Current antimicrobial prescription at outpatient dentistry centers and clinics in tertiary-care hospitals in Tokyo, Japan: A multicenter cross-sectional study

Yasuaki Tagashira; Masao Horiuchi; Atsushi Kosaka; Takuya Washino; Mikihiro Horiuchi; Shutaro Murakami; Itoe Tagashira; Hitoshi Honda

doi:10.1017/ash.2021.229

Current antimicrobial prescription at outpatient dentistry centers and clinics in tertiary-care hospitals in Tokyo, Japan: A multicenter cross-sectional study

Antimicrob Steward Healthc Epidemiol. 2021 Dec 13;1(1):e64. doi: 10.1017/ash.2021.229. eCollection 2021.

Authors

Yasuaki Tagashira^{1

2}, Masao Horiuchi³, Atsushi Kosaka⁴, Takuya Washino³, Mikihiro Horiuchi⁵, Shutaro Murakami⁶, Itoe Tagashira⁷, Hitoshi Honda¹

Affiliations

¹ Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
² Division of Infectious Diseases, Tokyo Medical and Dental University, Tokyo, Japan.
³ Department of Infection Prevention and Control, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.
⁴ Department of Infectious Diseases, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
⁵ Department of Pharmacy, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan.
⁶ Department of pharmacy, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
⁷ Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University, Tokyo, Japan.

Abstract

Background: Antimicrobial administration is necessary before specific dental procedures to prevent postprocedural infections and complications and antimicrobials are sometimes indicated for the treatment of odontogenic infections. However, antimicrobials are commonly misused by dentists.

Methods: This cross-sectional study was conducted at 4 public, tertiary-care hospitals in Tokyo, Japan, from June to July 2019. We included patients who received an antimicrobial prescription at the outpatient dentistry center or clinic at each participating hospital. The indications for antimicrobial prescription were (1) antimicrobial prescriptions for prophylaxis (APPs) or (2) antimicrobial prescriptions for treatment (APTs). Prescribing patterns were described in terms of antimicrobial choice, timing, and dosages for APPs and APTs.

Results: During the study period, 1,772 patients received an antimicrobial prescription. Among them 1,439 (81.2%) were APPs and 333 (18.8%) were APTs. The most common aim of APP was to prevent local infections and complications following tooth extraction (n = 1,244, 86.4%). The proportion of appropriate APPs was only 0.8% (12 of 1,439). Among 1,439 total APPs, 171 (11.9%) were unnecessary, 32 (2.2%) were inappropriate, and 1,224 (85.1%) were suboptimal. Whereas 101 (30.3%) of 333 APTs were appropriate, the remaining 97 instances (29.1%) were unnecessary, 86 (26.7%) were inappropriate, and 46 (13.8%) were suboptimal.

Conclusion: Inappropriate antimicrobial prescriptions were common among dentists in Japan. Understanding the differences in the current antimicrobial prescribing patterns for prophylaxis and treatment is critically important for implementing an effective antimicrobial stewardship program in dentistry.