Racial and Ethnic Differences in Exposure to Antibiotics Associated with Clostridioides difficile Infection in US Academic Dental Care

Background Severe Clostridioides difficile infection (CDI) morbidity and mortality disproportionately affect Black and Hispanic patients in the United States. Antibiotic exposure is the primary modifiable risk factor for CDI, and clindamycin is among the agents most strongly associated with related harm. Characterizing inequities in prescribing is critical. Dentistry is a major source of clindamycin prescriptions. Academic dental clinics serve diverse patient populations and provide an ideal setting to evaluate prescribing across racial and ethnic groups. We therefore examined antibiotic use and cumulative clindamycin exposure as measures of CDI-associated risk. Methods We conducted a retrospective study of electronic health records from 5 US academic dental institutions from 2021 through 2023. We analyzed 552,428 encounters among 132,770 patients with documented race/ethnicity to estimate adjusted odds of receiving any oral antibiotic and clindamycin by race/ethnicity. Secondary outcomes evaluated total antibiotic exposure among dental provider-prescribed antibiotics, focusing on higher-than-standard cumulative dosing of clindamycin (>8400 mg) and amoxicillin (>10,500 mg). Results Oral antibiotic prescribing occurred in 1.9% of encounters. Compared with White patients, Black, Hispanic, and Other race patients had slightly lower adjusted odds of receiving any oral antibiotic, while Black patients had greater odds of receiving a higher-than-standard cumulative clindamycin dose when clindamycin was prescribed (adjusted odds ratio, 2.19; 95% confidence interval, 1.25-3.82). Conclusion Racial and ethnic inequities in dental antibiotic prescribing extended beyond antibiotic receipt to cumulative clindamycin exposure. Although CDI outcomes were not directly measured, these prescribing differences may have implications for disparities in CDI-associated harm and warrant further investigation.