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Request Reference: 8970 Request Date: 02 Jan 2020
Request: Please provide an update (ideally to the end of 2019, or as near as possible) of the data you originally provided under FOI request 503857 and most recently updated in April 2014 through FOI request 4355. The reasons for this request are provided below. Background: It used to be standard practice for all patients with certain cardiac risk factors to be given antibiotic cover (ABC) prior to invasive dental procedures to reduce the risk they would develop infective endocarditis (IE). Over several years the benefit of ABC has been questioned and in March 2008 NICE produced new guidelines advising that ABC should be stopped for all dental procedures. The data we requested previously showed that after the March 2008 guideline change, there was a large reduction in ABC prescribing by dentists, doctors and other health care professionals. In March 2015, however, NICE changed its guidance again permitting healthcare providers to prescribe ABC again but without providing advice about which patients should be considered for ABC, which dental procedures should be covered by ABC or what antibiotic regimen should be used. This caused a lot of confusion. However, in August 2018, the Scottish Dental Clinical Effectiveness Programme (SDCEP) published advise for dentists and other clinicians on when and how to provide ABC. This advice was endorsed by NICE, the British cardiovascular Society and the Chief Dental Officers of the 4 devolved nations. It therefore become the standard of care for the whole UK. Objective: We want to extend the data we have previously received (covering 1st January 2004 - 28th February 2014) to as current a date as possible, to identify how (a) the NICE guidance change in March 2015 and (b) the SDCEP advice in August 2018 have further impacted on the prescribing of ABC. Information Required: ABC is prescribed as a single 3 gram dose of Amoxicillin 1 hour before the dental procedure. Listed in BNF section 5.1.1.3 as Amoxicillin 3 gram sachet sugar free, or Amoxil 3 gram sachet sugar free. Patients allergic to penicillin are given a single 600mg dose of Clindamycin. As a 600mg tablet is not available, this is normally dispensed as 4 x 150mg tablets. Clindamycin 150mg is listed in BNF section 5.1.6.0 as Clindamycin 150mg or Dalacin 150mg. Although Clindamycin is prescribed for other purposes (usually at 150-300mg 6 hourly for several days), it is only prescribed as a single 600mg dose for ABC purposes. If it is possible to identify prescriptions for a single dose of 600mg it would be very important for us to have this data. We do not require data for other Clindamycin regimes however. Previous FOI requests have provided us with the monthly prescribing data for a single 3g oral dose of Amoxicillin/Amoxil and a single 600mg oral dose of Clindamycin for the period between 1st January 2004 and 28th February 2014. We now request the same data from 1st March 2014 until 31st December 2019, or as recent a data as possible. You have previously given us this data split to show who issued the prescriptions: Dentist, GP, hospital or nurse practitioner. We would be grateful if you could provide the data now requested split in the same way (if possible). I hope you are able to help. Yours sincerely

Status: Complete
Response Date: 21 Feb 2020
Response: Please see attached response.

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