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CDC epidemiologist highlights antibiotic overuse at ADA CE course

December 22, 2015

By Michelle Manchir


Dr. Hicks
Washington — Antibiotic resistance is a growing problem in the U.S. and dentists can play a role in improving antibiotic prescribing, according to Lauri Hicks, D.O., a medical epidemiologist in the Division of Healthcare Quality Promotion for the Centers for Disease Control and Prevention.
    
Dr. Hicks presented the information at a CE course, "Getting Smart about Antibiotic Use in Dental Practice," to a capacity crowd in November at ADA 2015 — America's Dental Meeting.
    
Dr. Hicks, who is the medical director for the CDC's "Get Smart: Know When Antibiotics Work" program and the director of CDC's Office of Antibiotic Stewardship, discussed the overall problem of inappropriate antibiotic prescribing in the outpatient setting, characterizing modern times as "the end of the antibiotic era."
    
She discussed the issue as it relates to dentists, who in 2010 prescribed 10 percent of about 258 million courses of antibiotics prescribed by all health care providers that year, Dr. Hicks said, citing data from IMS Health.
    
No new types of antibiotics have been developed in more than 10 years, Dr. Hicks said, adding that more toxic antibiotics are being used to treat common infections.
    
"Health care providers must treat antibiotics as a precious and finite resource," she said.
    
Dr. Hicks also discussed the threat of antibiotic-resistant infections, including Clostridium difficile, which can be deadly and require long and costly treatments.
    
An estimated 2 million antibiotic-resistant illnesses and 23,000 deaths occur annually in the United States, according to a 2013 Centers for Disease Control and Prevention report.
    
While guidelines for most heath care providers are in place when it comes to prescribing antibiotics, often they may not be well promoted, understood or followed, Dr. Hicks said.
    
There are some resources on the topic available to dentists.
    
On June 2, the ADA was among 150 organizations across human and animal health to participate in a White House Forum on Antibiotic Stewardship.
    
The ADA will provide appropriate scientific and clinical expertise on antibiotic health care issues, offer continuing education at profession meetings and provide systematic reviews and current scientific information on the proper use of antibiotics in online resources, the White House said in a post-forum report. The Association was one of 15 participating health professional organizations cited by the White House as clinical societies that "stand out" in efforts to address the challenge.
    
In 2014, the ADA Council on Scientific Affairs convened a panel to develop an evidence-based clinical practice guideline on the use of prophylactic antibiotics in patients with prosthetic joints who are undergoing dental procedures, intending 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 (published in 2012.)
    
The ADA also provided input and has been promoting American Heart Association guidelines, which are available at ADA.org.
    
Dr. Hicks said dentists can be especially challenged on this topic because they may be subject to pressure from other clinicians to prescribe when not necessary, and because most studies assessing community antibiotic prescribing have not included prescribing by dentists.
    
She said that the CDC is currently exploring opportunities to measure and characterize antibiotic prescribing by dentists.
    
"It's important to have data for action to guide interventions and to track improvement," Dr. Hicks said. "We need to understand the opportunities to improve antibiotic prescribing in dentistry."
    
Dr. Hicks' presentation slides are posted here.
    
For ADA information and resources regarding antibiotic prophylaxis, click here and here
    
For more information about the CDC's efforts, visit CDC.gov/GetSmart.