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Kalas N, Nagy A, Kovács N, Dombrádi V, Bányai G, Bíró K, Boruzs K. Changes in Antibiotic Redemption Related to Hungarian Dental Care During COVID-19. Int Dent J 2024; 74:946-952. [PMID: 38461095 DOI: 10.1016/j.identj.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 03/11/2024] Open
Abstract
INTRODUCTION AND AIMS Antibiotic resistance is a global health problem that can affect individuals, health systems, and the economy. Our aim was to investigate how the redemption of antibiotics and the associated dental care changed during COVID-19 in Hungary. METHODS The ICD codes for the infections for which antibiotics should be prescribed in dental care were identified based on the professional recommendation. The database was provided by the National Health Insurance Fund Manager of Hungary. Pearson's chi-squared test with Bonferroni correction was used to compare both the redemption of antibiotics and the associated dental care based on the recommendations in the year 2020 of the COVID-19 and the 2 preceding years. RESULTS There were fewer antibiotic redemptions and associated dental care in 2020 than in 2018 and 2019. The ratio of professionally relevant and nonrelevant antibiotics redeemed did not change significantly between 2018 and 2019, but the proportion of antibiotics redeemed following recommendations increased significantly during the COVID-19 year of 2020 compared to the previous 2 years. The proportion of all dental care involving antibiotic redemptions increased significantly from 2018 to 2019, and then showed a further increase in 2020. The sex and age of the patient did not affect these findings, while the type of dental care did alter the trends in some cases. CONCLUSIONS Antibiotics in dentistry are required only for very low proportion of cases, due to the nature of dental care where most infections such as caries and periodontal disease could be managed without resorting to antibiotics. Antibiotic redemptions during COVID-19 pandemic period increased compared to the pre-pandemic period in Hungary. Therefore, Hungarian policy makers need to develop control systems to promote the correct use of antibiotics in dental care. CLINICAL RELEVANCE It is important to reduce unjustified use of antibiotics so as to curb the emergence of antibiotic resistance organisms.
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Affiliation(s)
- Nándor Kalas
- Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary; Dental Care Service, University of Debrecen Clinical Center, University of Debrecen, Debrecen, Hungary
| | - Attila Nagy
- Department of Health Informatics, Institute of Health Sciences, Faculty of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Nóra Kovács
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Viktor Dombrádi
- Department of Patient Safety, Health Services Management Training Centre, Faculty of Health and Public Administration, Semmelweis University, Budapest, Hungary
| | - Gábor Bányai
- Institute of Health Economics and Management, Faculty of Economics and Business, University of Debrecen, Debrecen, Hungary
| | - Klára Bíró
- Institute of Health Economics and Management, Faculty of Economics and Business, University of Debrecen, Debrecen, Hungary
| | - Klára Boruzs
- Institute of Health Economics and Management, Faculty of Economics and Business, University of Debrecen, Debrecen, Hungary.
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Feleke BE, Shaw JE, Magliano DJ. Trends in rates of hospitalisation for infection in people with diabetes and the general population. Diabet Med 2024:e15421. [PMID: 39116262 DOI: 10.1111/dme.15421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 07/17/2024] [Accepted: 07/23/2024] [Indexed: 08/10/2024]
Abstract
AIM To describe the trends of hospitalisation for infections in people with diabetes and in the general population. METHODS People with diabetes were identified from the Australian National Diabetes Services Scheme linked to hospitalisation datasets from 2010/11 to 2018/19. Data on hospitalisations in the general population were obtained from the Australian Institute of Health and Welfare. Joinpoint regression software was used to calculate the annual percentage change (APC) of rates. RESULTS The rate of hospitalisation for total infections increased with an APC of 2.6% (95% CI: 1.5, 3.7) among people with type 1 diabetes, 3.6% (2.6, 4.6) among people with type 2 diabetes, and 2.5% (1.3, 3.9) in the general population. Increasing rates were observed for sepsis, influenza, kidney infections, osteomyelitis, cellulitis, and foot infections in all groups. The rate of hospitalisation for urinary tract infection declined among people with type 2 diabetes though it was stable in other groups. The rate of hospitalisation for respiratory tract infections was stable among people with type 1 diabetes but increased in other groups. The rate of hospitalisation for gastrointestinal infection was stable in all cohorts. CONCLUSION Hospitalisation rates for infection have increased more rapidly over time in people with diabetes than in the general population.
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Affiliation(s)
- Berhanu Elfu Feleke
- Faculty of Medicine Nursing and Health Sciences, School of Public Health, and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Jonathan E Shaw
- Faculty of Medicine Nursing and Health Sciences, School of Public Health, and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Dianna J Magliano
- Faculty of Medicine Nursing and Health Sciences, School of Public Health, and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
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Sukumar S, Rahmanyar Z, El Jurf HQ, Akil WS, Hussain J, Martin FE, Ekanayake K, Martinez E. Mapping the oral resistome: a systematic review. J Med Microbiol 2024; 73:001866. [PMID: 39133536 PMCID: PMC11318793 DOI: 10.1099/jmm.0.001866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 07/17/2024] [Indexed: 08/13/2024] Open
Abstract
Studying individual ecological niches within the oral cavity is a logical first step to understanding the distribution of antimicrobial resistance genes (ARGs); however, it is not representative of the whole oral resistome. The aim of our systematic review was to provide a map of the oral resistome by reviewing the composition of individual niches. A total of 580 papers were retrieved from a search of all English language publications investigating the presence of oral ARGs in five electronic databases between January 2015 and August 2023. Fifteen studies [10 PCR and 5 next-generation sequencing (NGS)] were included in this review. The heterogeneity of methods precluded meta-analysis. ARGs are present throughout the oral cavity with 158 unique ARGs identified across 6 locations - supra and sub-gingival biofilm, mucosa, oropharynx, root canal system (RCS) and saliva. The supragingival biofilm had the highest resistome richness, while the RCS had the least. Tetracycline was the dominant antimicrobial resistance (AMR) class found. Three core genes were identified - tet(M), tet(O) and ermB.This review highlights the necessity of NGS studies to comprehensively characterize the oral resistome in its entirety. This is the logical foundation for future 'omics studies to truly understand the scope of the resistome and its contribution to AMR.
