St. Paul, MN—A Minnesota study focusing on Clostridium difficile cases in five counties found that 15% of patients with the serious infection had been prescribed antibiotics for dental procedures, but that one-third of their medical charts included no information on those prescriptions.

A presentation at IDWeek 2017, recently held in San Diego, reported on the study. Conducted by the Minnesota Department of Health (MDH), the survey tracked community-associated C difficle infections in five counties.

An earlier survey conducted by the MDH found that 36% of dentists prescribed antibiotics inappropriately based on American Dental Association recommendations, at least partly because they reported confusion about prescribing guidelines.

“Dentists have been overlooked as a source of antibiotic prescribing, which can potentially delay treatment when doctors are trying to determine what is causing a patient’s illness,” explained lead author Stacy Holzbauer, DVM, MPH. “It’s important to educate dentists about the potential complications of antibiotic prescribing, including C. diff. Dentists write more than 24.5 million prescriptions for antibiotics a year. It is essential that they be included in efforts to improve antibiotic prescribing.”

Appropriate prescriptions might be for infections related to tooth abscess, according to the report, but some prophylactic antibiotics—such as some of those related to patients with heart conditions or artificial joints—might no longer be recommended for the same duration as in the past.

“It is possible some dentists aren’t aware of the updated recommendations or are being asked by other healthcare providers to continue preventive antibiotics despite the change,” Holzbauer added. “Current recommendations note the risk of taking antibiotics —such as developing C. diff—is greater than the risk of an infection in those cases. 

Further, the inappropriate use of antibiotics helps fuel the creation of drug-resistant bacteria, which are very difficult to treat and are an increasing public health threat.”

To reach their conclusions, MDH researchers interviewed 1,626 people with community-associated C difficile between 2009 and 2015. Results indicate that 57% reported having been prescribed antibiotics, with 15% of those for dental procedures. 

Older patients were more likely to be prescribed antibiotics for dental procedures and also to take clindamycin, an antibiotic that is associated with C. difficile infection, the researchers note. 

“Research has shown that reducing outpatient antibiotic prescribing by 10% could decrease C. diff rates outside of hospitals by 17%,” Holzbauer said. “Limiting the use of inappropriate antibiotics in dentistry could also have a profound impact.”

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