Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Research
  • Published:

An analysis of the clinical appropriateness of out-of-hours emergency dental prescribing of antibiotics in Northern Ireland

British Dental Journal volume 228, pages 598–603 (2020)Cite this article

Abstract

Introduction The inappropriate prescribing of antibiotics in dentistry is potentially linked to the development of antimicrobial resistance, as well as being a considerable cost to healthcare. This study analysed the clinical appropriateness of antibiotics prescribed from 'walk-in' and telephone triage out-of-hours emergency dental clinics in Northern Ireland.

Methods Patient and prescribing data were collected from two out-of-hour emergency dental clinics over a two-month period between September and December 2017. In total, 434 prescriptions were analysed. Clinical appropriateness was determined on a case-by-case basis for each prescription by referencing dental prescribing guidelines.

Results Over half of the prescriptions analysed (52.77%) were judged as clinically inappropriate. A total of 19.12% of prescriptions were judged as inappropriate, as the antibiotic prescribed was not indicated for the diagnosis recorded by the clinician. Local measures were not attempted in 36.6% of cases. A significant difference (p = 0.002) was observed between the clinical appropriateness of prescriptions issued via walk-in and triage appointments with triage appointments issuing more clinically appropriate prescriptions.

Conclusions A significant number of prescriptions provided in out-of-hours emergency dental clinics in Northern Ireland were judged to be inappropriate according to current dental prescribing guidelines.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Government UK. Antimicrobial resistance: UK launches 5year action plan and 20-year vision. 2019. Available at https://www.gov.uk/government/news/antimicrobial-resistance-uk-launches-5-year-action-plan-and-20-year-vision (accessed June 2019).

  2. Wellcome Trust and UK Government. Tackling drug-resistant infections globally: final report and recommendations. 2016. Available at https://amr-review.org/sites/default/files/160525_Final%20paper_with%20cover.pdf (accessed June 2019).

  3. World Health Organisation. Antimicrobial resistance. 2018. Available at https://www.who.int/en/news-room/fact-sheets/detail/antimicrobial-resistance (accessed April 2019).

  4. Department of Health (Northern Ireland). Strategy and guidelines for tackling Antimicrobial Resistance. 2013. Available online at https://www.health-ni.gov.uk/sites/default/files/publications/dhssps/aracstrategyfortacklingantimicrobialresistancestar201217.pdf (accessed April 2019).

  5. NICE. Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use. 2015. Available at https://www.nice.org.uk/guidance/ng15/resources/antimicrobialstewardshipsystemsandprocessesfor effectiveantimicrobialmedicineusepdf -1837273110469 (accessed June 2019).

  6. Doron S, Davidson L E. Antimicrobial Stewardship. Mayo Clin Proc 2011; 86: 1113-1123.

  7. Sweeney L C, Dave J, Chamber P A, Heritage J. Antibiotic resistance in general dental practice - a cause for concern? J Antimicrob Chemother 2004; 53: 567-576.

  8. Cope A l, Barnes E, Howells E P et al. Antimicrobial prescribing by dentists in Wales, UK: findings of the first cycle of clinical audit. Br Dent J 2016; 221: 25-30.

  9. Government UK. Health and Social Care Information Centre. 2015. Available online at https://www.gov.uk/government/organisations/health-and-social-care-information-centre (accessed March 2020).

  10. Department of Health (Northern Ireland). Chief Medical Officer Annual Report 2016-17. 2017. Available online at https://www.health-ni.gov.uk/publications/chief-medical-officer-annual-reports (accessed April 2019).

  11. Buetow S A, Sibbald B, Cantrill J A, Halliwell S. Appropriateness in healthcare: application to prescribing. Soc Sci Med 1997; 45: 261-271.

  12. Baclet N, Ficheur G, Alfandari S et al. Explicit definitions of potentially inappropriate prescriptions of antibiotics in older patients: a complication derived from systematic review. Int J Antimicrob Agents 2017; 50: 640-648.

  13. Daley Y M, Martin M V. Are antibiotics being used appropriately for emergency dental treatment? Br Dent J 2001; 191: 391-393.

  14. Advisory Committee on Antimicrobial Prescribing, Resistance and Healthcare Associated Infection (APRHAI). APRHAI annual report 2016 to 2017. 2017. Available online at https://www.gov.uk/government/publications/APRHAI-annual-reports (accessed June 2019).

  15. Cope A L, Francis N A, Wood F, Chestnut I G. Antibiotic prescribing in UK general dental practice: a cross-sectional study. Community Dent Oral Epidemiol 2016; 44: 145-153.

  16. Palmer N O A. Antimicrobial resistance and antibiotic prescribing in dental practice. Dent Update 2016; 45: 954-960.

  17. Public Health England. Sugar reduction: the evidence for action. 2015. Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/470179/Sugar_reduction_The_evidence_for_action.pdf (accessed April 2019).

  18. Mitchell D A, Mitchell L, McCaul L. Oxford handbook of clinical dentistry. 6th ed. Oxford: Oxford University Press, 2014.

  19. Faculty of General Dental Practice. Antimicrobial prescribing standards. 2nd ed. 2014. Available at https://www.fgdp.org.uk/antimicrobial-prescribing-standards/contents (accessed April 2019).

  20. Scottish Dental Clinical Effectiveness Programme. Drug Prescribing for Dentistry: Dental Clinical Guidance. 3rd ed. 2016. Available at http://www.sdcep.org.uk/wp-content/uploads/2016/03/SDCEP-Drug-Prescribing-for-Dentistry-3rd-edition.pdf (accessed April 2019).

  21. Schuts E C, Hulscher M E J L, Mouton J W et al. Current evidence on hospital antimicrobial stewardship objectives: a systematic review and meta-analysis. Lancet Infect Dis 2016; 16: 847-856.

Download references

Author information

Authors and Affiliations

  1. School of Dentistry, Belfast Health and Social Care Trust, UK

    Jennifer McKay & Padraig Kerlin

  2. School of Pharmacy and Pharmaceutical Sciences, Ulster University, UK

    Edward Begley & Kathryn Burnett

  3. Health and Social Care Board, Northern Ireland, UK

    Donncha O’Carolan & Gerry Cleary

  4. Centre for Public Health, Queen’s University Belfast, UK

    Gerry McKenna

Authors
  1. Jennifer McKay
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Edward Begley
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Padraig Kerlin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Donncha O’Carolan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gerry Cleary
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gerry McKenna
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kathryn Burnett
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jennifer McKay.

Ethics declarations

There are no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

McKay, J., Begley, E., Kerlin, P. et al. An analysis of the clinical appropriateness of out-of-hours emergency dental prescribing of antibiotics in Northern Ireland. Br Dent J 228, 598–603 (2020). https://doi.org/10.1038/s41415-020-1435-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41415-020-1435-8

This article is cited by

Search

Advanced search

Quick links