Cargando…
1895. Serious Antibiotic-Related Adverse Effects Following Unnecessary Dental Prophylaxis in the United States
BACKGROUND: Dentists prescribe 10% of outpatient antibiotics in the United States, with a significant portion of these being for prophylaxis. We previously found that 80% of prescriptions for prophylaxis prescribed prior to dental visits are unnecessary; however, the sequelae of these unnecessary an...
Autores principales: | , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6809462/ http://dx.doi.org/10.1093/ofid/ofz359.122 |
_version_ | 1783461994443046912 |
---|---|
author | Gross, Alan E Suda, Katie J Zhou, Jifang Calip, Gregory Rowan, Susan A Hershow, Ronald Perez, Rose Evans, Charlesnika T McGregor, Jessina C |
author_facet | Gross, Alan E Suda, Katie J Zhou, Jifang Calip, Gregory Rowan, Susan A Hershow, Ronald Perez, Rose Evans, Charlesnika T McGregor, Jessina C |
author_sort | Gross, Alan E |
collection | PubMed |
description | BACKGROUND: Dentists prescribe 10% of outpatient antibiotics in the United States, with a significant portion of these being for prophylaxis. We previously found that 80% of prescriptions for prophylaxis prescribed prior to dental visits are unnecessary; however, the sequelae of these unnecessary antibiotics have not been characterized. Our objective was to assess the harms of unnecessary antibiotic prophylaxis using Truven, a national health claims database. METHODS: This was a retrospective cohort study of patients with dental visits from 2011 to 2015 linked to medical and prescription claims. Patients with commercial dental insurance without a hospitalization or extra-oral infection 14 days prior to antibiotic prophylaxis (≤2 days supply dispensed within 7 days before a dental visit) were assessed for inclusion. Patients with unnecessary antibiotic prophylaxis (defined as antibiotic prophylaxis in patients who both did not undergo a procedure that manipulated the gingiva/tooth periapex and did not have an appropriate cardiac diagnosis) were included and assessed for serious antibiotic-related adverse effects (AAE). The primary endpoint was the cumulative incidence of any AAE within 14 days post-prescription (composite of allergy, anaphylaxis, C. difficile infection, or ED visit). The secondary analyses were the cumulative incidence of each individual AAE and the risk difference of the primary endpoint between amoxicillin and clindamycin. RESULTS: Of the 168,420 dental visits with antibiotic prophylaxis, 136,177 (80%) were unnecessary and included for analysis. 3.8% of unnecessary prescriptions were associated with an AAE; primary and secondary endpoints are listed in the Table. ED visits (1.2%) and new allergies (2.9%) were most frequent. Clindamycin was associated with more AAE than amoxicillin (risk difference 322.1 per 1000 person-years, 95% CI: 238.5 - 405.8). CONCLUSION: Even though antibiotic prophylaxis is prescribed for a short duration (≤2 days), it is not without risk. Since most AAE are diagnosed in medical settings, dentists may not be aware of these adverse effects. These data provide further impetus to decrease unnecessary prescribing of antibiotic prophylaxis prior to dental procedures. [Image: see text] DISCLOSURES: All Authors: No reported Disclosures. |
format | Online Article Text |
id | pubmed-6809462 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-68094622019-10-28 1895. Serious Antibiotic-Related Adverse Effects Following Unnecessary Dental Prophylaxis in the United States Gross, Alan E Suda, Katie J Zhou, Jifang Calip, Gregory Rowan, Susan A Hershow, Ronald Perez, Rose Evans, Charlesnika T McGregor, Jessina C Open Forum Infect Dis Abstracts BACKGROUND: Dentists prescribe 10% of outpatient antibiotics in the United States, with a significant portion of these being for prophylaxis. We previously found that 80% of prescriptions for prophylaxis prescribed prior to dental visits are unnecessary; however, the sequelae of these unnecessary antibiotics have not been characterized. Our objective was to assess the harms of unnecessary antibiotic prophylaxis using Truven, a national health claims database. METHODS: This was