Dental Antibiotic Prescriptions Linked to Clostridium difficile
Dentist-prescribed antibiotics are likely responsible for a growing number of Clostridium difficile infections .
During a presentation at the Infectious Diseases Week 2017 conference in San Diego, the Minnesota Department of Health (MDH) reported that dentist-prescribed antibiotics are likely responsible for a growing number of Clostridium difficile infections — and that many of these prescriptions may be unnecessary. Between 2009 and 2015, MDH researchers interviewed 1626 individuals with community-associated C. difficile (i.e., infections in patients who did not have an overnight stay in a hospital or nursing home). They determined that 136 (or 15%) of these individuals had taken antibiotics prescribed for dental procedures. However, of those who had received antibiotics for dental treatment, 34% had no notation of antibiotics in their medical charts.
To improve interdisciplinary communication between health professionals and patients, Stacy Holzbauer, DVM, MPH, lead researcher and an epidemiology field officer for the U.S. Centers for Disease Control and Prevention and MDH, recommends that patients mention dental visits and medications they have taken to their medical providers. In addition, oral health professionals should continue to inquire about patients’ medical records and prescription history.
In a previous survey, MDH researchers found that 36% of dentists prescribed antibiotics in situations generally not recommended by the American Dental Association (ADA), including prophylactic prescriptions for patients with heart conditions and/or prosthetic joints. Updated 2015 ADA guidelines recommend antibiotic prophylaxis in only a small number of patients with heart conditions or joint replacements. In addition, the guidelines suggest that for patients with a history of complications associated with joint replacement surgery who are undergoing dental procedures that include gingival manipulation or mucosal incision, prophylactic antibiotics should only be considered after consultation with the patient and orthopedic surgeon. For this reason, it is imperative for oral health professionals to stay abreast of current recommendations, and judiciously consider when antibiotic prescriptions are appropriate.