Antibiotic Prescribing in Dental Practice: A Cross-sectional Survey in Trinidad and Tobago

BACKGROUND: Antimicrobial resistance (AMR) is a global threat. Trinidad and Tobago used the World Health Organisation's Global Action Plan to develop its National Action Plan (NAP) against AMR. A review of the NAP showed the need for use-based studies to direct interventions against AMR. This study was designed to provide evidence on dental prescribing habits, to support interventions against the emergence of antibiotic-resistant strains. METHODS: A cross-sectional study. A consent letter and questionnaire were developed in REDCap®, a link to which was sent to registered dentists. The questionnaire collected demographic information, knowledge of antibiotics and dental practice. SPSS version 22 was used for analysis: significance at a P-value <0.05 and the confidence interval at 95%. FINDINGS: Seventy-two dentists participated. For penicillin-allergic patients, 38.6% (24/62) reported prescribing clindamycin, and 4.8% (3/62) reported prescribing amoxicillin. A total of 9.8% (6/61) avoided antibiotic prescription in pregnancy. Actions taken for patients already on antibiotics varied greatly - assess, discontinue, continue and switch. Satisfactory individual-level compliance with prophylaxis guidelines was observed in 29.8% (17/56), 47% (21/45), and 20% (9/48) of participants for dental procedures, prosthetic joints, and cardiac conditions, respectively. Satisfactory individual-level compliance with guidelines on the therapeutic use of antibiotics for dental infections was observed in 74.1% (40/54). Satisfactory group-level compliance with prophylaxis guidelines was observed in 8/19 dental procedures and 2/14 cardiac conditions. Satisfactory compliance with guidelines on the therapeutic prescription of antibiotics was observed in 6/10 dental infections. No variable predicted compliance. CONCLUSION: The variability in compliance highlights a need for improved education and awareness. CLINICAL RELEVANCE: may impact antimicrobial stewardship activities, including production of training materials and development of local treatment recommendations.