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Affiliation(s)
- Smitha Sukumar
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, 2000, Australia
| | - Zalmay Rahmanyar
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, 2000, Australia
| | - Hagaar Q. El Jurf
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, 2000, Australia
| | - William S. Akil
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, 2000, Australia
| | - Jafar Hussain
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, 2000, Australia
| | - F. Elizabeth Martin
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, 2000, Australia
| | - Kanchana Ekanayake
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, 2000, Australia
| | - Elena Martinez
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, 2000, Australia
- Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, New South Wales, 2145, Australia
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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; 79:193-204. [PMID: 38795066 DOI: 10.1080/17843286.2024.2359182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [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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Albrecht H, Schiegnitz E, Halling F. Facts and trends in dental antibiotic and analgesic prescriptions in Germany, 2012-2021. Clin Oral Investig 2024; 28:100. [PMID: 38231453 PMCID: PMC10794513 DOI: 10.1007/s00784-024-05497-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/06/2024] [Indexed: 01/18/2024]
Abstract
OBJECTIVES The study aims to overview German dentists' development of antibiotic and analgesic prescriptions from 2012 to 2021. MATERIALS AND METHODS A longitudinal database analysis was performed based on the annual reports of the "Research Institute for Local Health Care Systems" (WIdO, Berlin). RESULTS From 2012 until 2021, dental antibiotic prescriptions fell by 17.9%. In contrast, the dental proportion of antibiotic prescriptions compared to all antibiotic prescriptions in Germany increased from 9.1 to 13.6%. Aminopenicillins enhanced their share from 35.6 to 49.4%, while clindamycin prescriptions declined from 37.8 to 23.4%. The proportion of ibuprofen prescriptions significantly increased from 60.4% in 2012 to 79.0% in 2021. CONCLUSIONS Since 2013, the most frequently prescribed antibiotic by German dentists has been amoxicillin reaching nearly half of all dental antibiotic prescriptions in 2021. Simultaneously, the proportion of clindamycin has steadily decreased, but the level is still high compared to international data. During the past decade, ibuprofen as a first-line analgesic in German dentistry was continuously gaining in importance. CLINICAL RELEVANCE Aminopenicillins have the best risk-benefit balance in dentistry, but the use of antibiotics generally must be limited only to cases of severe infections or compromised patients. Pre-existing diseases or permanent medications should always be considered when choosing an analgesic.
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Affiliation(s)
- Helena Albrecht
- Department of Oral and Maxillofacial Surgery, University Medical Center of the Johannes Gutenberg-University of Mainz, Mainz, Germany.
| | - Eik Schiegnitz
- Department of Oral and Maxillofacial Surgery, University Medical Center of the Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Frank Halling
- Gesundheitszentrum Fulda | Praxis für MKG-Chirurgie/Plast. OP, Fulda, Germany
- Department of Oral and Maxillofacial Surgery, University Hospital Marburg UKGM GmbH, Marburg, Germany
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Teoh L, Park JS, Moses G, McCullough M, Page A. To prescribe or not to prescribe? A review of the Prescribing Competencies Framework for dentistry. J Dent 2023; 137:104654. [PMID: 37574106 DOI: 10.1016/j.jdent.2023.104654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/06/2023] [Accepted: 08/08/2023] [Indexed: 08/15/2023] Open
Abstract
OBJECTIVES Dentists in Australia are the second largest prescriber group, and are generally not formally taught how to prescribe. The objective of this review is to describe the Prescribing Competencies Framework and its relevance to dentistry. DATA The four-model stage of prescribing by Coombes and colleagues, and the seven competencies within the Prescribing Competencies Framework devised by the Australian National Prescribing Service MedicineWise, are discussed and applied to dentistry. SOURCES AND STUDY SELECTION Each of the seven competencies are analysed and detailed in the context of clinical dental practice. Competencies 1-5 describe the skillset and tasks required by dentists to safely prescribe, whereas Competencies 6 and 7 describe the clinical environment and recommended resources to support dentists to prescribe safely and effectively. CONCLUSIONS The Prescribing Competencies Framework provides an overview of safe and effective prescribing. Prescribing is a process, and a separate skillset to clinical dentistry. The process involves information gathering, clinical assessment, effective communication and review of the patient. Access to timely and appropriate resources and relevant electronic sources of health information for clinicians are important to provide the support required for better informed prescribing decisions. The framework describes a patient-centered prescribing process, and ultimately prescribing should be a shared decision between the dentist and the patient. CLINICAL SIGNIFICANCE Safe and effective prescribing is an integral part of dentistry and dentists are the second largest prescriber group. However, dentists display high rates of inappropriate and unnecessary prescribing, and to minimise errors, the Prescribing Competencies Framework has been established. This article details how the Framework applies to clinical practice dentistry.
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Affiliation(s)
- Leanne Teoh
- Melbourne Dental School, The University of Melbourne, Carlton, Victoria, Australia.
| | - Joon Soo Park
- UWA Dental School, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Geraldine Moses
- School of Pharmacy, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Michael McCullough
- Melbourne Dental School, The University of Melbourne, Carlton, Victoria, Australia
| | - Amy Page
- School of Allied Health, University of Western Australia, Western Australia, Australia
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Nguyen S, Ahmed L, Villarosa A, George A, Yaacoub A. The use of antibiotics in acute oral health patients presenting at public dental clinics in the Western Sydney region. Fam Pract 2023; 40:9-15. [PMID: 35703923 DOI: 10.1093/fampra/cmac057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is a limited need for antibiotics when treating oral health problems, yet they are often prescribed, increasing risk of antimicrobial resistance (AMR). With AMR a threat to public health, the objectives of this study were to assess the frequency, suitability, and factors associated with antibiotic prescriptions for acute dental problems across Greater Western Sydney public dental clinics. METHODS Patients' reason for attending, details of any antibiotics use, and the treating dental practitioner's clinical examination and diagnosis were compared to current prescribing guidelines, and logistic regression was used to identify predictors of antibiotic prescription. RESULTS In all, 1,071 patients participated in the study, and 15.9% reported to using antibiotics for their dental problem. Over three-quarters obtained the antibiotics from their general medical practitioner (GMP). A high prevalence of antibiotics were not indicated for the patient's complaint (71.8%) including for those with a history of extraction, pain, or intraoral swelling, who had significantly higher odds of antibiotic prescription (OR > 9). The antibiotic type prescribed was generally suitable. CONCLUSIONS In summary, the data suggest that the majority of antibiotics were inappropriately prescribed for the patient's dental complaints and there is a need for interventions to improve compliance with antibiotic prescribing guidelines.
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Affiliation(s)
- Stephanie Nguyen
- Nepean Blue Mountains Local Health District Oral Health Services, Nepean Hospital, Derby St, Kingswood, NSW 2747, Australia
| | - Lamis Ahmed
- Nepean Blue Mountains Local Health District Oral Health Services, Nepean Hospital, Derby St, Kingswood, NSW 2747, Australia
| | - Amy Villarosa
- Centre for Oral Health Outcomes & Research Translation (COHORT), Western Sydney University/South Western Sydney Local Health District/Ingham Institute Applied Medical Research/University of Sydney, Liverpool, NSW 1871, Australia
| | - Ajesh George
- Centre for Oral Health Outcomes & Research Translation (COHORT), Western Sydney University/South Western Sydney Local Health District/Ingham Institute Applied Medical Research/University of Sydney, Liverpool, NSW 1871, Australia
| | - Albert Yaacoub
- Nepean Blue Mountains Local Health District Oral Health Services, Nepean Hospital, Derby St, Kingswood, NSW 2747, Australia
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Teoh L, Hopcraft M, McCullough M, Manski-Nankervis JA, Biezen R. Exploring the appropriateness of antibiotic prescribing for dental presentations in Australian general practice-A pilot study. Br J Clin Pharmacol 2022; 89:1554-1559. [PMID: 36440810 DOI: 10.1111/bcp.15617] [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: 05/31/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 11/29/2022] Open
Abstract
AIMS Dental pain is a common presentation in general medical practice for which patients are often prescribed antibiotics. The aim of this pilot study was to assess prescriptions by general medical practitioners (GPs) for dental presentations in Australia. METHODS Anonymised electronic medical data relating to antibiotic prescribing across 2 periods (3 August-30 November 2019 and 3 August-30 November 2020) were extracted from 8 general practices in Victoria that contributed data to the University of Melbourne's Data for Decisions programme. Extracted de-identified data included antibiotics prescribed for dental presentations, practice site number, visit date, patient age, sex, reason for prescription, reason for visit and the regimen of the antibiotic. Appropriateness of the prescribed antibiotic was assessed against the Australian national dental guidelines Therapeutic Guidelines Oral and Dental. RESULTS From 13 641 recorded prescriptions, 178 were recorded for dental presentations, representing 1.3% of all antibiotic prescriptions. When assessed against the guidelines, 23.6% (n = 42) were considered appropriate. The top 3 most commonly prescribed antibiotics were amoxicillin (n = 84, 47.2%), amoxicillin/clavulanic acid (n = 52, 29.2%) and metronidazole (n = 15, 8.4%). The reasons for inappropriate prescribing were as follows: third-line treatment being chosen, inappropriate spectrum, incorrect regimen or prescribing an antibiotic not recommended in the guidelines. CONCLUSION These results indicate a need to better understand the potential patient drivers for antibiotic prescription for GPs and patients, and resources GPs need to manage dental presentations. These results will inform the codesign of targeted interventions to address any educational gaps and barriers to accessing dental treatment and thus improving antibiotic prescribing.
