Understanding the impact of COVID-19 on dental antibiotic prescribing across England: 'it was a minefield'. Br Dent J 2022; https://doi.org/10.1038/s41415-022-5104-y

The national guidelines regarding antibiotic stewardship outline the indications for an antibiotic prescription, to ensure its appropriate use and to aid prevention of antibiotic resistance.1 The COVID-19 pandemic significantly regressed dentists' antibiotic prescribing rates in the UK. Following the termination of all routine and elective dental treatment in March 2020, there was a change in dental service delivery. The emergency protocol of 'Advice, Analgesics and Antimicrobials' (AAA) was implemented to remotely triage patients suffering from acute dental pain. This approach to patient care rendered dentistry the healthcare sector with the steepest increase in antimicrobial prescribing.2

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This study undertook quantitative and qualitative analysis with the aim of understanding how and why the increase in antibiotic prescribing occurred. To quantify the increase, the rate of prescriptions (FP10D) dispensed per 1,000 of the population was calculated and compared across all regions of NHS England; the data were pooled retrospectively prior to and post-pandemic. To qualify factors contributing to the increase in prescribing, 159 primary care general dentists across the regions completed an online survey consisting of 20 questions, from which key themes were established using descriptive and inferential statistics.

The results from the study deduced an average increase by 22% in the number of NHS antibiotic prescriptions administered across all regions, with the East of England spiking most to 29.1%. Interestingly, London had the shallowest spike, due to the high number of urgent dental centres (UDCs) in the region. This trend continued across the country until practices reopened in June 2020. The key themes identified in the patterns of individuals were that 89% of dentists reported an increased rate of prescribing; however, fewer than half felt confident in their remote diagnosis.

There was a general feeling of frustration and helplessness. Reasons for the increase ranged from clinicians feeling clinically compromised with the generic AAA protocol to a misalignment between local and national guidelines. Half of the cohort stated antibiotics were a prerequisite for a successful referral to a UDC, regardless of their clinical need.

Many concerns were expressed across the regions regarding the impact of the newfound prescribing culture. This has resulted in patient misinformation about the ability to use antibiotics to avoid a dental procedure or future expectations for prescriptions to cure all dental pain. Thus, this paper calls for reforms in emergency planning, with a deeper appreciation of the role antibiotics play in dental treatments and the risk antibiotic resistance poses to public health.