In Oral Surgery I have been banging on about this for years, since the days of the Mike Martin lectures in 1990's which changed my practice and provided me with the first audits of any substance that I was able to present to other people.
In 2002 (or there abouts) I ceased prescribing antibiotics for any minor Oral Surgery procedures as prophylaxis except in very small and strict cases, for example Type 1 Diabetics who are poorly controlled.
Following this we counted the numbers in our Oral Surgery service very carefully, altered some practices and managed to get our post operative infection rate to 0.5% confirming my initial thoughts that we were prescribing antibiotics prophylactically to 99.5% of our patients for no reason!
Soon after this I extrapolated the principle to implant surgery and stopped prescribing antibiotics for all implant surgery. We noticed a discernible rise in post-operative wound infections associated with GBR procedures and therefore refined the protocol to provide antibiotic cover for GBR procedures but not for cases where bone grafting was not carried out. Thus it has been for almost 10 years.
When I am in the midst of a complication cluster (which generally come every 12 - 18 months) I revisit this and wonder whether or not I should begin to prescribe antibiotics to try and reduce my failure rate from approximately 2% to lower than this. Then there was the systematic review studied by the Esposito Group in Manchester. This was a welcome study for anybody prescribing antibiotics as it confirmed the fact that the prescription of prophylactic antibiotics in implant surgery reduces early failure rates.
I promised Adam Patel that I would retrospectively look at my numbers before we had a discussion and entered into some sort of prospective analysis of our figures to assess whether antibiotic prescription for implant surgery made an significant difference in our practices and last week I managed to get around to looking at the numbers with the help of Marta, one of my implant nurses who collated the figures for us.
This is just a preliminary snap shot before we get down to the figures properly which I will blog about later together with the relevance of the Esposito study but the snapshot is here:
- I looked at my last 100 case - approximately 200 implants placed
- I looked at my last 100 implants placed without antibiotic cover
- In the last 100 cases, 6 implant failures (97% early survival rate) less than we usually get but smaller sample size and possible to explain this for individual cases
- In the last 100 implants placed without antibiotic cover - 100% survival rate
I completely understand the bias in the audit. I understand that the cases without antibiotic cover are simpler cases and the cases with antibiotic cover are likely to be more complex with GBR procedures but the results continue to confirm the basis of my practice and the need to reduce antibiotic prescription at all costs.
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