Impact of the COVID-19 pandemic on antibiotic prescribing by dental practitioners across the United Kingdom’s four countries: a pharmacoepidemiological study of populationlevel dispensing data, 2016–2023

Objectives: To evaluate and compare the rates of antibiotic prescribing by dental practitioners across the constituent countries of the United Kingdom between March 2020 and August 2023 and to estimate the total 'excess' prescribing that occurred during this interval beyond the rates predicted based upon trends between March 2016 and February 2020.

Methods: Retrospective pharmacoepidemiological study of dental practitioners' antibiotic prescribing, by secondary analysis of population-level National Health Service dispensing data from England, Scotland, Wales and Health and Social Care dispensing data from Northern Ireland.

Results: Effective August 2023, the antibiotic items dispensed rate for each country remained in excess of that predicted based upon pre-pandemic trends. Between March 2020 and August 2023, those rates were 175.6, 227.2, 195.0 and 321.8 antibiotic items per 1000 population for England, Scotland, Wales and Northern Ireland, respectively. Those represented estimated total 'excesses' of 27.7% (95% confidence limit [CL], 14.8, 43.7), 43.3% (95% CL, 29.9, 60.0), 33.2% (95% CL, 20.4, 49.0) and 42.9% (95% CL, 27.6, 62.3). Pairwise comparisons showed statistically significant differences between England and Scotland, England and Northern Ireland, and Wales and Northern Ireland (p < 0.001), Scotland and Wales (p = 0.001), and Scotland and Northern Ireland (p = 0.009). There was no statistically significant difference between England and Wales.

Conclusions: With shared prescribing guidelines and a single professional regulatory framework, it was unsurprising that similar antibiotic prescribing trends were found across the United Kingdom. Further research is required to investigate the reasons for the differences.