Research | Published:

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

BDJ volume 221, pages 2530 (08 July 2016) | Download Citation

Abstract

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.

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

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Acknowledgements

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.

Author information

Affiliations

  1. Speciality Trainee in Dental Public Health, Cardiff and Vale University Health Board

    • A. L. Cope
  2. Research Associate, Cardiff Unit for Research and Evaluation in Medical and Dental Education (CUREMeDE), School of Social Sciences, Cardiff University, 12 Museum Place, Cardiff, CF10 3BG

    • E. Barnes
  3. Senior Dental Officer, Directorate of Health Policy, Health and Social Services Group, Welsh Government, Cathays Park, Cardiff, CF10 3NQ

    • E. P. Howells
  4. Deputy Director Postgraduate Dental Education, Wales Deanery, 8th Floor, Neuadd Meirionnydd, Heath Park, CF14 4YS

    • A. M. Rockey
  5. Director; Postgraduate Dental Education, Wales Deanery, 8th Floor, Neuadd Meirionnydd, Heath Park, CF14 4YS

    • A. J. Karki
  6. Consultant in Dental Public Health, Public Health Wales, Dental Public Health, Public Health Wales, Temple of Peace and Health, Cardiff, CF10 3NW;

    • M. J. Wilson
  7. Senior Lecturer Oral Medicine School of Dentistry; Cardiff University, University Dental Hospital, Heath Park, Cardiff, CF14 4XY

    • M. A. O Lewis
  8. Professor of Oral Medicine School of Dentistry; Cardiff University, University Dental Hospital, Heath Park, Cardiff, CF14 4XY

    • J. G. Cowpe

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Corresponding author

Correspondence to A. L. Cope.

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DOI

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

Refereed Paper

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