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Teoh L, Taylor M, Ierano C, McCullough M, Thursky K, James R. Appropriateness of antimicrobial prescribing for oral and dental conditions in Australian hospitals: 2013 to 2022. J Dent 2024; 148:105241. [PMID: 39009335 DOI: 10.1016/j.jdent.2024.105241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 07/10/2024] [Accepted: 07/12/2024] [Indexed: 07/17/2024] Open
Abstract
OBJECTIVES Dentists manage a variety of oral infections in clinical practice. Inappropriate antimicrobial prescribing by dentists occurs frequently and antimicrobial stewardship strategies should include dentistry. The aim of this retrospective analysis of the Australian Hospital National Antimicrobial Prescribing Survey (Hospital NAPS) dataset, was to describe the types of oral and dental indications where antimicrobials were prescribed, and assess the guideline compliance and appropriateness of the antimicrobials in Australian hospitals. METHODS Data from the Hospital NAPS was extracted for oral and dental indications from 2013 to 2022. The types of oral and dental indications presented, and the corresponding antimicrobials prescribed were assessed for compliance according to national prescribing guidelines, and appropriateness according to the NAPS structured algorithm. RESULTS A total of 8,001 prescriptions for 7,477 patients were identified, from 433 hospitals. Antifungal, antibiotic and antiviral agents accounted for 84.5 %, 15.4 % and 0.03 % of prescriptions respectively. A greater proportion of antibiotics were prescribed in regional and rural areas compared to antifungals. The prescriptions assessed as compliant were 80.0 % and 44.7 % of antifungals and antibiotics respectively. Prescriptions assessed as appropriate were 84.4 % of antifungals, and 65.3 % of antibiotic prescriptions. CONCLUSIONS A wide variety of antimicrobials were used with moderate levels of compliance and appropriateness. Future interventions should include targeted education, utilisation of prescribing guidelines, and tools to diagnose and manage oral and dental conditions. Consideration can be given to adjustment of the Hospital NAPS tool to cater for oral conditions and include the provision of dental treatment in the management of these infections. CLINICAL SIGNIFICANCE A wide variety of oral and dental conditions are presented in Australian hospital settings, managed by a range of antibiotics and antifungals, with moderate levels of compliance to guidelines and appropriateness. Antimicrobial stewardship strategies should target and support dentistry in hospital settings.
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Affiliation(s)
- Leanne Teoh
- The University of Melbourne, Melbourne Dental School, Victoria, Australia.
| | - Marietta Taylor
- The University of Melbourne, Melbourne Dental School, Victoria, Australia
| | - Courtney Ierano
- Royal Melbourne Hospital Guidance Group, Melbourne Health, Melbourne, Australia; National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, Melbourne Australia
| | - Michael McCullough
- The University of Melbourne, Melbourne Dental School, Victoria, Australia
| | - Karin Thursky
- Royal Melbourne Hospital Guidance Group, Melbourne Health, Melbourne, Australia; National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, Melbourne Australia
| | - Rodney James
- Royal Melbourne Hospital Guidance Group, Melbourne Health, Melbourne, Australia; National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, Melbourne Australia
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Goodlet KJ, McCreary EK, Nailor MD, Barnes D, Brokhof MM, Bova S, Clemens E, Kelly B, Lichvar A, Pluckrose DM, Summers BB, Szempruch KR, Tchen S. Therapeutic Myths in Solid Organ Transplantation Infectious Diseases. Open Forum Infect Dis 2024; 11:ofae342. [PMID: 38983710 PMCID: PMC11232700 DOI: 10.1093/ofid/ofae342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 06/12/2024] [Indexed: 07/11/2024] Open
Abstract
Infection management in solid organ transplantation poses unique challenges, with a diverse array of potential pathogens and associated antimicrobial therapies. With limited high-quality randomized clinical trials to direct optimal care, therapeutic "myths" may propagate and contribute to suboptimal or excessive antimicrobial use. We discuss 6 therapeutic myths with particular relevance to solid organ transplantation and provide recommendations for infectious diseases clinicians involved in the care of this high-risk population.
