Antimicrobial prescribing by dentists in Wales, UK: findings of the first cycle of a clinical audit

Key Points

  • Highlights that antimicrobial resistance threatens the effective prevention and treatment of an ever-increasing range of infections and is therefore a major public health concern.

  • Suggests the judicious use of antimicrobials by all prescribers, including dentists, is therefore a vital step in stemming the emergence and spread of resistance.

  • Proposes that clinical audit is a way by which dental practitioners can assess their compliance with latest evidence based guidelines on antimicrobial prescribing


Objective To describe the findings of the first cycle of a clinical audit of antimicrobial use by general dental practitioners (GDPs).

Setting General dental practices in Wales, UK.

Subjects and methods Between April 2012 and March 2015, 279 GDPs completed the audit. Anonymous information about patients prescribed antimicrobials was recorded. Clinical information about the presentation and management of patients was compared to clinical guidelines published by the Scottish Dental Clinical Effectiveness Programme (SDCEP).

Results During the data collection period, 5,782 antimicrobials were prescribed in clinical encounters with 5,460 patients. Of these 95.3% were antibiotic preparations, 2.7% were antifungal agents, and 0.6% were antivirals. Of all patients prescribed antibiotics, only 37.2% had signs of spreading infection or systemic involvement recorded, and 31.2% received no dental treatment. In total, 79.2% of antibiotic, 69.4% of antifungal, and 57.6% of antiviral preparations met audit standards for dose, frequency, and duration. GDPs identified that failure of previous local measures, patient unwillingness or inability to receive treatment, patient demand, time pressures, and patients' medical history may influence their prescribing behaviours.

Conclusions The findings of the audit indicate a need for interventions to support GDPs so that they may make sustainable improvements to their antimicrobial prescribing practices.

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  1. 1

    British Dental Association. Antimicrobial Resistance in Dentistry Summit, Consensus Report. London: BDA, 2015.

  2. 2

    World Health Organization. Draft global action plan for antimicrobial resistance. Geneva: World Health Organization, 2015.

  3. 3

    European Commission. Communication from the Commission to the European Parliament and the Council. Action plan against the rising threats from Antimicrobial Resistance. Brussels: European Commission, 2011.

  4. 4

    Department of Health. UK 5 Year Antimicrobial Resistance Strategy 2013 to 2018. London: Department of Health, 2013.

  5. 5

    National Institute for Health and Care Excellence. Infection prevention and control. NICE quality standard [QS61]. London: NICE, 2014.

  6. 6

    Prescribing and Medicines Team, Health and Social Care Information Centre. Prescribing by Dentists, England, 2014. Leeds: Health and Social Care Information Centre, 2015.

  7. 7

    Health and Social Care Information Centre. Prescribing by Dentists, England 2014: Annex 2, raw data. 2015. Available at (accessed August 2015).

  8. 8

    Palmer N A, Dailey Y M, Martin M V . Can audit improve antibiotic prescribing in general dental practice? Br Dent J 2001; 191: 253–255.

    Article  Google Scholar 

  9. 9

    Chate R A C, White S, Hale L R O et al. The impact of clinical audit on antibiotic prescribing in general dental practice. Br Dent J 2006; 201: 635–641.

    Article  Google Scholar 

  10. 10

    Scottish Dental Clinical Effectiveness Programme. Drug prescribing for dentistry: dental clinical guidance. 2nd edition. Dundee: Scottish Dental Clinical Effectiveness Programme, 2011.

  11. 11

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

    Article  Google Scholar 

  12. 12

    Palmer N A, Pealing R, Ireland R S, Martin M V . A study of therapeutic antibiotic prescribing in National Health Service general dental practice in England. Br Dent J 2000; 188: 554–558.

    Article  Google Scholar 

  13. 13

    Kuriyama T, Nakagawa K, Karasawa T, Saiki Y, Yamamoto E, Nakamura S . Past administration of beta-lactam antibiotics and increase in the emergence of beta-lactamase-producing bacteria in patients with orofacial odontogenic infections. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000; 89: 186–192.

    Article  Google Scholar 

  14. 14

    Beacher N, Sweeney M P, Bagg J . Dentists, antibiotics and Clostridium difficile-associated diease. Br Dent J 2015; 219: 275–279.

    Article  Google Scholar 

  15. 15

    Palmer N O, Martin M V, Pealing R, Ireland R S . An analysis of antibiotic prescriptions from general dental practitioners in England. J Antimicrob Chemother 2000; 46: 1033–1035.

    Article  Google Scholar 

  16. 16

    Martin M V, Longman L P, Hill J B, Hardy P . Acute dentoalveolar infections: an investigation of the duration of antibiotic therapy. Br Dent J 1997; 183: 135–137.

