Private Practice Dentists Improve Antibiotic Use After Dental Antibiotic Stewardship Education From Infectious Diseases Experts

Debra A Goff; Julie E Mangino; Elizabeth Trolli; Richard Scheetz; Douglas Goff

doi:10.1093/ofid/ofac361

Private Practice Dentists Improve Antibiotic Use After Dental Antibiotic Stewardship Education From Infectious Diseases Experts

Open Forum Infect Dis. 2022 Jul 25;9(8):ofac361. doi: 10.1093/ofid/ofac361. eCollection 2022 Aug.

Authors

Debra A Goff¹, Julie E Mangino², Elizabeth Trolli³, Richard Scheetz⁴, Douglas Goff⁵

Affiliations

¹ Department of Pharmacy, The Ohio State University Wexner Medical Center, The Ohio State University College of Pharmacy, Columbus, Ohio, USA.
² Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA.
³ The Ohio State University College of Pharmacy, Columbus, Ohio, USA.
⁴ Oral and Facial Surgeons of Ohio, Dublin, Ohio, USA.
⁵ Gilbert and Goff Prosthodontists, Columbus, Ohio, USA.

Abstract

Background: Private practice dentists represent 72% of United States dentists. We conducted a prospective cohort study of private practice dentists comparing antibiotic use before and after dental antibiotic stewardship education by infectious diseases (ID) antibiotic stewardship experts.

Methods: Study phases were as follows: phase 1 (preeducation), 3 months of retrospective antibiotic data and a presurvey assessed baseline antibiotic knowledge; phase 2 (education), dentists attended 3 evening Zoom sessions; phase 3, (posteducation/interventions), 3 months of prospective audits with weekly feedback; phase 4, postsurvey and recommendations to reach more dentists.

Results: Fifteen dentists participated. Ten had practiced >20 years. Presurvey, 14 were unfamiliar with dental stewardship. The number of antibiotic prescriptions pre/post decreased from 2124 to 1816 (P < .00001), whereas procedures increased from 8526 to 9063. Overall, appropriate use (prophylaxis and treatment) increased from 19% pre to 87.9% post (P < .0001). Appropriate prophylaxis was 46.6% pre and 76.7% post (P < .0001). Joint implant prophylaxis decreased from 164 pre to 78 post (P < .0001). Appropriate treatment antibiotics pre/post improved 5-fold from 15% to 90.2% (P = .0001). Antibiotic duration pre/post decreased from 7.7 days (standard deviation [SD], 2.2 days) to 5.1 days (SD, 1.6 days) (P < .0001). Clindamycin use decreased 90% from 183 pre to 18 post (P < .0001). Postsurvey responses recommended making antibiotic stewardship a required annual continuing education. Study participants invited ID antibiotic stewardship experts to teach an additional 2125 dentists via dental study clubs.

Conclusions: After learning dental antibiotic stewardship from ID antibiotic stewardship experts, dentists rapidly optimized antibiotic prescribing. Private practice dental study clubs are expanding dental antibiotic stewardship training to additional dentists, hygienists, and patients across the United States.

Keywords: antibiotics; behavior change; dental antibiotic stewardship; dentists; education.