Dental News - Antibiotics for dental procedures linked to superbug infection

Dental Tribune International

Fri. 13. October 2017

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SAN DIEGO, USA: New research has found that the unnecessary prescription of antibiotics by dentists may be playing a significant role in cases of Clostridium difficile, a serious and potentially deadly infection that causes severe diarrhea. The researchers who conducted the study presented their findings at IDWeek 2017, held from 4 to 8 October in San Diego, specifying the importance of using medication only when needed.

The researchers, from the Minnesota Department of Health (MDH), focused on five counties within the state. In interviews with 1,626 people with community-associated C. difficile between 2009 and 2015, 57 percent reported having been prescribed antibiotics, 15 percent of whom received them for dental procedures. The study found that patients who were prescribed antibiotics for dental procedures tended to be older and more likely to receive clindamycin, an antibiotic that is associated with C. difficile infection. Of those who had received antibiotics for dental procedures, 34 percent had no mention of antibiotics in their medical charts.

“Dentists have been overlooked as a source of antibiotic prescribing, which can potentially delay treatment when doctors are trying to determine what is causing a patient’s illness,” said Dr. Stacy Holzbauer, lead author of the study and career epidemiology field officer for the Centers for Centers for Disease Control and Prevention (CDC) and MDH. “It’s important to educate dentists about the potential complications of antibiotic prescribing, including C. diff. Dentists write more than 24.5 million prescriptions for antibiotics a year. It is essential that they be included in efforts to improve antibiotic prescribing,” she added.

Some dentists prescribe antibiotics before treatment to prevent a heart infection in patients with cardiovascular conditions or to prevent an infection of an artificial joint, such as a hip or knee replacement; however, the American Dental Association (ADA) no longer recommends preventive antibiotics in most of those cases, as it once did. Current recommendations note that the risk of taking antibiotics—such as developing C. difficile—is greater than the risk of an infection in those cases. Additionally, the inappropriate use of antibiotics helps fuel the creation of drug-resistant bacteria, which are very difficult to treat.

“Research has shown that reducing outpatient antibiotic prescribing by 10 percent could decrease C. diff rates outside of hospitals by 17 percent,” said Holzbauer. “Limiting the use of inappropriate antibiotics in dentistry could also have a profound impact,” she said.

C. difficile may occur after just one dose of antibiotics and is one of the top three most urgent antibiotic-resistant threats identified. It causes almost half a million infections and leads to 15,000 deaths in a single year in the U.S., according to CDC estimates.

In an earlier survey, also conducted by MDH, it was found that 36 percent of dentists prescribed antibiotics in situations in which this is generally not recommended by the ADA. Additionally, it reported that dentists had challenges in making appropriate antibiotic prescribing decisions, including confusion about or perceived conflicts among prescribing guidelines.

IDWeek is a joint meeting of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association and the Pediatric Infectious Diseases Society.