Antibiotics are widely overused in many arenas — including veterinary dentistry. Through a better understanding of specific factors that support prescribing — instances in which they are necessary and appropriate — every practitioner has a very real opportunity to be a better steward.
The stakes go beyond any single patient. The indiscriminate or improper use of antibiotics is a driver of antimicrobial resistance, and the World Health Organization projects that deaths from antimicrobial resistance will overtake deaths from cancer by 2050. Antibiotic resistance is a global, One Health threat — a massive problem in human medicine and for our animal patients.
Surveys have shown that, in general practice, patients are often prescribed antibiotics after routine cleanings and extractions — even in cases with no documented periodontal disease. At the specialty level, prophylactic prescribing has also been found to occur with some frequency. So — do we need to be doing that? Is all of this prescribing warranted?
We do have evidence that helps to answer those questions and guide us in achieving best practices in antibiotic prescribing. In veterinary dentistry, for example, we know that the risk of post-op infection in immunocompetent patients requiring extensive extractions of teeth (regardless of stage of periodontal disease) is low (less that 1%). As such, prescribing antibiotics to prevent post-op infection (in an otherwise healthy individual) would be considered unnecessary.
So, which cases actually warrant antibiotics, and which don't? What does "immunocompetent" rule in — or rule out? And what is an appropriate drug and course of therapy when an antibiotic is indicated in veterinary dentistry? In her discussion on this topic, Dr. Stephanie Goldschmidt (a board certified specialist in veterinary dentistry and a Fellow in oral and maxillofacial surgery) further explains the evidence base to support indications, best practices, and drug selection when prescribing antibiotics in companion animal practice.
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