Evaluation of patients labeled with a penicillin allergy to promote antimicrobial stewardship in dental practice.

BACKGROUND: Approximately 10% of the US population self-reports a penicillin allergy history or are labeled as penicillin allergic. However, from 90% through 99% of these patients are not allergic on formal evaluation. CASE DESCRIPTION: Patients labeled as penicillin allergic receive broader-spectrum and sometimes less-effective antibiotics, thereby contributing to increased treatment failures, antibiotic resistance, and adverse drug reactions. Self-reported penicillin allergy can be eliminated or classified as low-, medium-, or high-risk after a careful review of patient history. This allows these patients to be delabeled; that is, having any reference to their penicillin allergy history or of having an allergy to penicillin eliminated from their health records. PRACTICAL IMPLICATIONS: Oral health care professionals are ideally placed to partner in both antibiotic stewardship interventions by means of recognizing pervasive mislabeling and aiding in the process of delabeling.

Appropriate antibiotic use in dentistry: a review of the literature and clinical recommendations.

This article reviews the latest evidence on the use of antibiotics in dentistry, beginning with the risks of antibiotic use, which include Clostridioides difficile infection and antimicrobial resistance. The article then reviews the clinical practice guidelines for antibiotic prophylaxis for patients with prosthetic joints or at high risk for infective endocarditis. In the absence of established guidelines, the discussion also examines the published evidence on best practices for antibiotic prophylaxis with regard to other medical conditions (eg, kidney disease, cancer, or immunosuppression), dental extractions, minor oral surgical procedures, and implant placement, offering sample prescriptions for these situations. In addition, the current clinical practice guideline for antibiotic use in patients with endodontic infections is reviewed. Due to the alarming rates of antibiotic-resistant bacterial infections and increasing antimicrobial resistance, it is imperative that dentists use evidence-based guidelines and recommendations when prescribing antibiotics to prevent and treat oral infections.

The use of prophylactic antibiotics prior to dental procedures in patients with prosthetic joints: Evidence-based clinical practice guideline for dental practitioners--a report of the American Dental Association Council on Scientific Affairs.

BACKGROUND: A panel of experts (the 2014 Panel) convened by the American Dental Association Council on Scientific Affairs developed an evidence-based clinical practice guideline (CPG) on the use of prophylactic antibiotics in patients with prosthetic joints who are undergoing dental procedures. This CPG is intended to clarify the "Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures: Evidence-based Guideline and Evidence Report," which was developed and published by the American Academy of Orthopaedic Surgeons and the American Dental Association (the 2012 Panel). TYPES OF STUDIES REVIEWED: The 2014 Panel based the current CPG on literature search results and direct evidence contained in the comprehensive systematic review published by the 2012 Panel, as well as the results from an updated literature search. The 2014 Panel identified 4 case-control studies. RESULTS: The 2014 Panel judged that the current best evidence failed to demonstrate an association between dental procedures and prosthetic joint infection (PJI). The 2014 Panel also presented information about antibiotic resistance, adverse drug reactions, and costs associated with prescribing antibiotics for PJI prophylaxis. PRACTICAL IMPLICATIONS AND CONCLUSIONS: The 2014 Panel made the following clinical recommendation: In general, for patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection. The practitioner and patient should consider possible clinical circumstances that may suggest the presence of a significant medical risk in providing dental care without antibiotic prophylaxis, as well as the known risks of frequent or widespread antibiotic use. As part of the evidence-based approach to care, this clinical recommendation should be integrated with the practitioner's professional judgment and the patient's needs and preferences.