Not only are antibiotics vastly overprescribed before most dental visits, using them for even a day or two increases the risk of serious side effects such as an allergic reaction or Clostridioides difficile (C. diff) infection, according to a large national study being presented at IDWeek 2019.
Antibiotics are often prescribed for a day or two before dental visits to prevent infections in certain people, such as those who have had hip or knee replacements, but current American Dental Association and American Heart Association guidelines no longer recommend this in most cases. The study of nearly 170,000 dental visits determined 80% of antibiotics prescribed before dental visits to prevent infection are unnecessary.
“While antibiotics can be life-saving, they can cause significant adverse events even after being taken for only a day or two,” said Alan E. Gross, PharmD, clinical associate professor at the University of Illinois at Chicago College of Pharmacy. “Also, misuse can lead to antibiotic resistance. Antibiotics should only be prescribed when necessary and people should talk with their dentist or physician to ask if they truly need antibiotics prior to a dental visit.”
Prescribing preventive (prophylactic) antibiotics before dental procedures remains common practice, the study shows. Under current guidelines, antibiotic prophylaxis is only recommended for patients who have a significant risk of getting a heart infection after having invasive dental procedures, such as those with a prosthetic heart valve.
Researchers analyzed a national claims database from 2011-2015 and determined preventive antibiotics were prescribed before 168,420 dental visits. Based on current ADA and AHA recommendations, they were prescribed unnecessarily for 136,177 (80%) visits and of those, 5,260 (3.8%) were associated with an adverse event within 14 days, including 3,912 allergic reactions (from simple rashes to potentially more severe reactions requiring hospitalization), 1,568 emergency room visits (potentially due to other adverse reactions) and 9 C. diff infections. They also determined clindamycin was associated with more adverse events than amoxicillin.
Outside of the hospital, clindamycin is more likely to be prescribed by dentists than any other health care providers. Even a single dose of clindamycin can cause C. diff, or an allergic reaction. Amoxicillin is the antibiotic most commonly prescribed by dentists and it can cause severe allergic reactions even after a single dose.
“While the vast majority of dental patients who take preventive antibiotics will not have a severe reaction, this is a reminder that antibiotics are not innocuous, even if taken for only a day or two,” said Katie J. Suda, PharmD, MS, associate professor at the University of Illinois at Chicago College of Pharmacy. “Ultimately, if an antibiotic is not indicated we should try to avoid exposure to them to lessen the likelihood of patient harm.”
In addition to Drs. Gross and Suda, co-authors of the study are: Jifang Zhou, MD, MPH, Gregory Calip, PharmD, MPH, PhD, Susan A. Rowan, DDS, Ronald Hershow, MD, Rose Perez, Charlesnika T. Evans, PhD, MPH, Jessina C. McGregor, PhD, FSHEA.
IDWeek 2019 is the annual meeting of the Infectious Diseases Society of America (IDSA), the Society for Healthcare Epidemiology of America (SHEA), the HIV Medicine Association (HIVMA) and the Pediatric Infectious Diseases Society (PIDS). With the theme “Advancing Science, Improving Care,” IDWeek features the latest science and bench-to-bedside approaches in prevention, diagnosis, treatment, and epidemiology of infectious diseases, including HIV, across the lifespan. IDWeek 2019 takes place Oct. 2-6 at the Walter E. Washington Convention Center in Washington, D.C. For more information, visit www.idweek.org