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Affiliation(s)
- Kellie J Goodlet
- Department of Pharmacy Practice, Midwestern University, Glendale, Arizona, USA
| | - Erin K McCreary
- Department of Medicine, Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michael D Nailor
- Department of Pharmacy Services, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Darina Barnes
- Department of Pharmacy, Comprehensive Transplant Center, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Marissa M Brokhof
- Department of Pharmacy, Rush University Medical Center, Chicago, Illinois, USA
| | - Sarah Bova
- Department of Pharmacy, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Evan Clemens
- Department of Pharmacy, University of Washington Medical Center, Seattle, Washington, USA
| | - Beth Kelly
- Department of Pharmacy, Indiana University Health, Indianapolis, Indiana, USA
| | - Alicia Lichvar
- Center for Transplantation, UC San Diego Health, San Diego, California, USA
| | - Dawn M Pluckrose
- Department of Pharmacy, Tufts Medical Center, Boston, Massachusetts, USA
| | - Bryant B Summers
- Comprehensive Transplant Center, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Kristen R Szempruch
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Stephanie Tchen
- Department of Pharmacy, Froedtert Hospital, Milwaukee, Wisconsin, USA
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Amaral AL, Herrera D, Lund B, Andrade SA. What is the science underpinning the prescription of antibiotics in dentistry? Evid Based Dent 2024:10.1038/s41432-024-01031-5. [PMID: 38902494 DOI: 10.1038/s41432-024-01031-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Accepted: 06/05/2024] [Indexed: 06/22/2024]
Abstract
DESIGN A critical review on the use of antimicrobials in dentistry. AIM To provide a general overview of the use of antimicrobials in dentistry. METHODS The paper was divided into different topics, starting with an approach to understanding both commensal and pathogenic oral microbiota. Subsequently, emphasis was placed on the main categories of antibiotics used in dentistry (β-lactams, tetracyclines, macrolides, lincosamides, nitroimidazoles and quinolones), and the basis for their prescription. Finally, the implications between systemic diseases and the use of orally-administered antibiotics are presented. RESULTS The study suggests that an adequate medical history can minimize the risk of systemic adverse effects, unwanted drug interactions, and allergies related to the use of antibiotics. In this regard, when facing a potential history of allergy to a particular group of antibiotics, the prescription of a different group is mandatory. In most indications, β-lactam antibiotics represent the first-choice in dentistry. Moreover, a short-term prescription of antibiotics when treating acute oral infections is recommended. The use should be extended for 2 to 3 days following the resolution of the infection, with an average duration of 6 days in order to prevent the development of antibiotic resistance. CONCLUSIONS Oral infections should be managed with interventions aiming at the elimination/reduction of the associated pathogens. Furthermore, inadequate prescription of antibiotics can lead to potential risks to the patient such as allergy, adverse effects, and development of microbial resistance.
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Affiliation(s)
- Ana Luisa Amaral
- Faculty of Dentistry, University of Itaúna (UIT), Itaúna, MG, Brazil
- Research Center on Biological Chemistry (NQBio), Federal University of São João del-Rei (UFSJ), Divinópolis, MG, Brazil
| | - David Herrera
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, Complutense University of Madrid, Madrid, Spain
| | - Bodil Lund
- Head of Department of Dental Medicine, Karolinska Institutet, Solna, Sweden
- Medical Unit of Plastic Surgery and Oral and Maxillofacial Surgery, Karolinska University Hospital, Solna, Sweden
| | - Sérgio Araújo Andrade
- Faculty of Dentistry, University of Itaúna (UIT), Itaúna, MG, Brazil.
- Research Center on Biological Chemistry (NQBio), Federal University of São João del-Rei (UFSJ), Divinópolis, MG, Brazil.
- Optics and Photonics Research Center (CEPOF), Physics Institute of São Carlos of the University of São Paulo (IFSC-USP), São Carlos, SP, Brazil.
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Martine C, Sutherland S, Born K, Thompson W, Teoh L, Singhal S. Dental antimicrobial stewardship: a qualitative study of perspectives among Canadian dentistry sector leaders and experts in antimicrobial stewardship. JAC Antimicrob Resist 2024; 6:dlae082. [PMID: 38779299 PMCID: PMC11109950 DOI: 10.1093/jacamr/dlae082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/05/2024] [Indexed: 05/25/2024] Open
Abstract
Objectives Dentistry is a significant contributor to the burden of antimicrobial overprescribing and hence to the global problem of antimicrobial resistance. However, antimicrobial stewardship in Canadian dentistry is nascent, with an acknowledged need for research and coordinated stewardship efforts. This study aimed to gain insights into the perspectives of Canadian dentistry sector leaders and experts on the main drivers of dental antibiotic overprescribing and potential stewardship strategies. Methods Exploratory qualitative design. Data collection: four one-time, 1 h focus group discussions with 22 experts and stakeholders in antimicrobial stewardship in Canada, recruited through a mix of purposive and snowball sampling. Data analysis: inductive thematic analysis. Results The analysis yielded five themes: outdated patterns; antimicrobials as a Band-Aid; fear and risk aversion; behavioural change; and why reinvent the wheel? Overprescription in dentistry stems primarily from a perpetuation of outdated prescribing patterns, ubiquitous use of antibiotics as a temporary solution, and an overly cautious antibiotic use by risk-averse providers. Stewardship strategies should be grounded on behavioural change (motivation, robust data and enactment of new behaviours) and may be modelled after tested medical interventions. Conclusions This study presents a roadmap for behavioural change in dental antibiotic prescribing, and points to the fact that the success of a stewardship actionable plan for Canadian dentistry may depend more on concerted efforts for change than on the creation of novel strategies. Hence, contextualizing and testing medical stewardship programmes in Canadian dentistry may be effective in combatting antibiotic overprescription, thereby contributing to global efforts to reduce antimicrobial resistance.
