Vol.73 No.3 May 2025
Changes in the use of oral third-generation cephalosporins by antimicrobial stewardship team intervention in the field of dental and oral surgery
1)Department of Dental and Oral Surgery, Tobata General Hospital, 1-3-33 Fukuryugi, Tobata-ku, Kitakyushu city, Fukuoka, Japan
2)Department of Internal Medicine, Tobata General Hospital
3)Department of Pharmacy, Tobata General Hospital
4)Department of Clinical Laboratory, Tobata General Hospital
5)Department of Nursing, Tobata General Hospital
Abstract
Antibiotic prescriptions in the field of dentistry account for approximately 10% of all antibiotic prescriptions. Penicillins, mainly amoxicillin, are recommended as first-line agents, both for treatment and prevention of dental infections, but oral third-generation cephalosporins are often prescribed in dental practice. In 2016, the Action Plan for Countermeasures against Antimicrobial Resistance was announced, which set out to reduce the use of oral cephalosporins in clinical practice. However, reduction in the prescription rates of these drugs in the field of dentistry has been insufficient. To support the appropriate use of antibiotics, an antimicrobial stewardship team (AST) was constituted in our hospital in January 2022; however, limited information is available on the effectiveness of the activities by the AST in the field of dentistry. 2,996 patients (93.3% outpatient prescriptions) who visited our Department of Dental and Oral Surgery between September 2021 and February 2024 and received prescriptions for oral antibiotics were enrolled in this study. These patients were classified into five 6-month time-periods, and the impact of the activities of the AST in the dentistry department on the appropriate use of oral third-generation cephalosporins and other oral antibiotics was assessed. The antimicrobial use density (AUD) of oral third-generation cephalosporins in the outpatient setting decreased significantly from 0.64±0.19 to 0.13±0.75 after the AST intervention. The AUD of oral third-generation cephalosporins for outpatient infection prevention showed a similar significant decrease. Meanwhile, the AUD of oral third-generation cephalosporins for the infection treatment decreased from 0.26±0.10 to 0.13±0.08 one year after the start of AST intervention and remained stable thereafter. Furthermore, the proportion of prescriptions for oral third-generation cephalosporins decreased from 61.0% to 11.7% overall (outpatient and inpatient), whereas the proportion of prescriptions for oral penicillins increased from 24.2% to 64.3% overall. These findings suggest that AST activities centered on pharmacists and dentists have contributed to appropriate use of antibiotics in our Department of Dental and Oral Surgery.
Key word
antimicrobial resistance, antimicrobial stewardship team, antimicrobial use density, penicillins, oral third-generation cephalosporins
Received
September 18, 2024
Accepted
January 15, 2025
Jpn. J. Chemother. 73 (3): 286-294, 2025
