Which antibiotics do you prescribe for dental infections?

Sample Portrait

Which antibiotics do you prescribe for dental infections?

As part of a special project in collaboration with the BC Centre for Disease Control (BCCDC) and with funding from the BC College of Oral Health Professionals (BCCOHP), the Therapeutics Initiative mailed an individual Portrait on prescribing for dental infections to approximately 4000 dentists in BC. Dentists were randomized to three groups to receive different combinations of individual prescribing portraits and a Therapeutics Letter. Dentists receive one of two slightly different Portraits. The Portraits were mailed to the early group in October 2023 and to the delayed group in April 2024.

This Portrait was accompanied by the Therapeutics Letter 148 (March-April 2024): Rethink Clindamycin for Dental Patient Safety.

Sample Portrait


Abbreviations used

BCCOHP: British Columbia College of Oral Health Professionals
BCCDC: British Columbia Centre for Disease Control
C. difficile: Clostridioides difficile
MSP: Medical Services Plan


References

  1. Therapeutics Letter: Rethink Clindamycin for Dental Patient Safety. Issue 148, March-April 2024. https://www.ti.ubc.ca/2024/04/10/rethink-clindamycin-for-dental-patient-safety/

Data definitions

Who received this portrait?

BC dentists meeting all of the following criteria received an individual Portrait:

  • Registered by the BC Medical Services Plan (MSP) as in active practice; and
  • with a valid mailing address in BC according to the BCCOHP; and
  • had ≥10 antibiotics prescriptions filled at community pharmacies in 2022, according to PharmaNet claims data.

How are patients assigned to this Portrait?

Patients were included in a Portrait if they met all of the following criteria:

  • Enrolled in MSP at least 1 month before the prescription;
  • prescribed antibiotic therapy by a BC dentist during the study period; and
  • were age >16 years at time of dispensation.

Patients were excluded if they received a course of antibiotics in the 2 weeks preceding prescription.

What prescriptions were counted in this Portrait?

Oral antibiotic prescription records are extracted from PharmaNet claims data and include all prescriptions filled at a community pharmacy in BC associated with the recipient clinician’s prescribing number.

The following prescription data were not included because we currently do not have access:

  • prescription data for federally insured patients, including Veterans, RCMP, Armed Forces and beneficiaries of the First Nations Health Authority or Non-Insured Health Benefits; and

…or because the data are not relevant to the project/analysis:

  • reversed prescription claims; and
  • out-of-province prescriptions; and
  • medication dispensed in a hospital or a correctional centre.

Prescription antibiotics included: Amoxicillin, amoxicillin/potassium clav, ampicillin, azithromycin, cefadroxil, cefixime, cefuroxime, cephalexin, ciprofloxacin, clarithromycin, clindamycin, cloxacillin, doxycycline, erythromycin, Fosfomycin, levofloxacin, metronidazole, minocycline, moxifloxacin, nitrofurantoin, norfloxacin, penicillin V, spiramycin, sulfamethoxazole/trimethoprim, tetracycline, trimethoprim.

Drugs excluded: any drug prescribed “for office use” was excluded

For more information on the use and selection of antibiotics, how to approach patients with penicillin allergy, and details on the role and harms of clindamycin, see the Therapeutics Letter. Up-to-date antibiotic selection guidance is available at: bugsanddrugs.org

PLEASE NOTE: The accuracy of your prescribing Portrait is dependent on the completeness of PharmaNet data; we are unable to capture data on patients who received but did not fill prescriptions or on patients treated from an “office use” supply.


Research component

The research objective is to determine the impact of the Portrait on prescribing of antibiotics for dental infection. The study will estimate and compare the impact of interventions (mailing two slightly different Portraits + Therapeutics Letter; and repeat messages) on prescribing of antibiotic medications by dentists in BC. This impact is evaluated by comparing pooled prescribing data from dentists in the early mailing group to pooled prescribing data from physicians in the delayed group.

All prescribing data analyzed for this study do not contain names, only encrypted patient and clinician numbers. No dentist or patient will be identified in any reports or publications. Portrait’s data access agreement requires the masking of data elements when <6 individuals (patients or clinicians) are included. Ethics approval for this study is obtained from the University of British Columbia Clinical Ethics Review Board. A behavioural intervention component will be carried out as a separate study conducted by our partner organization BCCDC under separate ethics approval.

Please note that British Columbia College of Oral Health Professionals (BCCOHP) does not have access to the prescribing data in the Portraits.

If you have any questions or would like further information with respect to this evaluation, you may contact the Portrait team at (604) 822-4887 or email portrait@ti.ubc.ca


Anecdotally we are hearing that some BC pharmacists are calling dentists about patients with penicillin allergies who are prescribed cefuroxime and suggesting clindamycin. The BC Centre for Disease Control (BCCDC) and the UBC Therapeutics Initiative (TI) released a statement about this, showing why cefuroxime is a safe alternative for penicillin allergic patients. Hopefully this will help with this issue.


FAQ

Can I request the names of my patients included in this Portrait?

No. Portrait’s data access agreement only permits access to encrypted patient identifiers. There is no way for us to identify individual patients in the data or to provide you with a list.

Why does my Portrait show ranges of patients that I treated (1-20, 20-30, etc.), and not exact numbers?

Portrait’s data access agreement requires the masking of data elements when <6 individuals (patients or clinicians) are included. As prescriptions are presented as percentages, we grouped the number of patients in order to mask low numbers of patients in each daily dose category.

I don’t see my question here. Where can I find more information?

We welcome your feedback. Questions can be directed to our Portrait team by phone (604) 822-4887 or email Portrait@ti.ubc.ca. You can also check out our program FAQ page.

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