Association between dentists' awareness of antimicrobial resistance and selection of oral third-generation cephalosporins: a cross-sectional study.

OBJECTIVE

Antimicrobial resistance (AMR) is a global public health concern. In Japan, outpatient dental practice frequently involves antimicrobial prescriptions, with oral third-generation cephalosporins prescribed more often than the guideline-recommended amoxicillin. We examined the association between dentists' multidimensional AMR-related attitudes and selection of oral third-generation cephalosporins.

DESIGN

Cross-sectional secondary analysis of a questionnaire survey.

PARTICIPANTS

The questionnaire survey was administered to 406 dentists affiliated with the Kagawa Dental Association (November 2024-January 2025), and 111 responses were analyzed (response rate, 27.3%).

METHODS

The primary outcome was self-reported selection of oral third-generation cephalosporins. AMR attitudes were quantified as overall and domain-specific scores for sense of crisis, self-efficacy, and role awareness. Multivariable logistic regression analysis was performed, adjusting for years of clinical experience, sex, post-treatment prophylactic antimicrobial use, and practice type (in-house vs. external pharmacy dispensing). Domain-specific scores were analyzed separately to avoid multicollinearity.

RESULTS

High overall AMR attitude scores were associated with a low likelihood of selecting third-generation cephalosporins (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.72-0.92). Self-efficacy (OR, 0.50; 95% CI, 0.34-0.73) and role awareness (OR, 0.59; 95% CI, 0.42-0.84) showed strong negative associations. Post-I treatment prophylactic antimicrobial use and practice type involving external pharmacy dispensing were positively (OR, 2.69; 95% CI, 1.07-6.75) and negatively (OR, 0.34; 95% CI, 0.15-0.77) associated with selection of third-generation cephalosporins, respectively.

CONCLUSIONS

Dentists' AMR-related attitudes, particularly self-efficacy and professional role awareness, were strongly associated with antimicrobial prescription choices. Interventions targeting these factors may promote appropriate antimicrobial use in dental practice.