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Affiliation(s)
- Leanne Teoh
- Melbourne Dental School, The University of Melbourne, Carlton, Victoria, Australia
| | - Matthew Hopcraft
- Melbourne Dental School, The University of Melbourne, Carlton, Victoria, Australia
| | - Michael McCullough
- Melbourne Dental School, The University of Melbourne, Carlton, Victoria, Australia
| | | | - Ruby Biezen
- Department of General Practice, The University of Melbourne, Carlton, Victoria, Australia
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Attitudes towards Antibiotic Prescription and Antimicrobial Resistance Awareness among Italian Dentists: What Are the Milestones? Healthcare (Basel) 2022; 10:healthcare10081585. [PMID: 36011242 PMCID: PMC9408165 DOI: 10.3390/healthcare10081585] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022] Open
Abstract
Antimicrobial resistance is a growing phenomenon, often associated with the improper prescription of antibiotics, prescribed by those who do not follow the guidelines for antibiotic stewardship. The aim of this study was to evaluate the current attitude towards antibiotic prescribing and antimicrobial resistance awareness among Italian dentists. An online questionnaire was distributed to Italian dentists from September to December 2021. The questionnaire was composed of three main sections. The first part was focused on demographic characteristics, the second part on prescription habits, and the third part on the dentists’ knowledge regarding the phenomenon of antimicrobial resistance. A chi-square test was used to find associations between different variables. The level of significance was set at p < 0.05. A total of 382 dentists completed the questionnaire. The main reasons for antibiotic prescribing were for abscesses (39.6%), extractions (24.5%), and pulpitis (14.1%). The majority of participants (85.3%) reported prescribing macrolides in the case of a penicillin allergy. Most dentists (98.9%) were aware of the antimicrobial resistance phenomenon, but only 7.4% of them consulted the guidelines for prescribing antibiotics. This study demonstrates that the same trend exists in Italy as in other countries in terms of the high prevalence of misuse and overuse of antibiotics, and that Italian dentists utilize a range of antibiotic management strategies.
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Outpatient Antibiotic Prescriptions in France: Patients and Providers Characteristics and Impact of the COVID-19 Pandemic. Antibiotics (Basel) 2022; 11:antibiotics11050643. [PMID: 35625287 PMCID: PMC9137595 DOI: 10.3390/antibiotics11050643] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/05/2022] [Accepted: 05/09/2022] [Indexed: 02/04/2023] Open
Abstract
In France, despite several successive plans to control antimicrobial resistance, antibiotic use remains high in the outpatient setting. This study aims to better understand outpatient antibiotic use and prescription in order to identify tailored targets for future public health actions. Using data from the French National Health Data System, we described and compared the individual characteristics of patients with and without an antibiotic prescription. The prescribed antibiotics (ATC-J01) were detailed and compared between 2019 and 2020. Antibiotic prescribing indicators that take prescriber activity into account were estimated and compared. Patients who were female, advanced age, and the presence of comorbidities were associated with antibiotic prescriptions. The overall prescription rate was estimated at 134 per 1000 consultations and 326 per 1000 patients seen in 2019. General practitioners (GPs), dentists and paediatricians were associated with 78.0%, 12.2% and 2.2% of antibiotic prescriptions, respectively, with high prescription rates (391, 447, and 313 p. 1000 patients seen, respectively). In comparison with 2019, this rate decreased in 2020 for paediatricians (−30.4%) and GPs (−17.9%) whereas it increased among dentists (+17.9%). The reduction was twice as high among the male prescribers than among their female counterparts (−26.6 and −12.0, respectively). The reduction in prescriptions observed in 2020 (−18.2%) was more marked in children (−35.8%) but less so among individuals ≥65 years (−13.1%) and those with comorbidities (−12.5%). The decrease in penicillin prescriptions represents 67.3% of the overall reduction observed in 2020. The heterogeneous decrease in prescriptions by age and antibiotic class could be explained by the impact of COVID-19 control measures on the spread of respiratory viruses; thus, a substantial proportion of the prescriptions avoided in 2020 is likely inappropriate, particularly among children. In order to keep the rate of prescriptions comparable to that observed in 2020, male prescribers, paediatricians and GPs should be encouraged to maintain that level, while a campaign to raise awareness of the appropriate use of antibiotics should be aimed at dentists in particular.
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Thompson W, Teoh L, Hubbard CC, Marra F, Patrick DM, Mamun A, Campbell A, Suda KJ. Patterns of dental antibiotic prescribing in 2017: Australia, England, United States, and British Columbia (Canada). Infect Control Hosp Epidemiol 2022; 43:191-198. [PMID: 33818323 PMCID: PMC9044466 DOI: 10.1017/ice.2021.87] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Our objective was to compare patterns of dental antibiotic prescribing in Australia, England, and North America (United States and British Columbia, Canada). DESIGN Population-level analysis of antibiotic prescription. SETTING Outpatient prescribing by dentists in 2017. PARTICIPANTS Patients receiving an antibiotic dispensed by an outpatient pharmacy. METHODS Prescription-based rates adjusted by population were compared overall and by antibiotic class. Contingency tables assessed differences in the proportion of antibiotic class by country. RESULTS In 2017, dentists in the United States had the highest antibiotic prescribing rate per 1,000 population and Australia had the lowest rate. The penicillin class, particularly amoxicillin, was the most frequently prescribed for all countries. The second most common agents prescribed were clindamycin in the United States and British Columbia (Canada) and metronidazole in Australia and England. Broad-spectrum agents, amoxicillin-clavulanic acid, and azithromycin were the highest in Australia and the United States, respectively. CONCLUSION Extreme differences exist in antibiotics prescribed by dentists in Australia, England, the United States, and British Columbia. The United States had twice the antibiotic prescription rate of Australia and the most frequently prescribed antibiotic in the US was clindamycin. Significant opportunities exist for the global dental community to update their prescribing behavior relating to second-line agents for penicillin allergic patients and to contribute to international efforts addressing antibiotic resistance. Patient safety improvements will result from optimizing dental antibiotic prescribing, especially for antibiotics associated with resistance (broad-spectrum agents) or C. difficile (clindamycin). Dental antibiotic stewardship programs are urgently needed worldwide.
