Sir, the recent British Dental Journal Upfront article1 highlighted the importance of a whole team approach to combatting antimicrobial resistance, with a range of excellent resources to refer to.

With regards to the SDCEP publication2 that was referred to, this was updated in June 2021 and stated:

In October 2020, the Scottish Antimicrobial Prescribing Group (SAPG) and its dental sub-group published a statement on the management of acute dento-alveolar infections. The SAPG statement reiterates that antibiotic therapy is only appropriate if immediate drainage is not achieved via local measures or where there is evidence of spreading infection or systemic involvement. When an antibiotic is unavoidable, Phenoxymethylpenicillin is now recommended as the preferred first line antibiotic. This is due to its narrower spectrum of activity, which is less likely to drive antimicrobial resistance.

In a recent audit across our four dental education facilities, we noted that dentists are often prescribing Amoxicillin as first line ahead of Phenoxymethylpenicillin for dentoalveolar infections. As stated in the SDCEP document, dental abscesses are usually infected with viridans Streptococcus spp. or gram-negative organisms, so utilising Phenoxymethylpenicillin as first line antibiotic reduces the risk of antibiotic resistance by narrowing the spectrum.

As we were unable to extract any local NHS dental prescribing data to see whether this pattern was specific to our clinics, we looked at antibiotic items dispensed by Cornish community pharmacies against dental prescriptions (data from NHS Cornwall and Isles of Scilly prescribing and medicines optimisation ICB). We found that the pattern of prescribing for dentistry across the county has some similarities on a far larger scale. Of the 6,542 dental prescriptions for penicillin-related antimicrobials over a recent six-month period, 6,038 were for Amoxicillin, 42 for Co-amoxiclav and 462 for Phenoxymethylpenicillin.

Though this is not prescribing but rather dispensing data and it does not specify the reason for the antibiotic, it does highlight that Phenoxymethylpenicillin is used far less frequently than Amoxicillin for dental prescriptions, so perhaps something for wider consideration by the profession.