A Survey of German Dentists on the Prophylactic Use of Antibacterial Drugs in Patients in Risk Groups: Diabetes, Joint Replacement, Risk of Endocarditis, and Immunosuppression or Organ Transplantation.

Introduction: Antibacterial drugs (ABDs) prescribed by dentists account for a significant proportion of all prescriptions for such drugs in Germany. The number of prescriptions is by no means uncontroversial, as guidelines are often lacking and antibacterial stewardship (antibiotic stewardship) calls for greater caution in the use of ABD. A survey was therefore conducted to answer the question of under what indications and with what consistency dentists in Germany use ABD. Methodology: In the survey, German dentists were asked to indicate the frequency of their ABD prescriptions for various dental procedures or comorbidities in four patient groups: patients at risk of endocarditis, joint replacement, diabetes, and organ transplantation or immunosuppression. They were also asked about the type of primary and secondary medication used. The responses were then summarized to form an overall picture and briefly compared with German-language guidelines. In addition, the year of state examination and the perceived level of confidence in using ABD were determined. Results: It was found that only in patients with a risk of endocarditis and organ transplantation or immunosuppression did some questions show a positive trend, and in patients with diabetes and joint replacement, a negative trend up to a negative consensus. In all cases, the primary ABD prescribed was amoxicillin and the secondary was clindamycin by an overwhelming majority of responses. Discussion: The inconsistent results indicate a great need for education on the use of prophylactically prescribed ABD. Particularly in cases of rare pre-existing conditions, there is a high level of uncertainty with a tendency toward prophylactic drug administration. Existing transnational guidelines ensure a more uniform approach overall. Conclusion: Although no widely consistent approach could be identified for the various questions, the use of ABD appears to be generally restrained.