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Affiliation(s)
- Wendy Thompson
- Division of Dentistry, University of Manchester, Manchester, United Kingdom
| | - Leanne Teoh
- Melbourne Dental School, University of Melbourne, Carlton, Victoria, Australia
| | - Colin C Hubbard
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois Chicago, Chicago, Illinois, United States
| | - Fawziah Marra
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - David M Patrick
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Abdullah Mamun
- British Columbia Centre for Disease Control, Surrey, British Columbia, Canada
| | | | - Katie J Suda
- Center for Health Equity Research and Promotion, Pittsburgh, Pennsylvania, United States
- Veterans' Affairs Pittsburgh Healthcare System, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
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SANTOS JS, CRUZ AJSD, RUAS CM, PEREIRA JÚNIOR EA, MATTOS FDF, KLEVENS RM, ABREU MHNG. What we know about antibiotics prescribed by dentists in a Brazilian southeastern state. Braz Oral Res 2022; 36:e002. [DOI: 10.1590/1807-3107bor-2022.vol36.0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/03/2021] [Indexed: 01/07/2023] Open
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Verma AR, Mathur VP. Anti-microbial resistance and dentistry. Indian J Dent Res 2021; 32:272-273. [PMID: 34810403 DOI: 10.4103/ijdr.ijdr_4_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ankita R Verma
- Department of Pedodontics and Preventive Dentistry, Center for Dental Education and Research, AIIMS, New Delhi, India
| | - Vijay Prakash Mathur
- Department of Pedodontics and Preventive Dentistry, Center for Dental Education and Research, AIIMS, New Delhi, India
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Hu YJ, Wang J, Harwell JI, Wake M. Association of in utero antibiotic exposure on childhood ear infection trajectories: Results from a national birth cohort study. J Paediatr Child Health 2021; 57:1023-1030. [PMID: 33586839 DOI: 10.1111/jpc.15371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/13/2020] [Accepted: 01/13/2021] [Indexed: 11/28/2022]
Abstract
AIM Most prescribed medicines during pregnancy are antibiotics, with unknown effects on a fetus and on the infant's acquired microbiome. This study investigates associations between in utero antibiotic exposure and ear infection trajectories over the first decade of life, hypothesising effects on early or persistent, rather than later-developing, ear infections. METHODS Design and participants: The Longitudinal Study of Australian Children birth cohort recruited a nationally-representative sample of 5107 infants in 2004. MEASURES Mothers reported antibiotic use in pregnancy when a child was 3-21 months old (wave 1), and ongoing problems with ear infection every 2 years spanning ages 0-1 to 10-11 years (waves 1-6). ANALYSIS Latent class models identified ear infection trajectories, and univariable and multivariable multinomial logistic regression determined odds of adverse trajectories by antibiotic exposure. RESULTS A total of 4500 (88.1% of original sample) children contributed (mean baseline age 0.7 years; 51.3% boys); 10.4% of mothers reported antibiotic use in pregnancy. Four probability trajectories for ear infection emerged: 'consistently low' (86.2%), 'moderate to low' (5.6%), 'low to moderate' (6.7%) and 'consistently high' (1.4%). Antibiotic use in pregnancy was associated with children following 'consistently high' (adjusted odds ratio 2.04, 95% confidence interval 1.08-3.88, P = 0.03) and 'moderate to low' (adjusted odds ratio 1.78, 95% confidence interval 1.25-2.53, P = 0.001) trajectories. CONCLUSIONS Antibiotic use in pregnancy is associated with an increased risk of persistent and early childhood ear infections. This highlights the wisdom of cautious antibiotic use during pregnancy, and the need for the study of potential mechanisms underlying these associations.
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Affiliation(s)
- Yanhong J Hu
- Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jing Wang
- Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Joseph I Harwell
- Division of Infectious Diseases, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Melissa Wake
- Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
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Aragoneses J, Suárez A, Rodríguez C, Algar J, Aragoneses JM. Knowledge, Attitudes, and Practices among Dental Practitioners Regarding Antibiotic Prescriptions for Pregnant and Breastfeeding Women in the Dominican Republic. Antibiotics (Basel) 2021; 10:668. [PMID: 34205115 PMCID: PMC8229999 DOI: 10.3390/antibiotics10060668] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/20/2021] [Accepted: 06/02/2021] [Indexed: 02/05/2023] Open
Abstract
In this study, we aimed to explore the trends among dentists in the Dominican Republic of providing antibiotic prescriptions to pregnant/breastfeeding dental patients. A survey was conducted among 98 dentists, using a self-administered questionnaire, about their knowledge and attitudes regarding antibiotic usage in pregnant/lactating women and the translation of these into practice. The majority of the survey population were female dentists (63.3%) aged 45-54 years. A chi-square test showed statistically significant differences in the knowledge sources between older and younger dentists, with a minority having chosen scientific literature as a source (p-value of 0.04). There were statistically significant associations between gender and certain attitudes and practice-based questions, with p-values of 0.04 and 0.01, respectively. The Spearman's correlation test showed a statistically significant correlation between knowledge and attitude (p-value 0.001), whereas no correlation was found with practice (p-value 0.23). A multiple response analysis showed that the majority of the respondents chose the second and third trimester for antibiotic prescriptions for acute conditions such as cellulitis, periodontal abscess, and pericoronitis. Most dentists had sufficient knowledge about antibiotic usage in pregnant/lactating women, but it did not translate into practice, and a certain proportion of the participants followed incongruent drug prescription. These findings can be used to focus on judicious antibiotic usage by dentists in the Dominican Republic.
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Affiliation(s)
- Javier Aragoneses
- Department of Medicine and Medical Specialties, Faculty of Health Sciences, University of Alcalá, 28801 Madrid, Spain;
| | - Ana Suárez
- Department of Preclinical Dentistry, School of Biomedical Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - Cinthia Rodríguez
- Department of Dentistry, Universidad Federico Henriquez y Carvajal, 10106 Santo Domingo, Dominican Republic;
| | - Juan Algar
- Department of Clinical Dentistry, School of Biomedical Sciences, Universidad Europea de Madrid, 28005 Madrid, Spain;
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Mian M, Teoh L, Hopcraft M. Trends in Dental Medication Prescribing in Australia during the COVID-19 Pandemic. JDR Clin Trans Res 2021; 6:145-152. [PMID: 33423578 PMCID: PMC7803793 DOI: 10.1177/2380084420986766] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The coronavirus disease 2019 (COVID-19) pandemic and subsequent restrictions on dental services have had a significant impact on the provision of dental care in Australia and around the world. OBJECTIVES To investigate the impact of COVID-19 on medications prescribed by dentists under the Australian Pharmaceutical Benefits Scheme (PBS). METHODS Data on the number of dental prescriptions dispensed for all medications listed on the PBS Dental Schedule, from January 2019 to June 2020, were extracted from publicly available data sets. Analysis of prescription trends was performed for 1) total medications, 2) each major medication class, and 3) individual medications. The number of prescriptions dispensed in each month from January 2020 to June 2020 was compared to the same month in 2019 to determine the relative (percentage) change, and z statistics were used to determine whether changes were statistically significant. RESULTS There was a significant decrease in dental prescriptions in April 2020 compared to April 2019 (14,785, 18%; P < 0.05). Decreases in prescriptions for antibiotics (10,512, 16%; P < 0.05) and opioid analgesics (3,129, 18%; P < 0.05) were smaller compared to other major medication classes. There was a significant increase in June 2020, compared with June 2019, for prescriptions of amoxicillin with clavulanic acid (4,903, 20%; P < 0.05), tramadol (89, 46%; P < 0.05), and oxycodone (381, 73%; P < 0.05). CONCLUSION Dental service restrictions during COVID-19 likely drove an unmet need for routine dental treatment, which had significant implications for public oral health following easing of restrictions. During the initial surge and subsequent lockdown, antibiotics and opioid analgesics may have been used an as alternative to routine operative treatment. Continued professional guidance is required to ensure dental prescribing remains evidence based during the pandemic period. KNOWLEDGE TRANSFER STATEMENT The COVID-19 pandemic and subsequent restrictions on dental practice have had a profound impact on the provision of dental care in Australia and elsewhere in the world. In this context, population-level medication surveillance is important to identify and respond to changes in prescribing patterns that have arisen due to COVID-19 and restrictions on the provision of dental care. This research is particularly important for governments, regulators, and professional associations to ensure therapeutic guidelines and recommendations during the pandemic period remain relevant and evidence based.