a retrospective cohort study of patients with dental visits from 2011 to 2015 linked to medical and prescription claims. Patients with commercial dental insurance without a hospitalization or extra-oral infection 14 days prior to antibiotic prophylaxis (≤2 days supply dispensed within 7 days before a dental visit) were assessed for inclusion. Patients with unnecessary antibiotic prophylaxis (defined as antibiotic prophylaxis in patients who both did not undergo a procedure that manipulated the gingiva/tooth periapex and did not have an appropriate cardiac diagnosis) were included and assessed for serious antibiotic-related adverse effects (AAE). The primary endpoint was the cumulative incidence of any AAE within 14 days post-prescription (composite of allergy, anaphylaxis, C. difficile infection, or ED visit). The secondary analyses were the cumulative incidence of each individual AAE and the risk difference of the primary endpoint between amoxicillin and clindamycin. RESULTS: Of the 168,420 dental visits with antibiotic prophylaxis, 136,177 (80%) were unnecessary and included for analysis. 3.8% of unnecessary prescriptions were associated with an AAE; primary and secondary endpoints are listed in the Table. ED visits (1.2%) and new allergies (2.9%) were most frequent. Clindamycin was associated with more AAE than amoxicillin (risk difference 322.1 per 1000 person-years, 95% CI: 238.5 - 405.8). CONCLUSION: Even though antibiotic prophylaxis is prescribed for a short duration (≤2 days), it is not without risk. Since most AAE are diagnosed in medical settings, dentists may not be aware of these adverse effects. These data provide further impetus to decrease unnecessary prescribing of antibiotic prophylaxis prior to dental procedures. [Image: see text] DISCLOSURES: All Authors: No reported Disclosures. Oxford University Press 2019-10-23 /pmc/articles/PMC6809462/ http://dx.doi.org/10.1093/ofid/ofz359.122 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Abstracts Gross, Alan E Suda, Katie J Zhou, Jifang Calip, Gregory Rowan, Susan A Hershow, Ronald Perez, Rose Evans, Charlesnika T McGregor, Jessina C 1895. Serious Antibiotic-Related Adverse Effects Following Unnecessary Dental Prophylaxis in the United States |
title | 1895. Serious Antibiotic-Related Adverse Effects Following Unnecessary Dental Prophylaxis in the United States |
title_full | 1895. Serious Antibiotic-Related Adverse Effects Following Unnecessary Dental Prophylaxis in the United States |
title_fullStr | 1895. Serious Antibiotic-Related Adverse Effects Following Unnecessary Dental Prophylaxis in the United States |
title_full_unstemmed | 1895. Serious Antibiotic-Related Adverse Effects Following Unnecessary Dental Prophylaxis in the United States |
title_short | 1895. Serious Antibiotic-Related Adverse Effects Following Unnecessary Dental Prophylaxis in the United States |
title_sort | 1895. serious antibiotic-related adverse effects following unnecessary dental prophylaxis in the united states |
topic | Abstracts |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6809462/ http://dx.doi.org/10.1093/ofid/ofz359.122 |
work_keys_str_mv | AT grossalane 1895seriousantibioticrelatedadverseeffectsfollowingunnecessarydentalprophylaxisintheunitedstates AT sudakatiej 1895seriousantibioticrelatedadverseeffectsfollowingunnecessarydentalprophylaxisintheunitedstates AT zhoujifang 1895seriousantibioticrelatedadverseeffectsfollowingunnecessarydentalprophylaxisintheunitedstates AT calipgregory 1895seriousantibioticrelatedadverseeffectsfollowingunnecessarydentalprophylaxisintheunitedstates AT rowansusana 1895seriousantibioticrelatedadverseeffectsfollowingunnecessarydentalprophylaxisintheunitedstates AT hershowronald 1895seriousantibioticrelatedadverseeffectsfollowingunnecessarydentalprophylaxisintheunitedstates AT perezrose 1895seriousantibioticrelatedadverseeffectsfollowingunnecessarydentalprophylaxisintheunitedstates AT evanscharlesnikat 1895seriousantibioticrelatedadverseeffectsfollowingunnecessarydentalprophylaxisintheunitedstates AT mcgregorjessinac 1895seriousantibioticrelatedadverseeffectsfollowingunnecessarydentalprophylaxisintheunitedstates |