Antibiotic Stewardship: What outcomes should be measured in dentistry?

Conference:

SAPC ASM 2022 - UCLan

Talk Code:

1B.2

Presenter:

Wendy Thompson

Twitter:

@wendythedentist

Co-authors:

Wendy Thompson, Leanne Teoh, Celine Pulcini, Susie Sanderson, David Williams, Vanessa Carter, Carole Pitkeathley

Author institutions:

University of Manchester, University of Melbourne, Université de Lorraine, Queen Mary University of London,

Problem

Antibiotic resistance is a global public health and patient safety problem. To conserve the effectiveness of antibiotics for future generations, antibiotic stewardship is advocated to ensure their use only where necessary. Dentistry accounts for some 10% of antibiotic prescriptions across global healthcare, with high rates of unnecessary use. Whilst numerous trials of antibiotic stewardship across primary healthcare exist, few studies of dental antibiotic stewardship have so far been published.Core outcome sets are widely used to maximise the value derivable from clinical trials. No core outcome set for antimicrobial stewardship in any part of healthcare has yet been published (or registered as in development). By developing international consensus on a core outcome set for antibiotic stewardship in dentistry, this study aims to produce the first one.

Approach

This core outcome set was developed using DelphiManager, with candidate outcomes from a literature review. International participants (10 academics, 10 dentists and 10 patient-representatives) were recruited via Twitter and FDI World Dental Federation. Outcomes scored ‘critical for inclusion’ by >70% after two Delphi rounds were included following a final consensus meeting. The full protocol for this study is available at: https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-022-06038-w

Findings

Outcomes relating to antibiotic use (such as rate of prescribing), harms or complications (for example, serious adverse outcomes) and the patient-reported outcome ‘ability to carry on with daily life as normal’ were included in the core set. Measures of care quality (such as patient satisfaction), time and cost were excluded. Some outcomes (such as time to resolution of symptoms) were excluded from the core outcome set as they are not relevant to both the treatment of dental infections and the prophylaxis of infections associated with operative dental procedures. These outcomes will be highlighted as examples of additional contextual outcomes which researchers may wish to include in their studies, in addition to the core outcomes.

Consequences

Consensus about a core outcome set for dental antibiotic stewardship has been achieved with academic, clinical and patient stakeholders from around the world, covering antibiotic use, complications and patient-reported outcomes. This core outcome set enables researchers of dental antibiotic stewardship to report their study results in a meaningful way, thus supporting the profession to contribute to global efforts to tackle antibiotic resistance.

Submitted by:

Wendy Thompson

Funding acknowledgement:

This study was funded by FDI World Dental Federation through its Antimicrobial Resistance Programme, which was supported by GSK Consumer Healthcare. The funding body had no role in the design of the study and collection, analysis, and interpretation of data or in writing the manuscript.