title: Dental care resistance prevention and antibiotic prescribing modification-the cluster-randomised controlled DREAM trial.
abstract: BACKGROUND
  Bacterial resistance development is one of the most urgent problems in healthcare worldwide. In Europe, dentistry accounts for a comparatively high amount of antibiotic prescriptions. In light of increasing levels of bacterial resistance, this development is alarming. So far, very few interventional studies have been performed, and further research is urgently needed. By means of a complex educational intervention, the DREAM trial aims at optimising antibiotic prescribing behaviour of general dentists in Germany.
  
  
  METHODS
  This is a cluster-randomised controlled trial, where each cluster consists of one dental practice and all of its patients in a defined period. Participants are general dentists practicing in the German region of Mecklenburg-Western Pomerania. Randomisation takes place after baseline data collection (6 months) and will be stratified by the antibiotic prescribing rates of the participating dental practices. Dentists randomised into the intervention group will participate in a complex small group educational seminar that aims at: increasing knowledge on bacterial resistance, pharmacology, and prophylaxis of infectious endocarditis; increasing awareness of dentist-patient communication using video-taped vignettes of dentist-patient communication on antibiotic treatment; improving collaboration between general dentists, general practitioners, and practice-based cardiologists on the necessity of antibiotic prophylaxis; enhancing awareness of the dentists' own prescribing habits by providing antibiotic prescribing feedback; and increasing patient knowledge on antibiotic treatment by providing patient-centred information material on antibiotic prophylaxis of endocarditis. The dentists randomised into the control group will not receive any educational programme and provide care as usual. Primary outcome is the overall antibiotic prescribing rate measured at T1 (period of six months after intervention). In a subgroup of adult patients affected by odontogenic infections, microbiological analyses for antibiotic resistance of oral streptococci are performed.
  
  
  CONCLUSIONS
  Major aim of the study is to improve the process of decision making with regard to antibiotic prescribing. The approach is simple to implement and might be used rapidly in graduate and post-graduate medical education. We expect the results of this trial to have a major impact on antibiotic prescription strategies and practices in Germany.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN09576376.
authors.affiliation: Institute of General Practice, Rostock University Medical Center, Postfach 100888, 18055 Rostock, Germany. christin.loeffler@med.uni-rostock.de.
authors.forename: Christin
authors.initials: C
authors.lastname: Löffler
authors.forename: Femke
authors.initials: F
authors.lastname: Böhmer
authors.forename: Anne
authors.initials: A
authors.lastname: Hornung
authors.forename: Hermann
authors.initials: H
authors.lastname: Lang
authors.forename: Ulrike
authors.initials: U
authors.lastname: Burmeister
authors.forename: Andreas
authors.initials: A
authors.lastname: Podbielski
authors.forename: Anja
authors.initials: A
authors.lastname: Wollny
authors.forename: Günther
authors.initials: G
authors.lastname: Kundt
authors.forename: Attila
authors.initials: A
authors.lastname: Altiner
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data; D003815:Dentists / Q000706:statistics & numerical data*; D024881:Drug Resistance, Bacterial; D004498:Education, Dental, Continuing / Q000458:organization & administration*; D005858:Germany; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012107:Research Design
chemical_list: D000900:Anti-Bacterial Agents