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Affiliation(s)
- M. Mian
- Oral and Maxillofacial Surgery Unit, Royal Dental Hospital of Melbourne, Carlton, Victoria, Australia
- Melbourne Medical School, University of Melbourne, Victoria, Australia
| | - L. Teoh
- Melbourne Dental School, University of Melbourne, Victoria, Australia
| | - M. Hopcraft
- Melbourne Dental School, University of Melbourne, Victoria, Australia
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Choi YY, Lee KH. Changes in Antibiotic Prescription After Tooth Extraction: A Population-Based Study from 2002 to 2018. Int Dent J 2021; 71:491-499. [PMID: 33771374 PMCID: PMC9275312 DOI: 10.1016/j.identj.2021.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Microbial resistance due to antibiotic misuse is a worldwide problem. This study aimed to examine the trends in antibiotic prescription after tooth extraction in Korea. METHODS From the database of National Health Insurance Sharing Service, patients who underwent tooth extraction from 2002 to 2018 were selected as subjects, and 10% of them were selected via stratified sampling based on sex and age. Overall, 15,838,529 cases were observed for annual antibiotic prescription and broad-spectrum antibiotic prescription patterns. Additionally, standardized annual antibiotic use was calculated using a defined daily dose. RESULTS Prescriptions were issued in 13,429,770 (84.8%) of the tooth extraction cases, of which 12,179,185 (90.7%) included antibiotics. Logistic regression analysis revealed that the likelihood of prescribing antibiotics after tooth extraction decreased in 2003 compared to 2002 (odds ratio, 0.95) but increased from 2004 to 2018. In the case of the broad-spectrum antibiotic prescription rate, there was no clear trend between 2002 and 2012 (odds ratio, 0.89-1.07); however, over the last 5 years, the likelihood of broad-spectrum antibiotic prescription has steadily increased. The value of antibiotics based on the defined daily dose of 1000 patients per day was calculated to be 4.39 in 2002, exhibiting a steady increase later and reaching 6.97 in 2018, whereas that of broad-spectrum antibiotics was 1.68 in 2002 and has since been on the rise; the highest was 3.82 in 2018. CONCLUSIONS Antibiotic use after tooth extraction increased over the last 17 years; additionally, the rate of prescribing broad-spectrum antibiotics has increased over the last 5 years.
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Affiliation(s)
- Yoon Young Choi
- Artificial Intelligence Big Data Medical Center, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Kyeong Hee Lee
- Department of Dental Hygiene, College of Bioecological Health, Shinhan University, Uijeongbu, Korea.
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Oral Antibiotic for Empirical Management of Acute Dentoalveolar Infections-A Systematic Review. Antibiotics (Basel) 2021; 10:antibiotics10030240. [PMID: 33670844 PMCID: PMC7997333 DOI: 10.3390/antibiotics10030240] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 12/21/2022] Open
Abstract
Concerns regarding increasing antibiotic resistance raise the question of the most appropriate oral antibiotic for empirical therapy in dentistry. The aim of this systematic review was to investigate the antibiotic choices and regimens used to manage acute dentoalveolar infections and their clinical outcomes. A systematic review was undertaken across three databases. Two authors independently screened and quality-assessed the included studies and extracted the antibiotic regimens used and the clinical outcomes. Searches identified 2994 studies, and after screening and quality assessment, 8 studies were included. In addition to incision and drainage, the antibiotics used to manage dentoalveolar infections included amoxicillin, amoxicillin/clavulanic acid, cefalexin, clindamycin, erythromycin, metronidazole, moxifloxacin, ornidazole and phenoxymethylpenicillin. Regimens varied in dose, frequency and duration. The vast majority of regimens showed clinical success. One study showed that patients who did not receive any antibiotics had the same clinical outcomes as patients who received broad-spectrum antibiotics. The ideal choice, regimen and spectrum of empirical oral antibiotics as adjunctive management of acute dentoalveolar infections are unclear. Given that all regimens showed clinical success, broad-spectrum antibiotics as first-line empirical therapy are unnecessary. Narrow-spectrum agents appear to be as effective in an otherwise healthy individual. This review highlights the effectiveness of dental treatment to address the source of infection as being the primary factor in the successful management of dentoalveolar abscesses. Furthermore, the role of antibiotics is questioned in primary space odontogenic infections, if drainage can be established.
