What is dental antibiotic stewardship?

Dental antibiotic stewardship means optimising prescribing so that dental procedures are delivered whenever possible and antibacterial drugs (antibiotics) are only used when necessary. The concept of ‘stewardship’ is about ‘careful and responsible management of something entrusted to your care’.

When were stewardships developed?

Antibiotic stewardship programmes were first developed and implemented in the 1990s, often led by pharmacists in the United States and by infectious disease/clinical microbiology specialists in Europe. These programmes were not always called antimicrobial stewardship programmes, in part due to the lack of an equivalent for ‘stewardship’ in many languages. Examples of translations include:

• (programme de) bon usage des antibiotiques (= programme of good antibiotic use) in French
• Strategien zum rationalen Einsatz von Antiinfektiva (= strategy of rational use of anti-infectives) in German
• rationeel antibiotica beleid/gebruik (= rational antibiotic policy/use) in Dutch.

What are the programmes?

Antibiotic stewardship programmes are sets of interventions aimed at promoting the use of antibiotics appropriately (i.e. in accordance with existing guidance). Historically, antibiotic stewardship programmes have been developed and implemented in hospital settings, yet most dental prescribing takes place in primary care/community settings.

Understanding where the most potential exists for reducing unnecessary use is an important element of planning a dental antibiotic stewardship programmes. Core elements have been identified in various contexts, including hospitals, nursing homes and community settings.

Stewardship framework

For dental antibiotic stewardship programmes, a range of interventions in community and hospital settings have been developed, tested and reported. The FDI World Dental Federation white paper on antibiotic resistance proposes a framework for dental antibiotic stewardship programmes which includes four elements:

1. Educating members of the dental team (not just prescribers)
2. Guidelines (to ensure accountability of organisations and individual prescribers) about appropriate clinical indications for antibiotic use which are appropriate to the local context
3. Undertaking audit and feedback of prescribing against the guidelines (accountability of organisations and individual prescribers)
4. Patient-facing material to help deliver key messages in relation to antibiotic stewardship in dentistry and beyond to the wider community

Cultural issues

The language issues outlined above highlight one of the many cultural issues that are important to consider at every stage of developing approaches to antibiotic stewardship. Empowering organisations and individuals to play a part in tackling antibiotic resistance and working in collaboration across healthcare are important too.

Examples of dental antibiotic stewardship resources from around the world are provided in the FDI World Dental Federation white papers online library. This is a fast-moving agenda and there are also academic papers on the topic.