Dental care resistance prevention and antibiotic prescribing modification-the cluster-randomised controlled DREAM trial

Christin Löffler, Femke Böhmer, Anne Hornung, Hermann Lang, Ulrike Burmeister, Andreas Podbielski, Anja Wollny, Günther Kundt, Attila Altiner, Christin Löffler, Femke Böhmer, Anne Hornung, Hermann Lang, Ulrike Burmeister, Andreas Podbielski, Anja Wollny, Günther Kundt, Attila Altiner

Abstract

Background: Bacterial resistance development is one of the most urgent problems in healthcare worldwide. In Europe, dentistry accounts for a comparatively high amount of antibiotic prescriptions. In light of increasing levels of bacterial resistance, this development is alarming. So far, very few interventional studies have been performed, and further research is urgently needed. By means of a complex educational intervention, the DREAM trial aims at optimising antibiotic prescribing behaviour of general dentists in Germany.

Method: This is a cluster-randomised controlled trial, where each cluster consists of one dental practice and all of its patients in a defined period. Participants are general dentists practicing in the German region of Mecklenburg-Western Pomerania. Randomisation takes place after baseline data collection (6 months) and will be stratified by the antibiotic prescribing rates of the participating dental practices. Dentists randomised into the intervention group will participate in a complex small group educational seminar that aims at: increasing knowledge on bacterial resistance, pharmacology, and prophylaxis of infectious endocarditis; increasing awareness of dentist-patient communication using video-taped vignettes of dentist-patient communication on antibiotic treatment; improving collaboration between general dentists, general practitioners, and practice-based cardiologists on the necessity of antibiotic prophylaxis; enhancing awareness of the dentists' own prescribing habits by providing antibiotic prescribing feedback; and increasing patient knowledge on antibiotic treatment by providing patient-centred information material on antibiotic prophylaxis of endocarditis. The dentists randomised into the control group will not receive any educational programme and provide care as usual. Primary outcome is the overall antibiotic prescribing rate measured at T1 (period of six months after intervention). In a subgroup of adult patients affected by odontogenic infections, microbiological analyses for antibiotic resistance of oral streptococci are performed.

Discussion: Major aim of the study is to improve the process of decision making with regard to antibiotic prescribing. The approach is simple to implement and might be used rapidly in graduate and post-graduate medical education. We expect the results of this trial to have a major impact on antibiotic prescription strategies and practices in Germany.

Trial registration: Current Controlled Trials ISRCTN09576376.

Figures

Figure 1
Figure 1
Flow chart of the DREAM trial.