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Lodi G, Azzi L, Varoni EM, Pentenero M, Del Fabbro M, Carrassi A, Sardella A, Manfredi M. Antibiotics to prevent complications following tooth extractions. Cochrane Database Syst Rev 2021; 2:CD003811. [PMID: 33624847 PMCID: PMC8094158 DOI: 10.1002/14651858.cd003811.pub3] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The most frequent indications for tooth extractions, generally performed by general dental practitioners, are dental caries and periodontal infections. Systemic antibiotics may be prescribed to patients undergoing extractions to prevent complications due to infection. This is an update of a review first published in 2012. OBJECTIVES To determine the effect of systemic antibiotic prophylaxis on the prevention of infectious complications following tooth extractions. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health Trials Register (to 16 April 2020), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2020, Issue 3), MEDLINE Ovid (1946 to 16 April 2020), Embase Ovid (1980 to 16 April 2020), and LILACS (1982 to 16 April 2020). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA We included randomised, double-blind, placebo-controlled trials of systemic antibiotic prophylaxis in patients undergoing tooth extraction(s) for any indication. DATA COLLECTION AND ANALYSIS At least two review authors independently performed data extraction and 'Risk of bias' assessment for the included studies. We contacted trial authors for further details where these were unclear. For dichotomous outcomes, we calculated risk ratios (RR) and 95% confidence intervals (CI) using random-effects models. For continuous outcomes, we used mean differences (MD) with 95% CI using random-effects models. We examined potential sources of heterogeneity. We assessed the certainty of the body of evidence for key outcomes as high, moderate, low, or very low, using the GRADE approach. MAIN RESULTS We included 23 trials that randomised approximately 3206 participants (2583 analysed) to prophylactic antibiotics or placebo. Although general dentists perform dental extractions because of severe dental caries or periodontal infection, only one of the trials evaluated the role of antibiotic prophylaxis in groups of patients affected by those clinical conditions. We assessed 16 trials as being at high risk of bias, three at low risk, and four as unclear. Compared to placebo, antibiotics may reduce the risk of postsurgical infectious complications in patients undergoing third molar extractions by approximately 66% (RR 0.34, 95% CI 0.19 to 0.64; 1728 participants; 12 studies; low-certainty evidence), which means that 19 people (95% CI 15 to 34) need to be treated with antibiotics to prevent one infection following extraction of impacted wisdom teeth. Antibiotics may also reduce the risk of dry socket by 34% (RR 0.66, 95% CI 0.45 to 0.97; 1882 participants; 13 studies; low-certainty evidence), which means that 46 people (95% CI 29 to 62) need to take antibiotics to prevent one case of dry socket following extraction of impacted wisdom teeth. The evidence for our other outcomes is uncertain: pain, whether measured dichotomously as presence or absence (RR 0.59, 95% CI 0.31 to 1.12; 675 participants; 3 studies) or continuously using a visual analogue scale (0-to-10-centimetre scale, where 0 is no pain) (MD -0.26, 95% CI -0.59 to 0.07; 422 participants; 4 studies); fever (RR 0.66, 95% CI 0.24 to 1.79; 475 participants; 4 studies); and adverse effects, which were mild and transient (RR 1.46, 95% CI 0.81 to 2.64; 1277 participants; 8 studies) (very low-certainty evidence). We found no clear evidence that the timing of antibiotic administration (preoperative, postoperative, or both) was important. The included studies enrolled a subset of patients undergoing dental extractions, that is healthy people who had surgical extraction of third molars. Consequently, the results of this review may not be generalisable to all people undergoing tooth extractions. AUTHORS' CONCLUSIONS The vast majority (21 out of 23) of the trials included in this review included only healthy patients undergoing extraction of impacted third molars, often performed by oral surgeons. None of the studies evaluated tooth extraction in immunocompromised patients. We found low-certainty evidence that prophylactic antibiotics may reduce the risk of infection and dry socket following third molar extraction when compared to placebo, and very low-certainty evidence of no increase in the risk of adverse effects. On average, treating 19 healthy patients with prophylactic antibiotics may stop one person from getting an infection. It is unclear whether the evidence in this review is generalisable to patients with concomitant illnesses or patients at a higher risk of infection. Due to the increasing prevalence of bacteria that are resistant to antibiotic treatment, clinicians should evaluate if and when to prescribe prophylactic antibiotic therapy before a dental extraction for each patient on the basis of the patient's clinical conditions (healthy or affected by systemic pathology) and level of risk from infective complications. Immunocompromised patients, in particular, need an individualised approach in consultation with their treating medical specialist.
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Affiliation(s)
- Giovanni Lodi
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Lorenzo Azzi
- Department of Medicine and Surgery, Unit of Oral Medicine and Pathology, University of Insubria, Varese, Italy
| | - Elena Maria Varoni
- Dipartimento di Scienze Biomediche, Chirurgiche e Odontoiatriche, Università degli Studi di Milano, Milan, Italy
| | - Monica Pentenero
- Dept. of Oncology, Oral Medicine and Oral Oncology Unit, University of Turin, Orbassano, Italy
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Antonio Carrassi
- Dipartimento di Scienze Biomediche, Chirurgiche e Odontoiatriche, Università degli Studi di Milano, Milan, Italy
| | - Andrea Sardella
- Dipartimento di Scienze Biomediche, Chirurgiche e Odontoiatriche, Università degli Studi di Milano, Milan, Italy
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The first national survey of antimicrobial use among dentists in Japan from 2015 to 2017 based on the national database of health insurance claims and specific health checkups of Japan. PLoS One 2020; 15:e0244521. [PMID: 33370390 PMCID: PMC7769482 DOI: 10.1371/journal.pone.0244521] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/11/2020] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To counter the global health threat of antimicrobial resistance, effective antimicrobial stewardship programs are needed to improve antimicrobial use (AMU) among dentists in addition to physicians. This study aimed to investigate the nationwide epidemiology of AMU among Japanese dentists to facilitate the development of dentist-centered programs. METHODS We conducted a retrospective population-based study using the National Database of Health Insurance Claims and Specific Health Checkups of Japan to analyze the AMU among Japanese dentists between 2015 and 2017. AMU was quantified as the defined daily doses per 1,000 inhabitants per day (DID). The trends in dentist-prescribed AMU were examined according to antimicrobial category and administration route. We also compared outpatient oral AMU between dentists and physicians as well as between on-site and off-site dispensing. RESULTS The DID values of dentist-prescribed AMU were 1.23 in 2015, 1.22 in 2016, and 1.21 in 2017. During this study period, outpatient oral antimicrobials comprised the majority (approximately 99%) of dentist-prescribed AMU, and cephalosporins were the most frequently prescribed antimicrobials (>60% of all antimicrobials). The DID values of outpatient oral AMU were 1.21 for dentists and 12.11 for physicians. The DID value for on-site dispensing was 0.89 in 2017, in which cephalosporins were the predominantly used antimicrobials (DID: 0.60). CONCLUSIONS Interventions that target dentists in Japan should focus on on-site dispensing of oral antimicrobials (especially cephalosporins) for outpatients. Further studies are needed to ascertain the underlying factors of oral cephalosporin prescriptions to guide the development of effective antimicrobial stewardship programs.
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Belibasakis GN, Lund BK, Krüger Weiner C, Johannsen B, Baumgartner D, Manoil D, Hultin M, Mitsakakis K. Healthcare Challenges and Future Solutions in Dental Practice: Assessing Oral Antibiotic Resistances by Contemporary Point-Of-Care Approaches. Antibiotics (Basel) 2020; 9:E810. [PMID: 33202544 PMCID: PMC7696509 DOI: 10.3390/antibiotics9110810] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 12/17/2022] Open
Abstract
Antibiotic resistance poses a global threat, which is being acknowledged at several levels, including research, clinical implementation, regulation, as well as by the World Health Organization. In the field of oral health, however, the issue of antibiotic resistances, as well as of accurate diagnosis, is underrepresented. Oral diseases in general were ranked third in terms of expenditures among the EU-28 member states in 2015. Yet, the diagnosis and patient management of oral infections, in particular, still depend primarily on empiric means. On the contrary, on the global scale, the field of medical infections has more readily adopted the integration of molecular-based systems in the diagnostic, patient management, and antibiotic stewardship workflows. In this perspective review, we emphasize the clinical significance of supporting in the future antibiotic resistance screening in dental practice with novel integrated and point-of-care operating tools that can greatly support the rapid, accurate, and efficient administration of oral antibiotics.
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Affiliation(s)
- Georgios N. Belibasakis
- Department of Dental Medicine, Karolinska Institutet, Alfred Nobels allè 8, 14104 Stockholm, Sweden; (B.K.L.); (C.K.W.); (D.M.); (M.H.)
| | - Bodil K. Lund
- Department of Dental Medicine, Karolinska Institutet, Alfred Nobels allè 8, 14104 Stockholm, Sweden; (B.K.L.); (C.K.W.); (D.M.); (M.H.)