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Affiliation(s)
- Christiana Martine
- Faculty of Dentistry, University of Toronto, 124 Edward St., Toronto M5G 1X3, ON, Canada
| | - Susan Sutherland
- Faculty of Dentistry, University of Toronto, 124 Edward St., Toronto M5G 1X3, ON, Canada
| | - Karen Born
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto M5T 3M6, ON, Canada
| | - Wendy Thompson
- Division of Dentistry, University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Leanne Teoh
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 161 Barry St, Carlton VIC 3010, Australia
| | - Sonica Singhal
- Faculty of Dentistry, University of Toronto, 124 Edward St., Toronto M5G 1X3, ON, Canada
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Đukić L, Soulis G, Janssens B, Müller F, Petrovic M, Kossioni A. Appropriate use of antibiotics for oral/dental conditions in older adults: a narrative review. Acta Clin Belg 2024:1-12. [PMID: 38795066 DOI: 10.1080/17843286.2024.2359182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 05/20/2024] [Indexed: 05/27/2024]
Abstract
OBJECTIVES Considering the high rates in the use of antibiotics for oral/dental conditions in older patients and the rise in antimicrobial resistance, appropriate antibiotic prescription is important. This narrative review aimed to discuss the challenges and special considerations when prescribing antibiotics to older patients for oral/dental conditions. METHODS PubMed/MEDLINE, Scopus, Web of Science, and articles' reference lists were searched for antibiotics use for oral conditions by older patients. Moreover, scientific and professional organisations' official websites were searched for guidelines on antibiotic use in dentistry. RESULTS Despite several guidelines about the use of antibiotics in dentistry, specific information on their administration to older patients is missing. Relevant challenges include age-related changes in pharmacokinetics and pharmacodynamics, comorbidities and polypharmacy associated with low adherence, contraindications, adverse reactions, and drug-drug interactions. In unfit and frail older patients some antibiotics should be avoided, or doses should be adjusted, according to medical conditions or medications received. Amoxicillin, with doses adapted to renal function, is one of the safest options, while other antibiotics should be chosen with caution upon indications and individual patient characteristics. CONCLUSIONS Healthcare providers should prescribe antibiotics to unfit and frail older adults with caution, given the multitude of comorbidities and potential interactions with medications received. Further research is needed on the safe and effective use of antibiotics in older patients.
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Affiliation(s)
- Ljiljana Đukić
- Department of Pharmacology in Dentistry, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - George Soulis
- Outpatient Geriatric Assessment Unit, Henry Dunant Hospital Center, Athens, Greece
| | - Barbara Janssens
- Department of Oral Health Sciences, Gerodontology, ELOHA (Equal Lifelong Oral Health for All) research group, Ghent University, Ghent, Belgium
| | - Frauke Müller
- Division of Gerodontology and Removable Prosthodontics, University of Geneva, Geneva, Switzerland
| | - Mirko Petrovic
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - Anastassia Kossioni
- Department of Prosthodontics, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
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Polymeri A, Marti KC, Aronovich S, Inglehart MR. Periodontists and oral surgeons' peri-implantitis-related education, knowledge, attitudes, and professional behavior: A national survey. J Dent Educ 2024. [PMID: 38661517 DOI: 10.1002/jdd.13547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/26/2024] [Accepted: 03/28/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES Each year, approximately 5 million dental implants are placed in the United States and one out of three patients is likely to experience peri-implantitis (PI). The objectives were to compare the PI-related education, knowledge, attitudes, and professional behavior of periodontists and oral maxillofacial surgeons (OMS), and to explore relationships between these constructs of interest. METHODS A total of 389 periodontists and 161 OMS responded to a web-based survey. Descriptive and inferential statistical analyses (independent sample t-tests, chi-square tests, and correlational analyses) were conducted. RESULTS On average, periodontists reported a higher percentage of time spent in residency on implant surgery (21.02% vs. 7.27%; p < 0.001), better education about PI (5-point scale with 1 = not at all well: means: 2.86 vs. 2.59; p < 0.001), and better knowledge of risk factors (4.07 vs. 3.86; p < 0.001) than OMS. Periodontists argued that oral hygiene-related treatment (4.45 vs. 4.22; p = 0.001) and regeneration-focused treatments such as guided tissue regeneration (3.62 vs. 3.20; p < 0.001) contributed more to successfully treating PI and used these treatments more in their practices (4.86 vs. 4.56; p < 0.001/3.06 vs. 2.68; p < 0.001) than OMS. They also considered PI as a more serious problem than OMS (4.55 vs. 3.80; p < 0.001). The better the respondents' PI-related knowledge was, the more they considered PI as a serious problem (r = 0.19; p < 0.001). The more cases they treated per month, the more they considered PI as a serious problem (r = 0.19; p < 0.001). CONCLUSIONS The results of the present study highlight the lack of standardization in the specialty training of periodontists and OMS. Best practice guidelines for the diagnosis and treatment of PI are needed to optimize graduate education about this important topic.
