Factors associated with using penicillins as the first-choice antimicrobial among dentists in Japan: a national cross-sectional study.

Objective: This study aimed to identify the factors associated with the use of penicillins as the first-choice antimicrobial in Japan's dental clinics.

Design: Cross-sectional questionnaire-based survey.

Setting: Dental clinics throughout Japan.

Participants: Dentists at the participating clinics.

Methods: Questionnaires were sent to 1,700 dental care facilities in July 2020, and responses were collected until September 2020. The survey gathered data on clinic characteristics, provision of on-site antimicrobial dispensing, choice of antimicrobials, and knowledge regarding antimicrobial resistance (AMR) and infective endocarditis (IE). Descriptive epidemiology and logistic regression analyses were performed to identify the factors associated with on-site dispensing of penicillins and their use as the first-choice antimicrobial.

Results: Responses were obtained from 342 (response rate: 20.1 %) dentists from dental clinics. While 93.9% of respondents were aware of the term "AMR," only 20.8% were familiar with Japan's National Action Plan on AMR. AMR countermeasures were implemented in 79.4% of clinics, but 58.4% of respondents lacked awareness of IE guidelines. In the multivariable logistic regression analyses, "adherence to IE guidelines" (odds ratio: 2.56, P = .001) and "clinic stocks ≥2 antimicrobials" (5.02, P = .002) were positively associated with on-site dispensing of penicillins. In contrast, "clinic with ≥2 full-time dentists" (odds ratio: .45, P = .033) was negatively associated with the use of penicillins as the first-choice antimicrobial.

Conclusions: There was a low awareness of the National Action Plan and IE guidelines among dentists. Enhancing educational activities and fostering environments that facilitate collaborative decision-making regarding antimicrobial use may help to improve antimicrobial stewardship in Japan's dental clinics.