(B-243) Adverse Drug Events (ADEs) Associated with Outpatient Antibiotic Fills to Children by Dentists, 2014-2019

Background: Dentists account for 1 in 10 antibiotic prescriptions in the U.S., including to children. In adults, >80% of dental antibiotics are inappropriate and have been associated with adverse drug events (ADEs). Concern regarding overuse also exists for children, and the American Academy of Pediatric Dentistry only recommends antibiotics for specific populations and procedures – e.g., children with cardiac conditions and procedures involving gingival manipulation or perforation of oral mucosa. However, rates of dental prescribing and associated ADEs in children are unknown.

Objectives: To describe national dental antibiotic use and associations with ADEs in U.S. children from 2014 to 2019.

Methods: We conducted a longitudinal cross-sectional study of children (2-17 years) prescribed an antibiotic by a dentist within 7 days before or after a dental visit using the Meritive MarketScan commercial and Medicaid claims databases. We required continuous insurance enrollment and excluded non-dental antibiotics. Our outcome was the proportion of antibiotics associated with severe ADEs – dermatologic reactions, hypersensitivities (anaphylaxis, angioedemia, allergy), or acute kidney failure within 14 days, or C.difficile infections (CDI) within 30 days. Prescriptions per year and the proportion associated with ADEs were summarized. Differences between visits with and without ADEs were identified using standardized mean differences (SMD) >0.20.

Results: From 2014 to 2019, we identified 841,604 dental visits among 589,031 children with an antibiotic dispensed. Among all dental visits with an antibiotic, 1,925 (2 per 1,000) were associated with ADEs. ADEs ranged from 2.2 per 1,000 in 2018 to 3.3 per 1,000 in 2014. The most common ADEs were dermatologic reactions (0.5 per 1,000) and hypersensitivities (0.2 per 1,000). We identified 87 C diff. infections, and 55 acute kidney failure diagnoses ( < 1 per 10,000). Fewer than one in three visits (29%) involved gingival manipulation, with no significant difference between ADE groups (SMD < 0.04). Compared to children without ADEs, children with ADEs were younger (median age 8 versus 9), filled more prescriptions for cephalosporins (24% versus 14%) or sulfonamides (13% versus 5%), and filled fewer prescriptions for amoxicillin (54% versus 70%).

Conclusions: Approximately 2 in 1,000 dental antibiotic fills to U.S. children were associated with potential ADEs in this study. Additionally, fewer than one in three fills were to children undergoing procedures like gingival manipulation. Although rare, individual risks for ADEs and population-level risks for resistance suggest a need for greater antibiotic stewardship to increase dental medication safety in children.