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Affiliation(s)
- Angeliki Polymeri
- Department of Periodontology, University of Amsterdam and Vrije Universiteit, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Kyriaki C Marti
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Sharon Aronovich
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
- Department of Oral and Maxillofacial Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Marita R Inglehart
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
- Department of Psychology, College of Literature, Science and the Arts (LS&A), University of Michigan, Ann Arbor, Michigan, USA
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7
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Thompson W, Teoh L, Pulcini C, Sanderson S, Williams D, Carter V, Pitkeathley C, Walsh T. International Consensus on a Dental Antibiotic Stewardship Core Outcome Set. Int Dent J 2023; 73:456-462. [PMID: 37055238 DOI: 10.1016/j.identj.2023.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 04/15/2023] Open
Abstract
INTRODUCTION Antibiotic resistance is a global health crisis. Ensuring responsible, appropriate use (stewardship) is an important for keeping antibiotics working as long as possible. Around 10% of antibiotics across health care are prescribed by oral health care professionals, with high rates of unnecessary use. To maximise the value from research to optimise antibiotic use in dentistry, this study developed international consensus on a core outcome set for dental antibiotic stewardship. METHODS Candidate outcomes were sourced from a literature review. International participants were recruited via professional bodies, patient organisations, and social media, with at least 30 dentists, academics, and patient contributors in total. Outcomes scored "critical for inclusion" by >70% of the participants (dentists, academics, and patients) after 2 Delphi rounds were included in the core outcome set following a final consensus meeting. The study protocol was registered with the COMET Initiative and published in BMC Trials. RESULTS A total of 33 participants from 15 countries, including 8 low- and middle-income countries, completed both rounds of the Delphi study. Antibiotic use outcomes (eg, appropriateness of prescribing), adverse or poor outcomes (eg, complications from disease progression), and a patient-reported outcome were included in the final, agreed core set. Outcomes relating to quality, time, and cost were not included. CONCLUSIONS This core outcome set for dental antibiotic stewardship represents the minimum which future studies of antibiotic stewardship in dentistry should report. By supporting researchers to design and report their studies in a way meaningful to multiple stakeholders and enabling international comparisons, the oral health profession's contribution to global efforts to tackle antibiotic resistance can be further improved.
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Affiliation(s)
| | - Leanne Teoh
- University of Melbourne, Melbourne, Australia
| | | | | | | | | | | | - Tanya Walsh
- University of Manchester, Manchester, United Kingdom
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Simon M, Pereira O, Constant ML, Guillet-Thibault J, Pulcini C, Thilly N. Characteristics of dentists and patients associated with appropriate antibiotic prescriptions by French dentists: a cross-sectional study using Health Insurance databases. BMC Oral Health 2023; 23:29. [PMID: 36653760 PMCID: PMC9846701 DOI: 10.1186/s12903-023-02727-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/10/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The use of antibiotics in dental care is often unnecessary or inappropriate. Our objectives were to identify (i) Clusters of dentists grouped according to their appropriateness score based on proxy indicators' results; and (ii) Dentists' and patients' characteristics associated with the appropriateness of antibiotic prescriptions. METHODS We used data of the Health Insurance reimbursement databases on antibiotics prescribed in 2019 by general dental practitioners of the Grand Est region in France. The appropriateness of antibiotic prescriptions was estimated by the results of recently published proxy indicators. We conducted a cluster analysis according to an appropriateness score calculated for each dentist, using the Ward method. We then conducted bivariate and multivariable analyses to identify characteristics associated with these clusters. RESULTS We included 3,014 dentists, who prescribed 373,975 antibiotics in 2019, and which were grouped into three clusters: average practices (n = 1,241), better (n = 686), and worse (n = 1,087) than average practices. Overall, dentists had more appropriate prescription practices when they were male (OR for belonging to cluster with "worse than average practices" = 1.37 (p = 0.003) for female), having a predominant surgery practice (p = 0.028) in the Lorraine area (p < 0.0001) for less years (p = 0.0002), when they had healthier patients (i.e., younger, with no chronic diseases, and who received less procedures), and when they had a more prudent use of drugs in general (i.e., less prescriptions of drugs, antibiotics, and non-steroidal anti-inflammatory). CONCLUSIONS We identified clusters and characteristics associated with the appropriateness of antibiotic prescriptions made by dentists, which might help guiding antimicrobial stewardship interventions.