References

    1. Foucault C, Brouqui P. How to fight antimicrobial resistance. FEMS Immunol Med Microbiol. 2007;49:173–183. doi: 10.1111/j.1574-695X.2006.00172.x.
    1. Shehab N, Patel PR, Srinivasan A, Budnitz DS. Emergency department visits for antibiotic-associated adverse events. Clin Infect Dis. 2008;47:735–743. doi: 10.1086/591126.
    1. Shlaes DM, Gerding DN, John JF Jr, Craig WA, Bornstein DL, Duncan RA, Eckman MR, Farrer WE, Greene WH, Lorian V, Levy S, McGowan JE Jr, Paul SM, Ruskin J, Tenover FC, Watanakunakorn C. Society for healthcare epidemiology of america and infectious diseases society of America joint committee on the prevention of antimicrobial resistance: guidelines for the prevention of antimicrobial resistance in hospitals. Clin Infect Dis. 1997;25:584–599. doi: 10.1086/513766.
    1. Adriaenssens N, Coenen S, Versporten A, Muller A, Minalu G, Faes C, Vankerckhoven V, Aerts M, Hens N, Molenberghs G, Goossens H. ESAC Project Group. European surveillance of antimicrobial consumption (ESAC): outpatient antibiotic use in Europe (1997-2009) J Antimicrob Chemother. 2011;66(Suppl 6):vi3–vi12.
    1. Adriaenssens N, Coenen S, Versporten A, Muller A, Vankerckhoven V, Goossens H. European surveillance of antimicrobial consumption (ESAC): quality appraisal of antibiotic use in Europe. J Antimicrob Chemother. 2011;66(Suppl 6):vi71–vi77.
    1. Sweeney LC, Dave J, Chambers PA, Heritage J. Antibiotic resistance in general dental practice–a cause for concern? J Antimicrob Chemother. 2004;53:567–576. doi: 10.1093/jac/dkh137.
    1. Dailey YM, Martin MV. Are antibiotics being used appropriately for emergency dental treatment? Br Dent J. 2001;191:391–393.
    1. Dar-Odeh NS, Abu-Hammad OA, Al-Omiri MK, Khraisat AS, Shehabi AA. Antibiotic prescribing practices by dentists: a review. Ther Clin Risk Manag. 2010;6:301–306.
    1. GERMAP 2008. Antibiotika-Resistenz und -Verbrauch: Bericht über den Antibiotikaverbrauch und die Verbreitung von Antibiotikaresistenzen in der Human- und Veterinärmedizin in Deutschland. Rheinbach, Germany: Bundesamt für Verbraucherschutz und Lebensmittelsicherheit, Paul-Ehrlich-Gesellschaft für Chemotherapie e.V. und Infektiologie Freiburg, Antiinfectives Intelligence Gesellschaft für klinisch-mikrobiologische Forschung und Kommunikation mbH; 2008.
    1. Halling F. Zwischen Anspruch und Wirklichkeit. Zahnarztl Mitt. 2010;9:50–55.
    1. Von Lübcke J. Evaluation der Rezeptierung von Antibiotika bei niedergelassenen Zahnärzten in Norddeutschland. Dissertation: University of Hamburg; 2009.
    1. Finch RG, Metlay JP, Davey PG, Baker LJ. Educational interventions to improve antibiotic use in the community: report from the international forum on antibiotic resistance ( IFAR ) colloquium, 2002. Lancet Infect Dis. 2004;4:44–53. doi: 10.1016/S1473-3099(03)00860-0.
    1. Arnold S, Straus S. Interventions to improve antibiotic prescribing practices in ambulatory care (Review) Cochrane database Syst Rev. 2005;4:CD003539.
    1. Altiner A, Brockmann S, Sielk M, Wilm S, Wegscheider K, Abholz H-H. Reducing antibiotic prescriptions for acute cough by motivating GPs to change their attitudes to communication and empowering patients: a cluster-randomized intervention study. J Antimicrob Chemother. 2007;60:638–644. doi: 10.1093/jac/dkm254.
    1. Palmer NAO, Dailey YM, Martin MV. Can audit improve antibiotic prescribing in general dental practice? Design An intervention study carried out in general dental. Br Dent J. 2001;191:253–255.
    1. Seager JM, Howell-Jones RS, Dunstan FD, Lewis MAO, Richmond S, Thomas DW. A randomised controlled trial of clinical outreach education to rationalise antibiotic prescribing for acute dental pain in the primary care setting. Br Dent J. 2006;201:217–222. doi: 10.1038/sj.bdj.4813879.
    1. Muller A, Coenen S, Monnet DL, Goossens H. European Surveillance of Antimicrobial Consumption (ESAC): outpatient antibiotic use in Europe, 1998-2005. Euro Surveill. 2007;12(41):3284.
    1. Goossens H, Ferech M, Vander Stichele R, Elseviers M. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet. 2005;365:579–587. doi: 10.1016/S0140-6736(05)17907-0.
    1. Chardin H, Yasukawa K, Nouacer N, Plainvert C, Aucouturier P, Ergani A, Descroix V, Toledo-Arenas R, Azerad J, Bouvet A. Reduced susceptibility to amoxicillin of oral streptococci following amoxicillin exposure. J Med Microbiol. 2009;58:1092–1097. doi: 10.1099/jmm.0.010207-0.

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