Inappropriate antibiotic prescribing at dental appointments isn’t only an issue in terms of misuse and potential health effects for patients. It’s an expensive mistake, to the tune of some $31 million in excess costs to the US health-care system and patients.
A research study called “Estimating the cost of inappropriate antibiotic prophylaxis prior to dental procedures” by Infection Control and Hospital Epidemiology and recently reported on by Healio indicates that among the more than 167 million US adults who go to the dentist each year (65.8% of adults), 7,965,084 (4.8%) receive prophylactic antibiotics, with 6,617,132—more than 80%—prescribed inappropriately.
And the costs of that add up: dentists are the top prescribers of clindamycin, the most common antibiotic leading to Clostridioides difficile (CDI), with the study indicating that inappropriate prescribing of that drug resulted in an excess of 768 inpatient CDI cases annually and up to 103 cases of severe hypersensitivity or anaphylaxis that led to hospitalization, which researchers say added up to $7.30 million and $874,584, respectively.
The $31 million tally of excess costs is the sum of $10.8 million in excess health-care costs annually, including the adverse effects costs from clindamycin and other antibiotics (amoxicillin and cephalexin), as well as $20.5 million in out-of-pocket prescription expenses.
“Dentists play a substantial role in antibiotic prescriptions, accounting for 6% to 10% of all antibiotic prescriptions in the U.S.,” study author Cynthia Gong, PharmD, PhD, told Healio. “Addressing the issue of inappropriate antibiotic use in dentistry is crucial to reduce the burden of preventable adverse effects and health care costs and downstream antibiotic resistance.”
Confusion among dental professionals about when and whether to prescribe certain antibiotics is longstanding. In “Antibiotic prophylaxis for dental procedures: What’s the right call?” dental hygienist and author Amanda Hill, BS, RDH, notes that such past uncertainty was valid at least in part due to at-times seemingly uncertain messaging from expert sources:
“In 2014, the American Dental Association (ADA) Council on Scientific Affairs assembled an expert panel to conduct a systematic review stating, ‘for patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to the dental procedure.’ But it wasn’t until 2016 that the American Academy of Orthopaedic Surgeons (AAOS) developed criteria saying, ‘the chance of oral bacteremia being related to joint infections is extremely low, with no evidence for association.’ “
“So for two years, we sat in limbo between providers,” said Hill, adding that currently, “thankfully both professional associations mostly agree” on appropriate use criteria.
But such agreement hasn’t yet necessarily resulted in clear understanding about antibiotic premedication among dental professionals: “Despite guidelines limiting antibiotic prophylaxis to high-risk individuals, a significant number of prescriptions are inconsistent with these recommendations. The study aimed to estimate the costs associated with this practice and assess its impact from a health care payer perspective,” Gong said.
Sourced from Inappropriate antibiotic prescribing at dental visits costs millions annually, by Caitlin Stulpin/Healio Infectious Disease