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Affiliation(s)
- Maïa Simon
- grid.29172.3f0000 0001 2194 6418Université de Lorraine, APEMAC, Nancy, France ,grid.410527.50000 0004 1765 1301Université de Lorraine, CHRU de Nancy, Département Méthodologie Promotion Investigation, F-54000 Nancy, France
| | - Ouarda Pereira
- Direction Régionale du Service Médical (DRSM) Grand Est, Strasbourg, France
| | - Marie-Louise Constant
- grid.410527.50000 0004 1765 1301Université de Lorraine, CHRU de Nancy, Service d’Odontologie, F-54000 Nancy, France
| | - Julie Guillet-Thibault
- grid.410527.50000 0004 1765 1301Université de Lorraine, CHRU de Nancy, Service d’Odontologie, F-54000 Nancy, France
| | - Céline Pulcini
- grid.29172.3f0000 0001 2194 6418Université de Lorraine, APEMAC, Nancy, France ,grid.410527.50000 0004 1765 1301Université de Lorraine, CHRU de Nancy, Département de Maladies Infectieuses, F-54000 Nancy, France
| | - Nathalie Thilly
- grid.29172.3f0000 0001 2194 6418Université de Lorraine, APEMAC, Nancy, France ,grid.410527.50000 0004 1765 1301Université de Lorraine, CHRU de Nancy, Département Méthodologie Promotion Investigation, F-54000 Nancy, France
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Nassif N, Noueiri B. Antibiotic Prescription for Dental Procedures in Type 1 Diabetic Children. Int J Clin Pediatr Dent 2023; 16:60-63. [PMID: 37020756 PMCID: PMC10067975 DOI: 10.5005/jp-journals-10005-2464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
In diabetic patients, maintaining blood glucose levels as close to normal as possible is an objective in dental management especially in pediatric ones. Patients with poorly controlled diabetes are at greater risk of developing infections. Therefore, the prescription of antibiotics may be necessary for some dental procedures. Aim The aim is to optimize the benefit and minimize the risk of antibiotics in dental treatments performed in diabetic children. Materials and methods A cross-sectional approach was conducted on 155 type 1 diabetic children (72 controlled and 83 uncontrolled). The types of dental acts held for the study were pulpotomies, pulpectomies, pediatric crowns, scaling, and extraction. For the balanced diabetic patients, no antibiotics were prescribed except for infected teeth. In the unbalanced diabetic group, for the acts causing bleeding, prophylactic antibiotics were administered. In presence of dental infection, antibiotics were administered for at least 5 days. Results The analysis of data was carried out using Statistical Package for the Social Sciences Computer Software (SPSS 21.0, Inc., Chicago, Illinois, USA). A probability value of <0.05 was regarded as statistically significant. Around 126 acts in the balanced group and 145 in the unbalanced ones were performed. In balanced diabetic children, 125 successes and one failure were noted. In the unbalanced group, 142 successes and three failures were recorded. The comparison between variables did not show any statistical significance (p-value = 0.382). Conclusion This study demonstrated that working with diabetic young patients is possible and safe as long as some measures are considered. It is crucial to identify the dental acts that necessitate antibiotics administration and to differentiate between balanced and unbalanced diabetic children for the same dental procedure. How to cite this article Nassif N, Noueiri B. Antibiotic Prescription for Dental Procedures in Type 1 Diabetic Children. Int J Clin Pediatr Dent 2023;16(1):60-63.
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Affiliation(s)
- Nahla Nassif
- Department of Pediatric Dentistry and Public Dental Health, Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon
| | - Balsam Noueiri
- Department of Pediatric Dentistry and Public Dental Health, Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon
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Bessa LJ, Botelho J, Machado V, Alves R, Mendes JJ. Managing Oral Health in the Context of Antimicrobial Resistance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192416448. [PMID: 36554332 PMCID: PMC9778414 DOI: 10.3390/ijerph192416448] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/05/2022] [Accepted: 12/05/2022] [Indexed: 05/25/2023]
Abstract
The oral microbiome plays a major role in shaping oral health/disease state; thus, a main challenge for dental practitioners is to preserve or restore a balanced oral microbiome. Nonetheless, when pathogenic microorganisms install in the oral cavity and are incorporated into the oral biofilm, oral infections, such as gingivitis, dental caries, periodontitis, and peri-implantitis, can arise. Several prophylactic and treatment approaches are available nowadays, but most of them have been antibiotic-based. Given the actual context of antimicrobial resistance (AMR), antibiotic stewardship in dentistry would be a beneficial approach to optimize and avoid inappropriate or even unnecessary antibiotic use, representing a step towards precision medicine. Furthermore, the development of new effective treatment options to replace the need for antibiotics is being pursued, including the application of photodynamic therapy and the use of probiotics. In this review, we highlight the advances undergoing towards a better understanding of the oral microbiome and oral resistome. We also provide an updated overview of how dentists are adapting to better manage the treatment of oral infections given the problem of AMR.
