challenging due to a lack of guidelines for oral infections. In 2019, the American Dental Association (ADA) published clinical practice guidelines (CPG) on the management of acute oral infections. Our objective was to describe baseline national antibiotic prescribing for acute oral infections prior to the release of the ADA CPG and to identify patient-level variables associated with an antibiotic prescription.

Design:

Cross-sectional analysis.

Methods:

We performed an analysis of national VA data from January 1, 2017, to December 31, 2017. We identified cases of acute oral infections using International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) codes. Antibiotics prescribed by a dentist within ±7 days of a visit were included. Multivariable logistic regression identified patient-level variables associated with an antibiotic prescription.

Results:

Of the 470,039 VA dental visits with oral infections coded, 12% of patient visits with irreversible pulpitis, 17% with apical periodontitis, and 28% with acute apical abscess received antibiotics. Although the median days’ supply was 7, prolonged use of antibiotics was frequent (≥8 days, 42%–49%). Patients with high-risk cardiac conditions, prosthetic joints, and endodontic, implant, and oral and maxillofacial surgery dental procedures were more likely to receive antibiotics.

Conclusions:

Most treatments of irreversible pulpitis and apical periodontitis cases were concordant with new ADA guidelines. However, in cases where antibiotics were prescribed, prolonged antibiotic courses >7 days were frequent. These findings demonstrate opportunities for the new ADA guidelines to standardize and improve dental prescribing practices.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 12 , December 2021 , pp. 1422 - 1430
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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