Inappropriate dental antibiotic prescriptions to prevent infective endocarditis cost the US healthcare system nearly $31 million a year, according to a modeling study published today on Infection Control & Hospital Epidemiology.

Although guidelines from the American Heart Association and the American Dental Association limit the use of prophylactic antibiotics to prevent infective endocarditis to those with cardiac conditions at highest risk, research has shown that 83.1% of dental antibiotics prescribed for that reason are inappropriate.

To estimate the costs associated with this practice, researchers used 2018 US Census data on adults aged 18 and older who had a dental visit with an antibiotic prescribed and on the reported incidence of infective endocarditis among those without predisposing cardiac conditions who underwent dental procedures. They calculated drug costs; adverse event costs associated with prescriptions of amoxicillin, cephalexin, and clindamycin; and out-of-pocket costs (co-pays).

About 5% of patients get preventive antibiotics

In their base case, 167 million US adults have a dental visit each year, and 7.9 million (4.8%) receive prophylactic (preventive) antibiotics. They calculated that if 83.1% of those prescriptions are inappropriate, antibiotic costs for the healthcare system would amount to $2.69 million, and costs of adverse events (eg, Clostridioides difficile and hypersensitivity) would amount to $5.82 million for amoxicillin, $1.99 million for clindamycin, and $380,849 for cephalexin. Patient out-of-pocket expenses for the antibiotic prescriptions would total $20.5 million.

Dentists account for 6%–10% of all antibiotic prescriptions in the United States.

The researchers also estimated that, without any inappropriate dental antibiotic use for infective endocarditis, there would be roughly three excess cases of infective endocarditis a year, costing $131,149.

"Overall, while the estimated costs associated with inappropriate antibiotic use in dentistry may not be significant, dentists account for 6%–10% of all antibiotic prescriptions in the United States,  resulting in a nontrivial burden of preventable adverse effects," the study authors wrote.

A pilot study conducted at an academic medical center highlights the benefits of direct review of antibiotic prescriptions by pharmacists, researchers reported today in Antimicrobial Stewardship & Healthcare Epidemiology.

The pharmacist-driven antimicrobial stewardship intervention, implemented at Temple University Medical Center, involved pharmacist review of oral antibiotic prescriptions for patients being discharged before the prescriptions were electronically sent to outpatient pharmacies. Each prescription was reviewed for correct antibiotic selection, dose, frequency, duration, and safety using inpatient laboratory and procedure results, progress notes, and medication administration records. To evaluate the program, Temple University School of Pharmacy researchers assessed the number of pharmacist interventions for oral antibiotic discharge prescriptions, as well as cost savings.

A total of 149 oral antibiotic prescriptions were reviewed during the study period, and 55 interventions were made, 42 (76%) of which were accepted. The most common reason for the intervention was inappropriate duration (19), followed by incorrect dosing (16) and antibiotic selection (9); other reasons for intervention included no indication for antibiotics (4), need for additional monitoring (4), and drug-drug interactions (3). The total estimated cost savings was $20,743.

Significant cost savings may be associated with discharge stewardship.

The study authors say the findings indicate that expansion of the program is warranted.

"Unnecessary antibiotics and dosing errors were identified, likely preventing unwanted adverse effects and outcomes associated with inappropriate antibiotic use," they wrote. "Additionally, significant cost savings may be associated with discharge stewardship."

The International AIDS Vaccine Initiative (IAVI) recently announced the launch of the first human trial of a Sudan Ebola virus vaccine, an investigational vesicular stomatitis virus (VSV) vector vaccine donated by Merck and licensed by IAVI.

Currently, there are no approved vaccines or treatments for Sudan Ebola. An outbreak in Uganda last year resulted in 164 cases, 55 of them fatal. During the outbreak, a World Health Organization (WHO) working group recommended that ring vaccine trials with three potential candidate vaccines prioritize the VSV-EBOV vaccine licensed by IAVI, because it is made with the sample platform as the approved VSV-EBOV vaccine for the Zaire strain, which has shown to be safe and effective.

In a statement, IAVI said the first-in-human phase 1 trial is funded by the US Biomedical Advanced Research and Development Authority (BARDA), which is part of the Department of Health and Human Services (HHS). IAVI said it is the vaccine candidate's regulatory sponsor and is responsible for all future aspects of its clinical development, including how it measures up against IAVI's other Sudan Ebola vaccine, which uses the same virus vector but is made using a new production platform.

The trial will enroll 36 healthy adults at two clinical sites in the United States. The blinded placebo-controlled study will assess three dosage levels of the intramuscular shot, and researchers will track safety and immune response in the participants for 6 months after vaccination.