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Affiliation(s)
- Lucinda J. Bessa
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz—Cooperativa de Ensino Superior, Caparica, 2829-511 Almada, Portugal
| | - João Botelho
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz—Cooperativa de Ensino Superior, Caparica, 2829-511 Almada, Portugal
- Clinical Research Unit (CRU), CiiEM, Egas Moniz—Cooperativa de Ensino Superior, Caparica, 2829-511 Almada, Portugal
- Evidence-Based Hub, CiiEM, Egas Moniz—Cooperativa de Ensino Superior, Caparica, 2829-511 Almada, Portugal
| | - Vanessa Machado
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz—Cooperativa de Ensino Superior, Caparica, 2829-511 Almada, Portugal
- Clinical Research Unit (CRU), CiiEM, Egas Moniz—Cooperativa de Ensino Superior, Caparica, 2829-511 Almada, Portugal
- Evidence-Based Hub, CiiEM, Egas Moniz—Cooperativa de Ensino Superior, Caparica, 2829-511 Almada, Portugal
| | - Ricardo Alves
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz—Cooperativa de Ensino Superior, Caparica, 2829-511 Almada, Portugal
- Clinical Research Unit (CRU), CiiEM, Egas Moniz—Cooperativa de Ensino Superior, Caparica, 2829-511 Almada, Portugal
| | - José João Mendes
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz—Cooperativa de Ensino Superior, Caparica, 2829-511 Almada, Portugal
- Clinical Research Unit (CRU), CiiEM, Egas Moniz—Cooperativa de Ensino Superior, Caparica, 2829-511 Almada, Portugal
- Evidence-Based Hub, CiiEM, Egas Moniz—Cooperativa de Ensino Superior, Caparica, 2829-511 Almada, Portugal
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Cooper L, Sneddon J, Thompson W, Guise T, Robertson D, Smith A. Tackling antimicrobial resistance in practice: dental students’ evaluation of university teaching supplemented by an online course. JAC Antimicrob Resist 2022; 4:dlac039. [PMID: 35415610 PMCID: PMC8994195 DOI: 10.1093/jacamr/dlac039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/16/2022] [Indexed: 11/20/2022] Open
Abstract
Background Antimicrobial resistance (AMR) presents a global threat to public health. Engaging all healthcare professionals including undergraduates in efforts to tackle AMR is vital. Sharing and spreading good practice in teaching on AMR and antimicrobial stewardship (AMS) is a key ambition in Scotland. In 2020, the University of Glasgow Dental School supplemented teaching with mandatory completion by final year undergraduates of an online education programme on the essential role of dental teams in reducing AMR. Objectives To evaluate final year dental students’ knowledge and experience of utilizing an online international educational, interactive resource to supplement university teaching: Tackling Antibiotic Resistance: What Should Dental Teams Do? Methods Cross-sectional qualitative evaluation using a self-administered questionnaire with open questions about course content, learning and personal action planning. Data were thematically analysed using NVivo12 Pro software. Results A total of 88 students completed a questionnaire, which indicated online training had increased their understanding of AMR and AMS from a global perspective and confirmed these topics were an integral part of their undergraduate education programme. Their action plans demonstrated enthusiasm for creating an AMS culture in clinical practice and an understanding of the need for ongoing education of themselves, their colleagues and patients. Conclusions Education delivery using a variety of media to support teaching and learning in Glasgow Dental School was effective in ensuring that students understand their role in tackling AMR. Students were positive about the addition of an online education programme to supplement university teaching. This approach may be beneficial for other undergraduate dentistry programmes.
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Affiliation(s)
- Lesley Cooper
- Scottish Antimicrobial Prescribing Group, Healthcare Improvement Scotland, Glasgow, UK
| | - Jacqueline Sneddon
- Scottish Antimicrobial Prescribing Group, Healthcare Improvement Scotland, Glasgow, UK
- British Society for Antimicrobial Chemotherapy, Birmingham, UK
| | - Wendy Thompson
- Division of Dentistry, University of Manchester, Manchester, UK
| | - Tracey Guise
- British Society for Antimicrobial Chemotherapy, Birmingham, UK
| | | | - Andrew Smith
- Scottish Antimicrobial Prescribing Group, Healthcare Improvement Scotland, Glasgow, UK
- Dental School, University of Glasgow, Glasgow, UK
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Thompson W, Teoh L, Pulcini C, Williams D, Pitkeathley C, Carter V, Sanderson S, Torres G, Walsh T. Dental antibiotic stewardship: study protocol for developing international consensus on a core outcome set. Trials 2022; 23:116. [PMID: 35120581 PMCID: PMC8817512 DOI: 10.1186/s13063-022-06038-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/17/2022] [Indexed: 11/18/2022] Open
Abstract
Background Antimicrobial resistance is both a global public health and patient safety problem driven by overprescribing of antibiotic and other antimicrobial drugs. To conserve the effectiveness of antibiotics for future generations, antibiotic stewardship approaches to using them only where appropriate and necessary are advocated. Dentistry accounts for about 10% of antibiotic prescriptions across global healthcare, with 80% not in accordance with guidance in some countries. Core outcome sets enable the results of studies to be compared in order to maximise the value which can be derived from them. The aim of this study is to develop an international consensus on a core outcome set for dental antibiotic stewardship. Methods Consensus on outcomes which are critical for inclusion in the core outcome set for dental antibiotic stewardship will be sought through two rounds of a Delphi survey (using the DelphiManager online system) followed by a final online consensus meeting. Thirty participants will be recruited to the Delphi Panel from across three stakeholder groups: ten dentists, ten academics and ten adults experienced with dental antibiotics as either a patient or parent/carer of a patient who has been prescribed them. Consensus will be achieved if more than 70% of the panel agree that an outcome is critical, with at least one from each stakeholder group in agreement. A long-list of candidate core outcomes has been developed from previously published studies with additions recommended by the steering group. The steering group will oversee development of the core outcome set and includes people from around the world with experience of dental antibiotics: clinicians, researchers and people with experience of being prescribed dental antibiotics and/or surviving an antibiotic resistant infection. Discussion To date, few studies of dental antibiotic stewardship have been published. Internationally, dental antibiotic guidelines and patterns of use vary widely, so a core outcome set is particularly important to facilitate meaningful comparisons between studies. This core outcome set will encompass antibiotic prescribing for both therapeutic indications, such as for people with acute infections, and for prophylactic indications, such as the prevention of distant site infections (like infective endocarditis) following dental procedures. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06038-w.
