Antibiotic Stewardship

Antibiotic stewardship is the effort to measure antibiotic prescribing; to improve antibiotic prescribing by clinicians and use by patients so that antibiotics are only prescribed and used when needed; to minimize misdiagnoses or delayed diagnoses leading to underuse of antibiotics; and to ensure that the right drug, dose, and duration are selected when an antibiotic is needed.  For more information on antibiotic stewardship, including a printable checklist for antibiotic prescribing in dentistry [PDF-332K], visit CDC’s Get Smart: Know When Antibiotics Work website.

Inappropriate antibiotic use contributes to the spread of antibiotic resistance (meaning that drugs may be less likely to work in the future). Inappropriate antibiotic use also contributes to increased health care costs, adverse drug reactions, and health care and community-associated Clostridium difficile infections (a potentially deadly form of diarrhea). Annually in the United States, approximately two million people develop infections from antibiotic-resistant bacteria, and 23,000 people die as a result of these infections.

At the end of an article on “Combating antibiotic resistance,” the American Dental Association (ADA) Council on Scientific Affairs provides a set of clinical guidelines [PDF-133K] that should be used as a resource when prescribing antibiotics. The ADA also provides guidance for antibiotic prophylaxis prior to dental procedures, focused on prevention of prosthetic joint infection and infective endocarditis.  In 2015, ADA released the following clinical recommendation for management of patients with prosthetic joints undergoing dental procedures: “In general, for patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection. For patients with a history of complications associated with their joint replacement surgery who are undergoing dental procedures that include gingival manipulation or mucosal incision, prophylactic antibiotics should only be considered after consultation with the patient and orthopedic surgeon. To assess a patient’s medical status, a complete health history is always recommended when making final decisions regarding the need for antibiotic prophylaxis.”

Additional resources include the American Academy of Pediatric Dentistry’s Guideline on Use of Antibiotic Therapy for Pediatric Dental Patients [PDF-120K] and the American Association of Endodontists’ Use and Abuse of Antibiotics [PDF-1M].

Among health care providers in 2014, general dentists prescribed about 9% of all antibiotic prescriptions (approximately 24.9 million prescriptions). An important principle of antibiotic stewardship, for dentists and all health care providers, is to only prescribe antibiotics when medically necessary. Dentists should educate their patients on when antibiotics are needed. Because the scientific literature is constantly evolving, dentists should routinely review and incorporate available guidelines (see previous question) into their daily clinical practice and seek continuing education on proper treatment and management of oral infections.

For more information, see “Considerations for responsible antibiotic use in dentistry,” a paper supported by the Organization for Safety, Asepsis and Prevention (OSAP) for the Safest Dental Visit campaign.