- Department of Clinical Dentistry, University of Bergen, 5009 Bergen, Norway
- Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, 5021 Bergen, Norway
| | - Carina Krüger Weiner
- Department of Dental Medicine, Karolinska Institutet, Alfred Nobels allè 8, 14104 Stockholm, Sweden; (B.K.L.); (C.K.W.); (D.M.); (M.H.)
- Department of Oral and Maxillofacial Surgery, Folktandvården Stockholm, Eastman Institutet, 11324 Stockholm, Sweden
| | - Benita Johannsen
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany;
| | - Desirée Baumgartner
- Laboratory for MEMS Applications, IMTEK—Department of Microsystems Engineering, University of Freiburg, Georges-Koehler-Allee 103, 79110 Freiburg, Germany;
| | - Daniel Manoil
- Department of Dental Medicine, Karolinska Institutet, Alfred Nobels allè 8, 14104 Stockholm, Sweden; (B.K.L.); (C.K.W.); (D.M.); (M.H.)
| | - Margareta Hultin
- Department of Dental Medicine, Karolinska Institutet, Alfred Nobels allè 8, 14104 Stockholm, Sweden; (B.K.L.); (C.K.W.); (D.M.); (M.H.)
| | - Konstantinos Mitsakakis
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany;
- Laboratory for MEMS Applications, IMTEK—Department of Microsystems Engineering, University of Freiburg, Georges-Koehler-Allee 103, 79110 Freiburg, Germany;
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Park JS, Kruger E, Tennant M. Financial contributions made by patients towards dispensed medicines prescribed by Australian dentists from 2006 to 2018: a cost-analysis study. AUST HEALTH REV 2020; 45:167-172. [PMID: 33176901 DOI: 10.1071/ah20140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/24/2020] [Indexed: 01/08/2023]
Abstract
Objective This cost-analysis study explored Pharmaceutical Benefits Scheme (PBS) data to determine the financial patient contribution (PC) towards dispensed medications prescribed by dentists and temporal trends in cost contributions. Methods For this study we used the PBS online dataset and only included concessional data in the analysis. Data on dental medications dispensed under the PBS from 2006 to 2018 were accessed. For all medicines aggregated to different pharmacological categories (antibiotics, analgesics and opiates, anti-inflammatories, antifungals, benzodiazepines, anticonvulsants and anti-emetics, and emergency medications), a temporal trend was generated using annual PC data. Cumulative patient and mean annual PC data were also generated in a similar manner. Results Cumulative PC over the study period for dental PBS prescriptions was A$28783361 (A$5.55 per dispensing). The mean annual PC for dental PBS was A$2214105 (for the entire concessional population from 2006 to 2018), with a statistically significant and strong correlation between year and PC (Dental PBS, A$59756 per year; r=0.98: P<0.0001). Antibiotics represented the highest proportion of PC (87.8%), whereas the lowest proportion of PC was for emergency medications (e.g. adrenaline, atropine, glucagon, naloxone), which amounted to 0.003%. Conclusions This study highlights the increasing contributions made by patients towards antibiotic prescriptions. What is known about the topic? Australian dentists can independently prescribe subsidised medications as per a set scope for general and specialist dentists, regulated under the PBS with requisite adherence to specific legal requirements. What does this paper add? This is the first study highlighting the increased level of patient financial contributions towards dental medicines, according to different pharmacological categories, dispensed by pharmacists in Australia. What are the implications for practitioners? This study creates a base for future research assessing the appropriateness of the PBS subsidy and the PBS Safety Net threshold, possibly reassessing the out-of-pocket pricing on brand substitution and appropriately reassessing the current dental PBS schedule.
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Affiliation(s)
- Joon Soo Park
- International Research Collaborative - Oral Health and Equity, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia. ; ; and Corresponding author.
| | - Estie Kruger
- International Research Collaborative - Oral Health and Equity, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia. ;
| | - Marc Tennant
- International Research Collaborative - Oral Health and Equity, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia. ;
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Angarita-Díaz MDP, Bernal-Cepeda L, Rodriguez-Paz M, Vergara-Mercado M, Herrera-Herrera A, Forero-Escobar D, Mora-Reina J, Ochoa-Acosta EM, Maya-Giraldo M, Caceres-Matta S, Tamayo J, Martinez-Cajas C, Fortich-Mesa N, Bermudez-Reyes P, Vergara-Bobadilla H. Prescribing antibiotics by dentists in Colombia: Toward a conscientious prescription. J Public Health Dent 2020; 81:100-112. [PMID: 33104249 DOI: 10.1111/jphd.12416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 09/15/2020] [Accepted: 10/09/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Inappropriate prescription of antibiotics contributes to antibiotic resistance. Therefore, the objective of this study was to determine the awareness, attitudes, and intention to practice of dentists prescribing antibiotics in Colombia in order to design a virtual learning environment on this subject. METHODS In a descriptive study across seven cities, 700 dentists from different Colombian cities were requested to complete a validated questionnaire containing five sections: general information, awareness on antibiotic effectiveness and antibiotic resistance, attitudes regarding prescription decision, intention to practice concerning clinical cases, and complementary information. The level of awareness, attitudes, and intention to practice was determined and Chi-square test was used to determine the existence of significant differences among cities. RESULTS The majority of dentists showed a medium level regarding the number of correct answers on awareness (62.4 percent) and attitudes (88.7 percent) and a high level on intention to practice (91.7 percent). Common errors within the awareness section included the meaning of the term "antibiotic resistance" (35 percent) and most dentists were not convinced that such resistance could be derived from prescription of antibiotics (51.2 percent). In the attitudes section, only 45 percent declared that they prescribe antibiotics based mainly on symptoms, and the intention to practice section showed a significant percentage of unnecessary prescription (51 percent for pacemaker users) or absence of prescription (53.9 percent for ventricular septal defect) in antibiotic prophylaxis for infectious endocarditis (IE). CONCLUSION The dentists interviewed should be trained and made aware of antibiotic resistance, microbiological and clinical foundations, and current antibiotic prophylaxis guidelines.
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Affiliation(s)
| | | | | | | | | | - Diana Forero-Escobar
- School of Dentistry, Cooperative University of Colombia, Villavicencio, Colombia
| | - Julián Mora-Reina
- School of Dentistry, Cooperative University of Colombia, Villavicencio, Colombia
| | | | | | | | - Julián Tamayo
- School of Dentistry, University Institute of Colombian Colleges, Cali, Colombia
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Bolstad AI, Saetre MM, Aasgaard AS, Bunaes DF. Shift in antibiotic prescription at a University Dental Clinic in Norway 2013-2017. Eur J Oral Sci 2020; 128:518-525. [PMID: 33084160 DOI: 10.1111/eos.12741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2020] [Indexed: 01/03/2023]
Abstract
A considerable number of prescriptions for antibiotics are issued by dentists. Educational institutions have a special responsibility to promote informed attitudes among dental students towards prescribing antibiotics. The purpose of this study was to analyze the antibiotic prescriptions issued during a 5-year period (2013-2017) at a University Dental Clinic (UDC) in Norway. All patient records containing prescriptions for patients ≥18 yr of age as of 2013-2017 were identified through an electronic search. In total, 6,014 patient record lines containing prescriptions were obtained, 1,047 (17.4%) of which were prescriptions for systemic antibiotics. These patient record lines were analysed to identify the specific antibiotic prescribed, the indication or diagnosis for which it was prescribed, and whether microbiological testing (to determine antibiotic sensitivity) had been carried out. Acute infections were the most common context for prescribing antibiotics. Surprisingly, prophylaxis was the second most frequent reason stated. Disease related to pulp necrosis (43%) and postoperative infections (26%) was the most common diagnosis for therapeutic antibiotic prescriptions. Antibiotic therapy was more commonly used to treat peri-implantitis than to treat periodontitis. Only 60% of the clindamycin prescriptions were issued to patients with penicillin allergy. Further studies are warranted concerning antibiotic use at UDC because this can probably be more restrictive, in particular concerning usage related to antibiotic prophylaxis. Microbiological testing should be performed before administration of antibiotic therapy for periodontitis and peri-implantitis. The reason for prescribing antibiotics should always be stated in the patient's record lines.