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Affiliation(s)
- Wendy Thompson
- Division of Dentistry, University of Manchester, Manchester, UK.
| | - Leanne Teoh
- Melbourne Dental School, University of Melbourne, Carlton, Victoria, Australia
| | | | - David Williams
- Institute of Dentistry, Queen Mary University of London, London, UK
| | | | | | | | | | - Tanya Walsh
- Division of Dentistry, University of Manchester, Manchester, UK
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Trends in Antibiotic Self-Medication for Dental Pathologies among Patients in the Dominican Republic: A Cross-Sectional Study. J Clin Med 2021; 10:jcm10143092. [PMID: 34300258 PMCID: PMC8308055 DOI: 10.3390/jcm10143092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/05/2021] [Accepted: 07/11/2021] [Indexed: 11/21/2022] Open
Abstract
The World Health Organisation has warned of the increase in antibiotic resistance, estimating that by 2050 it could become the leading cause of death worldwide. Several studies and literature reviews show a correlation between antibiotic use and bacterial resistance, with unnecessary broad-spectrum antibiotics, such as amoxicillin/clavulanic acid and azithromycin, being one of the main causative factors. An interview-based survey of 2160 participants was conducted to assess the prevalence in the practice of self-medication with antibiotics among dental patients in the Dominican Republic. A series of open-ended questions regarding self-medication and class of antibiotics were put to the patients. Over a third of the study population (39.7%) admitted to the practice of antibiotic self-medication. Most of the respondents (58.4%) who indulged in self-medication were females, and it was prevalent in the older adults between 32–42 years old (36%). There was a negative correlation between age and self-medication practice (p < 0.001) observed with point biserial correlation test. Binary logistic regression analysis found an odds ratio of 0.97 (p < 0.001). The most consumed antibiotics were amoxicillin/clavulanic acid (52%), amoxicillin (31.1%), and azithromycin (10.1%). It is imperative to educate patients about the harmful effects of self-medication and to stress the need for governments to implement stricter laws on non-prescription drug availability.
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Antibiotic prescription for endodontic infections among Italian dental practitioners: what is the extent of over-prescription? Antimicrob Agents Chemother 2021; 65:e0091421. [PMID: 34252306 DOI: 10.1128/aac.00914-21] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objectives: Objectives of this study were to evaluate the pattern of antibiotic prescription for endodontic infections (EIs) among Italian dental practitioners (DPs), and to explore the role of potential predictors of antibiotic over-prescription. Methods: A nationwide cross-sectional survey was conducted between 1st April to 30th October 2019 using a structured questionnaire. Information was gathered on demographics and professional characteristics, and practices regarding antibiotic prescription both for therapeutic and prophylactic purposes. Results: Of the 1250 invited DPs, 563 answered the general questionnaire (response rate 52.6%). The proportions of DPs who prescribed an antibiotic without indication for therapeutic and prophylactic purposes is 33.3% and 30.2%, respectively. The acute alveolar abscess without systemic involvement represents the clinical scenario at high risk of over-prescription for therapeutic purposes. Possible predictors of over-prescribing included demographics and professional characteristics, and it was found to be higher in EIs without indication than in the cases in which the prescription is indicated for therapeutic purposes. The odds of over-prescription for prophylactic purposes were higher in the cases of acute apical periodontitis and lower in the cases of symptomatic irreversible pulpitis compared with acute and chronic alveolar abscess, in which the prescription is indicated. Conclusions: The main findings of the present study provide an up-to-date insight about the pattern of antibiotic prescriptions for EIs and evidence useful to identify opportunities to reduce over-prescription among DPs through tailored interventions. The development of practical antibiotic prescribing guidelines with a clear description of indications and regimens ease of use is strongly needed.
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Ang CY, Dhaliwal JS, Muharram SH, Akkawi ME, Hussain Z, Rahman H, Kok YY, Dhaliwal SKS, Ming LC. Educational resource for antimicrobial resistance and stewardship for dentistry programmes: a research protocol. BMJ Open 2021; 11:e048609. [PMID: 34233993 PMCID: PMC8264905 DOI: 10.1136/bmjopen-2021-048609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Antimicrobial resistance (AMR) is a global public and patient safety issue. With the high AMR risk, ensuring that the next generation of dentists that have optimal knowledge and confidence in the area of AMR is crucial. A systematic approach is vital to design an AMR content that is comprehensive and clinically relevant. The primary objective of this research study will be to implement a consensus-based approach to elucidate AMR content and curriculum priorities for professional dentistry programmes. This research aims to establish consensus along with eliciting opinion on appropriate AMR topics to be covered in the Bachelor of Dental Surgery syllabus. METHODS AND ANALYSIS A three-phase approach to validate content for curriculum guidelines on AMR will be adopted. First, literature review and content analysis were conducted to find out the available pertinent literature in dentistry programmes. A total of 23 potential literature have been chosen for inclusion within this study following literature review and analysis in phase 1. The materials found will be used to draft curriculum on antimicrobials for dentistry programmes. The next phase involves the validation of the drafted curriculum content by recruiting local and foreign experts via a survey questionnaire. Finally, Delphi technique will be conducted to obtain consensus on the important or controversial modifications to the revised curriculum. ETHICS AND DISSEMINATION An ethics application is currently under review with the Institute of Health Science Research Ethics Committee, Universiti Brunei Darussalam. All participants are required to provide a written consent form. Findings will be used to identify significant knowledge gaps on AMR aspect in a way that results in lasting change in clinical practice. Moreover, AMR content priorities related to dentistry clinical practice will be determined in order to develop need-based educational resource on microbes, hygiene and prudent antimicrobial use for dentistry programmes.
