Antibiotic Prescribing and Stewardship Opportunities within a Veterans Affairs Dental Care Practice

BACKGROUND: Antibiotic overuse is a major healthcare problem worldwide. Dental providers prescribe approximately 10% of outpatient antibiotics nationally. As a part of a larger quality improvement initiative, the prescribing habits of the Veterans Affairs Pittsburgh Dental Providers were reviewed. METHODS: Outpatient antibiotic prescriptions by dental providers at the Veterans Affairs Pittsburgh Dental Clinic from June 2015 - May 2016 were identified. A random sample of all prescriptions were reviewed for antibiotic prescribed, type of visit during which the prescription occurred, procedure associated with prescription, and indication. Available American Dental Association (ADA) guidelines were used to define appropriateness. RESULTS: Over the period reviewed, 15111 total outpatient prescriptions were filled at VA Pittsburgh, of which 1505 (10%) were prescribed by 21 dental providers. Antibiotics most commonly prescribed by dentists were amoxicillin (78%), clindamycin (13%), penicillin VK (4%), and amoxicillin/clavulanate (3%). Antibiotic prescriptions ranged from 1–15 days with an average of 5 days. 182/1505 (12%) of antibiotic prescriptions were randomly selected for chart review. Seventy-eight percent (142/182) visits were labeled as routine, and 22% (40/182) were acute. The most common procedures performed at visits where antibiotics were prescribed were exams 24 % (43/182), extractions 42% (77/182) and cleanings 9% (17/182). The most common reasons for antibiotic prescriptions were post-operative complications 52% (96/182), prophylaxis 19% (34/182) and abscess 13% (23/182). Seventy-four percent (135/182) of antibiotic prescriptions were concordant with existing ADA guidelines. Of non-concordant prescriptions, 43% (21/48) were written for antibiotic prophylaxis. CONCLUSION: Dental providers are active prescribers of outpatient antibiotics, and current dental guidelines are weak in antibiotic restriction. Opportunities for prescribing improvement exist, in particular with prophylaxis. Dental providers represent a potentially overlooked target for antimicrobial stewardship intervention. DISCLOSURES: All authors: No reported disclosures.