S1. Antimicrobial Stewardship program development and implementation
Oral Abstract Submission
Daniel Carlsen, PharmD
PGY2 Infectious Diseases Pharmacy Resident
Edward Hines, Jr. VA Hospital
Chicago, IL
Disclosure: Nothing to disclose
Katie J. Suda, PhamD, MS
Research Health Scientist
Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines VA Hospital and University of Illinois at Chicago College of Pharmacy
Hines, IL
Disclosure: Nothing to disclose
Ursula C. Patel, PharmD, BCPS, AAHIVP
Infectious Diseases Clinical Pharmacy Specialist
Edward Hines, Jr. VA Hospital
Willowbrook, IL
Disclosure: Nothing to disclose
Gretchen Gibson, DDS
AEGD Assistant Director
Oral Health Quality Group, Veterans Health Care System of the Ozarks
Fayetteville, AR
Disclosure: Nothing to disclose
Marianne M. Jurasic, DMD, MPH
National Coordinator and Researcher
VA Office of Dentistry, Oral Health Quality Group and Boston University
Boston, MA
Disclosure: Nothing to disclose
Margaret A. Fitzpatrick, MD, MS
Associate Investigator
Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital
Hines, IL
Disclosure: Nothing to disclose
Kelly Echevarria, PharmD, BCPS AQ-ID
National Clinical Pharmacy Program Manager for Infectious Diseases
Pharmacy Benefits Management, Department of Veterans Affairs
San Antonio, Texas
Disclosure: Nothing to disclose
Michael Durkin, MD, MPH
Assistant Professor of Medicine
Washington University
St. Louis, Missouri
Disclosure: Nothing to disclose
Jessina C. McGregor, PhD, FSHEA
Associate Professor
Oregon State University
Portland, Oregon
Disclosure: Nothing to disclose
.jpg "Charlesnika T. Evans, PhD, MPH photo")
Charlesnika T. Evans, PhD, MPH
Associate Professor and Research Health Scientist
Northwestern University and VA
Hines, Illinois
Disclosure: BioK+: Consultant
Background : US dentists prescribe 10% of outpatient antibiotics. However, assessing the appropriateness of dental antibiotic prescribing has been challenging due to a lack of guidelines for common infections. In 2019, the American Dental Association proposed clinical practice guidelines (CPG) on the management of common acute oral infections for the first time. Our objective was to describe national baseline antibiotic prescribing for the treatment of irreversible pulpitis, apical periodontitis, and acute apical abscess prior to the release of the proposed CPG.
Methods : We performed a cross-sectional analysis of national VA data from 1/1/2017 - 12/31/2017. We identified cases of irreversible pulpitis, apical periodontitis, and acute apical abscess using ICD-10-CM codes. Patient demographics, facility location, medical conditions, dental procedure codes (“CDTs”), and diagnostic (ICD-10-CM) codes were extracted from the VA Corporate Data Warehouse. Antibiotics prescribed by a dentist within 7 days of a visit were included. Multivariable logistic regression identified variables associated with antibiotic prescribing for each infection.
Results : Of the 470,039 VA dental visits with oral infections coded, 25% of irreversible pulpitis, 41% of apical periodontitis, and 61% of acute apical abscess visits received antibiotics. Amoxicillin was prescribed most frequently. Although the median days’ supply was 7 days, prolonged use of antibiotics was frequent (9.2% of irreversible pulpitis, 17.8% of apical periodontitis, 28.7% of acute apical abscess received antibiotics for ≥ 8 days). Of the irreversible pulpitis visits with antibiotics prescribed, 20.0% received ≥ 2 antibiotics. Patients with high risk cardiac conditions, prosthetic joints, and certain dental procedures were associated with receipt of antibiotics (Table).
Conclusion : Prior to the release of the ADA guidelines, 75.8% and 59.4% of irreversible pulpitis and apical periodontitis were concordant with proposed recommendations. These data identify opportunities to improve prescribing and serve as a benchmark for future outpatient antimicrobial stewardship efforts. Future work should assess definitive dental treatment and populations without access to oral health care.