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Affiliation(s)
- Chuan Yok Ang
- Pengiran Anak Puteri Rashidah Sa'adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam (UBD), Gadong, Brunei Darussalam
| | - Jagjit Singh Dhaliwal
- Pengiran Anak Puteri Rashidah Sa'adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam (UBD), Gadong, Brunei Darussalam
| | - Siti Hanna Muharram
- Pengiran Anak Puteri Rashidah Sa'adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam (UBD), Gadong, Brunei Darussalam
| | - Muhammad Eid Akkawi
- Kulliyyah of Pharmacy, International Islamic University, Kuantan Campus, Kuantan, Malaysia
| | - Zahid Hussain
- University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Hanif Rahman
- Pengiran Anak Puteri Rashidah Sa'adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam (UBD), Gadong, Brunei Darussalam
| | - Yuh Yen Kok
- Pengiran Anak Puteri Rashidah Sa'adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam (UBD), Gadong, Brunei Darussalam
| | - Sachinjeet Kaur Sodhi Dhaliwal
- Pengiran Anak Puteri Rashidah Sa'adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam (UBD), Gadong, Brunei Darussalam
| | - Long Chiau Ming
- Pengiran Anak Puteri Rashidah Sa'adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam (UBD), Gadong, Brunei Darussalam
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Current antimicrobial prescription at outpatient dentistry centers and clinics in tertiary-care hospitals in Tokyo, Japan: A multicenter cross-sectional study. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY 2021; 1:e64. [PMID: 36168467 PMCID: PMC9495602 DOI: 10.1017/ash.2021.229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 10/26/2021] [Accepted: 10/26/2021] [Indexed: 11/12/2022]
Abstract
Background: Antimicrobial administration is necessary before specific dental procedures to prevent postprocedural infections and complications and antimicrobials are sometimes indicated for the treatment of odontogenic infections. However, antimicrobials are commonly misused by dentists. Methods: This cross-sectional study was conducted at 4 public, tertiary-care hospitals in Tokyo, Japan, from June to July 2019. We included patients who received an antimicrobial prescription at the outpatient dentistry center or clinic at each participating hospital. The indications for antimicrobial prescription were (1) antimicrobial prescriptions for prophylaxis (APPs) or (2) antimicrobial prescriptions for treatment (APTs). Prescribing patterns were described in terms of antimicrobial choice, timing, and dosages for APPs and APTs. Results: During the study period, 1,772 patients received an antimicrobial prescription. Among them 1,439 (81.2%) were APPs and 333 (18.8%) were APTs. The most common aim of APP was to prevent local infections and complications following tooth extraction (n = 1,244, 86.4%). The proportion of appropriate APPs was only 0.8% (12 of 1,439). Among 1,439 total APPs, 171 (11.9%) were unnecessary, 32 (2.2%) were inappropriate, and 1,224 (85.1%) were suboptimal. Whereas 101 (30.3%) of 333 APTs were appropriate, the remaining 97 instances (29.1%) were unnecessary, 86 (26.7%) were inappropriate, and 46 (13.8%) were suboptimal. Conclusion: Inappropriate antimicrobial prescriptions were common among dentists in Japan. Understanding the differences in the current antimicrobial prescribing patterns for prophylaxis and treatment is critically important for implementing an effective antimicrobial stewardship program in dentistry.
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Canada's oral health professionals and antimicrobial stewardship. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2020; 46:376-379. [PMID: 33814985 PMCID: PMC7997642 DOI: 10.14745/ccdr.v46i1112a02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Antimicrobial resistance (AMR) is a global concern as it poses a serious threat to our capacity to treat common infectious diseases. Canada has been engaged in actions to address the AMR challenge since 1997, and these actions include a four-pillar national strategy: surveillance; stewardship; infection prevention and control; and research and innovation. Dentists play a significant role in contributing to the efforts around these four-pillars, especially that of stewardship. Studies show that antibiotic prescriptions for oral health reasons, are increasing over time, and 60% to 80% of antibiotics prescribed in a dental setting are not necessarily clinically indicated. The development, promotion and implementation of initiatives to promote optimal use of antimicrobials across Canada will require collaboration among many stakeholders, including the oral health community. Antimicrobial resistance and antimicrobial stewardship are already being discussed within the dental profession in Canada; however, there is still more work to be done in a variety of areas including, but not limited to, dentists' access to and use of current evidence-based guidelines and prescribing protocols enforced by their governing bodies to ensure appropriate prescribing of antibiotics when necessary, and timely and affordable access to oral health care services by Canadians.
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