Use of antimicrobial agents in veterinary dentistry

As part of our continuing commitment to pharmaceutical stewardship in veterinary medicine, Banfield is investigating current antimicrobial usage (AMU) to identify opportunities for improvement. Together with collaborators from Mars Veterinary Health and UC Davis School of Veterinary Medicine, we recently examined AMU in canine and feline patients undergoing dental treatments in primary care practices across the US¹. Local or systemic antimicrobials were used in 16.4% of procedures in dogs and 14% of procedures in cats. Drugs classified as “highest priority critically important antibiotics” by the World Health Organization were used in 26.5% of treated dogs and 52% of treated cats. One of the goals of pharmaceutical stewardship is to minimize the use of antimicrobial agents to preserve their efficacy as we face the threat of increasing antimicrobial resistance. The frequency with which these important drugs are used in companion animals receiving dental treatments suggests that a reevaluation of current practices and the development of professional guidelines focused on usage may be warranted.

What this means for veterinary teams
This research describes the patterns of AMU in canine and feline dentistry within primary care practice. We hope these valuable data will inform interventions designed to optimize patient care and promote prudent AMU during dental procedures.

About the study
Dental disease is common in dogs² and cats³, and dental procedures are among the most frequently performed in veterinary clinics. Antimicrobial agents may be used in dental procedures to prevent infection at distant sites due to bacteremia (release of bacteria into the bloodstream), to reduce local infection associated with surgery, or to treat oral infections. They may also be used prophylactically during dental procedures, although such use has not been thoroughly characterized. Given the volume of procedures performed, veterinary dentistry is an important focus for antimicrobial stewardship efforts.

We studied 818,150 dental procedures (713,901 in dogs and 104,249 in cats) performed with general anesthesia at Banfield’s network of primary care practices in the US in 2020. Procedures included professional dental cleanings and, where indicated, dental nerve blocks and extractions. For each procedure, we recorded patient demographic data, details of antimicrobial treatment, periodontal disease score, and number of teeth extracted.

Top-line results
Local or systemic antimicrobial agents were used in 16.4% of procedures in dogs and 14% of procedures in cats. Increasing age, extraction of teeth, and presence of periodontal disease were associated with increased likelihood of AMU. This study did not evaluate whether patients had other concurrent conditions that may have influenced antimicrobial usage choices, although we are planning to investigate this in an upcoming study. Clindamycin, amoxicillin-clavulanate, and amoxicillin were among the most commonly used agents in both dogs and cats. Drugs classified as “highest priority critically important antibiotics” (HPCIAs) by the World Health Organization were used in 26.5% of treated dogs and 52% of treated cats. This class of drugs includes antibiotics such as third- and fourth-generation cephalosporins and fluoroquinolones. We noted marked differences among clinics in AMU: some clinics almost never used antimicrobials while some used them much more frequently.

Implications for antimicrobial stewardship
There are currently no accepted professional standard guidelines for antimicrobial prophylaxis in veterinary dentistry. Recommendations that exist tend to be very general or adapted from human health care. However, our results suggest that, even applying broad indications for prophylactic AMU, current practice may benefit from more specific, evidence-based guidelines. The striking variation in AMU across clinics supports this possibility.

Another area of investigation in this study was the timing of antibiotic administration. It is generally accepted that antibiotic administration (when indicated) should coincide with the period of greatest risk of infection. Infection risk is likely highest during the dental procedure itself, and the need for post-procedural antibiotic administration may be questionable.

The findings strongly indicate an urgent need for professional guidelines for AMU in veterinary dentistry. We hope to partner with other experts in the veterinary community to develop and disseminate this vital resource.

HPCIAs, in particular, should be addressed, given their frequent usage in veterinary dentistry. Of course, there are many considerations when choosing antimicrobial agents, and route of administration is one of those factors. One HPCIA, cefovecin, is a long-term injectable antibiotic and may be selected to prevent owners having to administer antibiotics at home. Owner education presents another opportunity to improve antimicrobial stewardship by limiting the use of HPCIAs. Veterinary teams can support owners in taking a more active role in administering antibiotics at home by conditioning pets to be handled successfully and coaching owners in on improved pet handling and medication administration techniques, options to make the experience more enjoyable, and the importance of following instructions and completing the prescribed course of medications.

New antimicrobial agents are not being developed fast enough to outpace increasing antimicrobial resistance⁴, which threatens both humans and animals. In some areas of practice, professional guidelines for usage exist (including many from the International Society for Companion Animal Infectious Diseases⁵) and can be a great resource. In areas where guidelines do not exist (e.g., dentistry), veterinary professionals can consider establishing a policy to guide AMU at the hospital or practice level until professional guidelines become available.

1. Soltero-Rivera M, Weese SJ, Battersby I, et al. Antimicrobial use practices in canine and feline dental procedures performed in primary care practices in the US. PLoS One. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0295070
2. O'Neill DG, James H, Brodbelt DC, et al. Prevalence of commonly diagnosed disorders in UK dogs under primary veterinary care: results and applications. BMC Vet Res 2021;17:69.
3. Girard N, Servet E, Biourge V, et al. Periodontal health status in a colony of 109 cats. J Vet Dent 2009;26:147-155.
4. The Pew Charitable Trusts. Cystic Fibrosis Patient Urges Congress to Support the Development of New Antibiotics. https://www.pewtrusts.org/en/research-and-analysis/articles/2023/11/14/cystic-fibrosis-patient-urges-congress-to-support-the-development-of-new-antibiotics
5. International Society for Companion Animal Infectious Diseases. Guidelines and Consensus Statements. https://www.iscaid.org/guidelines