Antibiotic prescribing by dentists has increased Why?
Antibiotic prescribing by dentists has increased Why?
复制标题
DOI：
10.1016/j.adaj.2015.12.014
复制
发表时间：
2016-05-01
影响因子：
3.9
通讯作者：
Patrick, David M.
中科院分区：
文献类型：
--
作者：
Marra, Fawziah;George, Diana;Patrick, David M.
背景。尽管在加拿大不列颠哥伦比亚省，抗生素处方的总体比率一直在下降，但作者进行了一项研究来解释牙医处方率上升的原因。作者从一个集中的、以人群为基础的处方数据库中获得了1996年至2013年门诊处方的匿名、行列数据，其中包括一个可变编码处方许可机构。分析采用解剖治疗分类标准代码和定义日剂量（DDD）值。作者将处方率归一化，并以每1,000居民每天DDDs （DID）表示处方率。加拿大牙科协会发布了一个网络研讨会，邀请牙医们来信讨论这一趋势的驱动因素。从1996年到2013年，总体抗生素使用从18.24 DID下降到15.91 DID，医生处方从17.25 DID下降到14.11 DID，下降了18.2%。然而，牙科处方增加了62.2%，从0.98 DID增加到1.59 DID，其占抗生素处方的比例从6.7%增加到11.3%。60岁以上的牙科患者的处方率增加最多。来自加拿大和美国牙医的交流确定了以下解释主题：根尖周脓肿和不可逆牙髓炎的不必要处方；与种植牙及其并发症相关的处方增加；要求减少瓣膜性心脏病和假关节患者围手术期抗生素覆盖的指南采纳缓慢；强调美容实践减少了普通牙医的手术技能；保险不足的做法促使抗生素替代手术；人口老龄化;以及人均牙科注册人数。在未来的研究中，应进一步探讨牙科处方的新主题；然而，已经确定的主题可以指导继续牙科教育会议抗生素管理的优先事项。实际意义。应该审查抗生素处方，以确保我们符合指导方针。大多数医生会找到机会少开处方，持续时间也更短。
Background. Although the overall rate of antibiotic prescribing has been declining in British Columbia, Canada, the authors conducted a study to explain the increased rate of prescribing by dentists.Methods. The authors obtained anonymized, line-listed data on outpatient prescriptions from 1996 to 2013 from a centralized, population-based prescription database, including a variable coding prescriber licensing body. Analyses used Anatomical Therapeutic Classification standard codes and defined daily dose (DDD) values. The authors normalized prescribing rates to the population and expressed the rates in DDDs per 1,000 inhabitants per day (DID). The Canadian Dental Association released a webinar that invited correspondence from dentists about the drivers of the trend.Results. From 1996 to 2013, overall antibiotic use declined from 18.24 DID to 15.91 DID, and physician prescribing declined 18.2%, from 17.25 DID to 14.11 DID. However, dental prescribing increased 62.2%, from 0.98 DID to 1.59 DID, and its proportionate contribution increased from 6.7% to 11.3% of antibiotic prescriptions. The rate of prescribing increased the most for dental patients 60 years or older. Communication from dentists in Canada and the United States identified the following explanatory themes: unnecessary prescriptions for periapical abscess and irreversible pulpitis; increased prescribing associated with dental implants and their complications; slow adoption of guidelines calling for less perioperative antibiotic coverage for patients with valvular heart disease and prosthetic joints; emphasis on cosmetic practices reducing the surgical skill set of average dentists; underinsurance practices driving antibiotics to be a substitute for surgery; the aging population; and more dental registrants per capita.Conclusions. Emerging themes for dental prescribing should be explored further in future studies; however, themes already identified may guide priorities in antibiotic stewardship for continuing dental education sessions.Practical Implications. Antibiotic prescribing should be reviewed to make sure that we are compliant with guidelines. Most practitioners will find opportunities to prescribe less often and for shorter durations.