Background

In 2016, dentists accounted for 6% of all outpatient antibiotic prescriptions in Belgium. This study aimed to evaluate antibiotic prescribing trends in dental practice from 2017 to 2021 in Belgium and explore the influence of prescriber demographics (age, gender and specialty), and of the COVID-19 pandemic on prescribing behaviour.

Methods

Reimbursement data from the Belgian National Institute for Health and Disability Insurance (NIHDI) were analysed to evaluate systemic antibiotic (ATC J01) prescriptions by dentists from 2017 to 2021. Antibiotic use was quantified in Defined Daily Doses (DDDs — WHO ATC/DDD Index 2023) and expressed as DDD per 1000 inhabitants per day (DID. Data on dentist demographics (age, gender, specialty) and professional activity (number of consultations) were also obtained from NIHDI and used  to assess prescribing behaviour.

Results

Total antibiotic prescriptions by Belgian dentists (measured in DDD) increased by 2.4% from 2017-2019, followed by a 3.4% decline in 2020, coinciding with the onset of the COVID-19 pandemic and restrictions on dental activities. This was followed by a rebound of +6.3% in 2021. Despite the overall decline in 2020, the volume of J01 antibiotics prescribed per consultation increased during that year.

The proportion of total outpatient J01 antibiotic prescription attributable to dentists steadily increased throughout the study period, rising from 5.3% in 2017 to 7.3% in 2021. Male and older dentists consistently prescribed more antibiotics than their younger and female counterparts. A comparison of prescribing patterns before and after the introduction of national antibiotic guidelines for dentistry in 2020 showed limited  change in the proportion of recommended antibiotics prescribed. Similarly, the proportional use of popular but non-recommended antibiotics (e.g. amoxicillin-clavulanic acid and nitrofurantoin) remained largely unchanged.

Conclusion

The study demonstrates that antibiotic prescribing among Belgian dentists is influenced by various factors, including prescriber characteristics and external disruptions such as the COVID-19 pandemic. While adherence to guidelines appears stable, possibilities exist to further optimize prescribing practices, particularly by increasing the use of recommended antibiotics and reducing the reliance on non-recommended agents.