Antibiotic Stewardship Program

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Instructor: Dr. Tom Paumier

Duration: 4 hours

Lessons: 8

Skill Level: Beginner

Price: $450

Course Overview

Why is it important to implement an antibiotic stewardship program in your dental office, group practice, DSO, Institutional Clinic, Dental school, or Residency program?

Antibiotic use is not benign, and can cause immediate adverse reactions that are easily recognized and treated, but also can have untoward effects months to years later, and dentists may be unaware they are occurring. The most significant delayed adverse reactions are antimicrobial resistance and Clostridioides difficile (C. diff) infections (CDI). The CDC estimates that 2.8 million antibiotic-resistant infections occur yearly resulting in 35,000 deaths. Additionally, 500,000 C. diff infections occur each year leading to 28,000 deaths. And these are likely significant underestimates. That amounts to a death related to antibiotic use
every 8-10 minutes! Considering the dental profession prescribes 10% of all antibiotics amounting to nearly 26 million prescriptions per year, dentists contribute to the alarming increase in antimicrobial resistance which lead to superbug infections. A focus on antimicrobial stewardship at the individual clinician level, group and corporate practice level and institutional level and in dental schools and residency programs will enable better outcomes for patients and ensure compliance with best practices for antibiotic prescribing in dentistry.

What is part of an antimicrobial stewardship program?

1). Education about current Clinical Practice Guidelines and best practices for antibiotic use in the following areas:

Antibiotic Prophylaxis for distant site infections (prosthetic joints, cardiac and other medical conditions)
Antibiotic Prophylaxis for routine oral surgical procedures including extractions, implant placement, periodontal procedures and other minor surgery. Therapeutic use of antibiotics for odontogenic infections. Dosage, timing and duration of antibiotic use for all conditions listed.

2). Understanding Risks of Antibiotic Use:

Identifying who is at greatest risk for C. diff infection (CDI) and developing antimicrobial resistance and superbug infections.
Identifying which antibiotics are most harmful. How to minimize risks of antibiotics for individual patients by a thorough medical history.

3). Why it is important to question patients who claim a penicillin allergy. 4). Clinical Tools to ensure compliance with best practices for antibiotic prescribing including questions to ask prior to prescribing antibiotics, algorithms for when to prescribe as well as what to prescribe. 5). Information sheets for patients:

Why AP for patients with prosthetic joints is not necessary.
Why the antibiotic prescribed will not cure a dental infection, how to use the antibiotic properly and the risks of taking an antibiotic.

6). Office Guides:

C. diff Risk Assessment Tool.
How to Identify Patients at Highest Risk for AMR.
When to prescribe antibiotics and when not to prescribe, or when to use a contingency prescription.
Sample antibiotic prescriptions.
Questions to ask patients prior to prescribing antibiotics.

7). On demand webinars:

Antibiotic Prophylaxis for patients with prosthetic joints, oral cavity related bacteremia, and C. diff risks.
Antibiotic Prophylaxis for patients with cardiac and other medical conditions.
Antibiotic Stewardship and appropriate antibiotic use for odontogenic infections, extractions, implant placement, periodontal treatments and other minor oral surgery.

8). Recommendations:

Monitor number of prescriptions written per month. How many were after an oral/physical exam, or by phone without an in person exam?
Monitor appropriateness and concordance with existing clinical practice guidelines and best practices.
Monitor for appropriate antibiotic choice, dosage, frequency, and duration.
Monitor for appropriate questioning of patient before giving prescription.
Monitor for number of contingency prescriptions for when immediate treatment is not available.
Monitor for specific number of prescriptions for Clindamycin.
Monitor appropriate questioning of patients prior to prescribing antibiotics.

By implementing this antibiotic stewardship program you will learn the answers to these questions and understand how to use antibiotics appropriately to minimize the risk of adverse outcomes.

How does bacteremia from invasive dental procedures cause distant site infections?
Is the patients oral health condition related to risk for bacteremia and distant site infections?
Does antibiotic prophylaxis prevent distant site infections?
What happens when you take antibiotics before dental work?
Do all antibiotics provide protection from distant site infections with the same efficacy?
Why should Clindamycin never be used for antibiotic prophylaxis but may be appropriate for some odontogenic infections?
Who is most at risk of developing a C. diff infection?
What antibiotics put patients at most risk of C. diff infections?
Do you know why recommending a patient use Imodium if they develop diarrhea after taking an antibiotic could possibly kill them?
Can a patient who takes a single dose of antibiotic develop antibiotic resistant organisms?
Who is at most risk of developing antimicrobial resistant organisms?
Why is antibiotic prophylaxis contraindicated for all patients who have prosthetic joints.
Is it necessary to delay dental care prior to or after a patient has a prosthetic joint placed?
What should you do if the orthopedic surgeon recommends antibiotic prophylaxis and the patient prefers to use it?
How should you handle patients who forget to take their antibiotic prophylaxis before their appointment?
What cardiac conditions are appropriate to use antibiotic prophylaxis?
Is it necessary to use antibiotic prophylaxis for patients who have had a bone marrow transplant, kidney or lung transplant, are undergoing dialysis or chemotherapy, have cerebrospinal fluid shunts, deep brain stimulators, breast implants or other medical conditions?
Does an aortic aneurysm repair require antibiotic prophylaxis?
How might better questioning patients about being penicillin allergic potentially prevent them from acquiring a MRSA or C. diff infection or developing a surgical site infection?
What penicillin allergic patients can safely take cephalosporins?
When should you prescribe antibiotics after extractions or minor oral surgery?
What antibiotic if used when placing implants increases your likelihood of implant failure?
Are antibiotics necessary when placing implants with or without bone grafting, and if so, how should they be prescribed?
Should antibiotics be used when doing periodontal root planing and if indicated what is the only effective drug(s)?
Are antibiotics necessary when doing crown lengthening, apical surgery or other minor oral surgical procedures?
Are you writing your antibiotic prescriptions to be taken “until gone” and why that may put you at legal risk?

Course Content

Course Instructor

Dr. Tom Paumier

A 1987 cum laude graduate of the Ohio State University College of Dentistry, completed a general practice residency at St. Elizabeth Medical Center in Youngstown, Ohio. He has been in private practice in Canton, Ohio, since 1988. Dr. Paumier is on the faculty of the Mercy Medical Center GPR in Canton and is a fellow in the International College of Dentists and American College of Dentists. He was a member of the American Dental Association Council on Scientific Affairs’ Expert Panel on Prosthetic Joint Prophylaxis and the ADA/American Academy of Orthopaedic Surgeons’ Expert Panel for Prosthetic Joint Prophylaxis Appropriate Use Criteria. He also serves on the ADA Expert Panel for Antibiotic Therapeutics. He is a past president of the Ohio Dental Association.