    Article  Google Scholar 

  17. 17

    National Leadership and Innovation Agency for Healthcare. Analysis of the Dental Workforce in Wales. Llanharan: National Leadership and Innovation Agency for Healthcare, 2012.

  18. 18

    National Leadership & Innovation Agency For Healthcare. How to Improve – The guide for reliable and sustained improvement. Cardiff: 1000 Lives Plus, 2010.

  19. 19

    National Institute for Clinical Excellence. Principles for Best Practice in Clinical Audit. Abingdon, Oxon: Radcliffe Medical Press, 2002.

  20. 20

    Yesudian G T, Gilchrist F, Bebb K et al. A multicentre, multicycle audit of the prescribing practices of three paediatric dental departments in the North of England. Br Dent J 2015; 218: 681–685.

    Article  Google Scholar 

  21. 21

    Tulip D E, Palmer N O A . A retrospective investigation of the clinical management of patients attending an out of hours dental clinic in Merseyside under the new NHS dental contract. Br Dent J 2008; 205: 659–664.

    Article  Google Scholar 

  22. 22

    Cope A, Francis N, Wood F, Mann M K, Chestnutt I G . Systemic antibiotics for symptomatic apical periodontitis and acute apical abscess in adults. Cochrane Database Syst Rev 2014; 6: CD010136.

    Google Scholar 

  23. 23

    Fedorowicz Z, van Zuuren E J, Farman A G, Agnihortry A, Al-Langawi J H. Antibiotic use for irreversible pulpitis. Cochrane Database Syst Rev 2013; 12: CD004969.

    Google Scholar 

  24. 24

    Daly B, Sharif M O, Newton T, Jones K, Worthington H V . Local interventions for the management of alveolar osteitis (dry socket). Cochrane Database Syst Rev 2012; 12: CD006968.

    PubMed  Google Scholar 

  25. 25

    Igoumenakis D, Giannakopoulos N N, Parara E, Mourouzis C, Rallis G . Effect of causative tooth extraction on clinical and biological parameters of odontogenic infection: a prospective clinical trial. J Oral Maxillofac Surg 2015; 73: 1254–1258.

    Article  Google Scholar 

  26. 26

    Seppanen L, Lemberg K K, Lauhio A, Lindqvist C, Rautemaa R . Is dental treatment of an infected tooth a risk factor for locally invasive spread of infection? J Oral Maxillofac Surg 2011; 69: 986–993.

    Article  Google Scholar 

  27. 27

    Cope A L, Chestnutt I G . Inappropriate prescribing of antibiotics in primary dental care: reasons and resolutions. Prim Dent J 2014; 3: 33–38.

    Article  Google Scholar 

  28. 28

    Palmer N A O, Dailey Y M . General dental practitioners' experiences of a collaborative clinical audit on antibiotic prescribing: A qualitative study. Br Dent J 2002; 193: 46–49.

    Article  Google Scholar 

  29. 29

    Palmer N O, Martin M V, Pealing R, Ireland R S . Paediatric antibiotic prescribing by general dental practitioners in England. Int J Paediatr Dent 2001; 11: 242–248.

    Article  Google Scholar 

  30. 30

    Ellison SJ. An outcome audit of three day antimicrobial prescribing for the acute. Br Dent J 2011; 211: 591–594.

    Article  Google Scholar 

  31. 31

    Department of Health Expert Committee on Antimicrobial Resistance and Health Care Associated Infections and Public Health England. Antimicrobial prescribing and stewardship competencies. London: Public Health England, 2013.

  32. 32

    Seager J M, Howell-Jones R S, Dunstan F D, Lewis M A, Richmond S, Thomas D W . A randomised controlled trial of clinical outreach education to rationalise antibiotic prescribing for acute dental pain in the primary care setting. Br Dent J 2006; 201: 217–222.

    Article  Google Scholar 

  33. 33

    Scott S E, Khwaja M, Low E L, Weinman J, Grunfeld E A . A randomised controlled trial of a pilot intervention to encourage early presentation of oral cancer in high risk groups. Patient Educ Couns 2012; 88: 241–248.

    Article  Google Scholar 

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The authors would like to acknowledge the contributions of S. Geddes, H. Bennett, K. Bishop, D. Thomas, N. Monaghan and A. Willson for their involvement in the development of the audit, to K. Croydon and B. Stuart from the Wales Deanery (PGMDE) for their work in the delivery of the audit, and to A. Bullock and S. Phillips from the Cardiff Unit for Research and Evaluation in Medical and Dental Education (CUREMeDE), Cardiff University.

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Correspondence to A. L. Cope.

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Cope, A., Barnes, E., Howells, E. et al. Antimicrobial prescribing by dentists in Wales, UK: findings of the first cycle of a clinical audit. Br Dent J 221, 25–30 (2016).

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