Antibiotic Prescriptions of Pediatric Dentists in a University and Adherence to Official Guidelines

Hypothesis and Objective: The hypothesis of the study was that there was no difference between the antibiotic (AB) prescribing practices of dentists at the university-based pediatric dental clinic and the American Academy of Pediatric Dentistry (AAPD) best practice recommendations for antibiotic prescribing. The objective of this retrospective cross-sectional study was to review the AB prescribing practices of dentists at the Pediatric Dentistry Department, UIC and to evaluate these practices against the current AAPD best practice AB prescribing recommendations. Methods: The electronic health record system was searched to obtain all pediatric patient records that had AB prescriptions for odontogenic infections in the period from 03/10/2018 to 06/02/2020. Strict inclusion/exclusion criteria were applied, and a final study sample identified. The day notes of the subjects corresponding to AB prescriptions were accessed for information regarding the dental problem requiring antibiotic, as well as AB type, dose, frequency, duration, and patient demographics. The collected information was categorized and analyzed. Prescribing practices were evaluated against the latest AAPD best practice recommendations. Two trained and calibrated examiners independently assessed the data for determination of appropriateness of antibiotic prescribing. Disagreements were resolved. The inter- and intra-examiner reliability was assessed using Cohen’s Kappa. Results: The final sample included 279 subjects (54.8% male, 49.5% White, 37.3% Hispanic). The compliance with AAPD prescribing guidance was 100% for type, duration, frequency and 93.5% for AB dosing. Only 61.6% of the prescriptions were justified according to diagnosis and systemic involvement. Examiner reliability was excellent with κ>0.88. Conclusions: The adherence to AAPD guidelines was found to be medium with 38.2% of AB prescriptions deemed inappropriate. Statistically significantly more inappropriate prescriptions were given to medically compromised patients, syndromic patients, children younger than 7 years of age and patients presenting with a dental problem associated with a permanent tooth. Funding: None IRB/ACC Protocol #: 2020-0717.