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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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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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). https://doi.org/10.1038/sj.bdj.2016.496
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