What we know about antibiotics prescribed by dentists in a Brazilian southeastern state

Abstract The objective of this study was to analyze possible associations between antibiotic dental prescriptions in the public health service, health service characteristics, and social characteristics of the municipalities. Using the register of dispensing in the public health service of a state in the Southeast region of Brazil, in 2017 we analyzed patterns of antibiotic prescriptions by dentists. Data were obtained from the Integrated Pharmaceutical Services Management System (SIGAF, in Portuguese). The outcome variable was the number of Daily Defined Doses (DDD) per 1,000 residents/year in each municipality. CART (Classification and Regression Tree) technique was used to determine the influence of the following variables: populational social characteristics (Human Development Index, Gini Index, the proportion of rural population and proportion of families benefiting from the Bolsa Família Program) and oral health services characteristics (access to individual dental care, number of dentists and oral health teams per 1,000 residents, and percentage of preventive and restorative individual dental procedures. Data analysis was performed using IBM SPSS Statistics 21.0. Antibiotics were the medications most prescribed by dentists in the public health service, with penicillin being the most frequently prescribed class. The average DDD/1,000 residents/year for the 421 municipalities surveyed was 96.54 (range 0.008 and 619.660). Select factors were associated with antibiotic prescriptions including access to individual dental care (Adjusted p-value ≤0.001), a number of oral health teams/1,000 inhabitants (Adjusted p-value=0.001), and Gini Index (Adjusted p-value = 0.046). Access to oral health services and inequality were associated with the use of antibiotics.摘要 本研究旨在分析公共卫生服务中牙科抗生素处方、卫生服务特征与各市域社会特征之间的潜在关联。本研究依托巴西东南部某州公共卫生服务的配药登记数据，于2017年对牙医开具的抗生素处方模式展开分析。研究数据取自综合药品服务管理系统（Integrated Pharmaceutical Services Management System，SIGAF）。本研究的结局变量为各市域每千名居民每年的每日规定剂量（Daily Defined Doses，DDD）数。本研究采用分类与回归树（Classification and Regression Tree，CART）技术，对以下变量的影响进行分析：人口社会特征（人类发展指数、基尼系数、农村人口占比以及受益于巴西家庭补助金计划（Bolsa Família Program）的家庭占比），以及口腔卫生服务特征（个体化牙科护理可及性、每千名居民对应的牙医与口腔卫生团队数量、个体化牙科预防与修复治疗的占比）。数据分析采用IBM SPSS Statistics 21.0软件完成。公共卫生服务中医师开具的处方药物中，抗生素为最常用类别，其中青霉素类处方占比最高。本次调研覆盖的421个市域，其平均每千名居民每年DDD数为96.54（区间范围0.008至619.660）。多项因素与抗生素处方存在显著关联，具体包括个体化牙科护理可及性（校正后P值≤0.001）、每千名居民对应的口腔卫生团队数量（校正后P值=0.001）以及基尼系数（校正后P值=0.046）。口腔卫生服务可及性与社会不平等程度均与抗生素使用存在关联。