Use of Antibiotic Prophylaxis for Tooth Extractions, Dental Implants and Periodontal Surgical Procedures

BACKGROUND: Guidelines for dental procedure antibiotic prophylaxis have changed significantly, reducing the number of patients indicated to receive antibiotics. The primary objective was to determine the frequency and appropriateness of dental antibiotic prophylaxis at a VA dental clinic. METHODS: This was a cross-sectional study of patients undergoing tooth extractions, dental implants and periodontal procedures in 2015. These procedures are among the most common procedures with the potential for bacteremia post-dental procedure. Patients receiving antibiotics for a separate oral or non-oral infection on the date of the dental procedure were excluded. RESULTS: Of 183 Veterans undergoing the included dental procedures, 82.5% received antibiotic prophylaxis. Amoxicillin (71.3% of antibiotics) and clindamycin (23.8%) were prescribed most frequently; 44.7% of clindamycin was prescribed to patients not labeled as penicillin allergic. The mean duration of antibiotics was 7.1 +/- 1.6 (1–14) days; 82.5% receiving seven days supply. Of those that received antibiotic prophylaxis, 92.1% received post-procedure antibiotics only, 2.6% pre-procedural antibiotics only and 5.3% received pre- and post-procedure antibiotics. When prophylaxis was indicated (procedure and/or cardiac condition), 85.3% received an antibiotic. However, 72.7% received post-procedure antibiotics when only pre-procedure administration was indicated. When pre-procedure antibiotics were indicated, 11.5% did not receive any antibiotics (pre- or post-procedure). Only 8.2% received antibiotics appropriately based on administration time, procedure and co-morbidities. Three months post-procedure, there were no occurrences of Clostridium difficile, infective endocarditis, prosthetic joint infections or oral infections. CONCLUSION: The majority of patients undergoing a dental procedure received antibiotic prophylaxis. While the majority of these antibiotics were indicated pre-procedure, prescribing of post-procedure antibiotic for excessive durations was frequent. Dental stewardship efforts should ensure appropriate timing, indications, and duration of antibiotic prophylaxis. DISCLOSURES: All authors: No reported disclosures.