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Affiliation(s)
- Anne I Bolstad
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Malene M Saetre
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Anette S Aasgaard
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Dagmar F Bunaes
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Bergen, Norway
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Park JS, Page AT, Kruger E, Tennant M. Dispensing patterns of medicines prescribed by Australian dentists from 2006 to 2018 - a pharmacoepidemiological study. Int Dent J 2020; 71:106-112. [PMID: 32856305 PMCID: PMC9275101 DOI: 10.1111/idj.12605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES Dentists are independent prescribers that can prescribe subsidised medicines under the Australian Pharmaceutical Benefits Scheme (PBS). It is hypothesised that increased dental prescribing can partly be accounted for by the growth in both the Australian population and the number of practising dentists. This pharmacoepidemiological study aims to determine the dispensing patterns of medications amongst dentists and to identify trends over time. MATERIALS AND METHODS Data on dental medications under PBS from 2006 to 2018 were accessed. All the dentist-prescribed concessional medicines dispensed at pharmacies in 2018 were included for time trend analysis. Cumulative dispensing counts and defined daily dose (DDD) per 1,000 concessional population days (DPD) were analysed for time trend analysis. RESULTS Out of the 56 medications within the dental PBS schedule, the top 20 medicines had a total cumulative dispensing count of 5,058,556, which accounts for 97.4% of the total dispensing count. Eleven out of 20 medicines were antibiotics. Overall, increases were observed for seven out of 20 medicines (amoxicillin + clavulanic acid, clindamycin, ibuprofen, diazepam, oxycodone, tramadol, naproxen) in both dispensing count and trend, as expressed per DPD. CONCLUSION This study highlights the increasing dispensing pattern and trends of dentist-prescribed antibiotics, opioids and benzodiazepines. Further investigation may be required to determine whether the medicine use is appropriate. In the future, this could provide new educational opportunities on the appropriate use of medicines for dentists.
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Affiliation(s)
- Joon Soo Park
- International Research Collaborative – Oral Health and Equity, The University of Western Australia, Crawley, WA, Australia
| | - Amy T. Page
- Pharmacy Department, Alfred Health, Melbourne, Vic., Australia
- Centre for Medicine Use and Safety, Monash University, Parkville, Vic., Australia
- Centre for Optimisation of Medicines, University of Western Australia, Crawley, WA, Australia
| | - Estie Kruger
- International Research Collaborative – Oral Health and Equity, The University of Western Australia, Crawley, WA, Australia
| | - Marc Tennant
- International Research Collaborative – Oral Health and Equity, The University of Western Australia, Crawley, WA, Australia
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Teoh L, Thompson W, Suda K. Antimicrobial stewardship in dental practice. J Am Dent Assoc 2020; 151:589-595. [PMID: 32718488 DOI: 10.1016/j.esmoop.2020.04.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/05/2020] [Accepted: 04/21/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Antibiotic resistance is a global public health problem that is responsible for increased patient morbidity and mortality and financial burden. Dental antibiotic prescribing contributes to approximately 10% of all antibiotic prescriptions, and an estimated 80% of that prescribing is deemed inappropriate. Dental antimicrobial stewardship (AMS) has an important role to play in international efforts to tackle antibiotic resistance. The aim of the authors was to comment on the implementation of AMS strategies in outpatient dental practices. METHODS The authors included previous studies regarding outpatient antibiotic stewardship, longitudinal studies quantifying dispensed dental antibiotic prescription use, and interventional studies aimed at implementing AMS interventions in dentistry. RESULTS Researchers in several studies conducted trials regarding the use of various interventions, mostly comprising a combination of audit, feedback, dissemination of guidelines, and educational components to improve dental prescribing. CONCLUSIONS AND PRACTICAL IMPLICATIONS In regard to the establishment of an AMS strategy, aspects to be considered should include raising awareness about the risks of unnecessary use of antibiotics. Engaging and educating the entire dental team and patients, as well as collaborating with other specialized professionals, are important elements. Context-specific interventions with a methodical and measured approach are ideal.
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Discrepancy in Therapeutic and Prophylactic Antibiotic Prescribing in General Dentists and Maxillofacial Specialists in Australia. Antibiotics (Basel) 2020; 9:antibiotics9080492. [PMID: 32784644 PMCID: PMC7459474 DOI: 10.3390/antibiotics9080492] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 07/29/2020] [Accepted: 08/06/2020] [Indexed: 02/07/2023] Open
Abstract
There are concerns that general dentists (GDs) and dental specialists may be prescribing antibiotics inappropriately. This study explored the prescribing habits and decision-making processes of GDs versus oral and maxillofacial surgeons (OMFSs). A case-based online questionnaire was used to examine the prescribing of therapeutic and prophylactic antibiotics in two clinical scenarios. Stratified and systematic sampling strategies were implemented to provide a representative sample. The final valid sample was 60 GDs and 18 OMFSs. The majority of OMFSs (61.1%) routinely prescribed antibiotics for the surgical removal of third molars, which was significantly greater than for GDs (23.5%). For implant placement procedures, 72.2% of OMFSs and 62.1% of GDs prescribed antibiotics. Amoxicillin was the most selected agent for both scenarios. All OMFSs would prescribe antibiotic prophylaxis for patients with uncontrolled diabetes mellitus in both cases, but only 56.0–63.0% of GDs would do this. GDs based prescribing decisions primarily on information from prescribing guides, while OMFSs relied more on information gained from specialist training. Surgical prophylaxis protocols differed considerably between groups. Both groups used surgical prophylaxis for some situations that are outside current recommendations. Education with regards to discrepancies between clinical practice and current guidelines for antimicrobial therapy is needed to progress antimicrobial stewardship.
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Park JS, Kruger E, Tennant M. Dispensing patterns of emergency medicines prescribed by Australian dentists from 1992 to 2018 – a pharmacoepidemiology study. Int Dent J 2020; 70:254-258. [DOI: 10.1111/idj.12562] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Teoh L, Stewart K, Marino RJ, McCullough MJ. Improvement of dental prescribing practices using education and a prescribing tool: A pilot intervention study. Br J Clin Pharmacol 2020; 87:152-162. [PMID: 32436349 DOI: 10.1111/bcp.14373] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 01/16/2023] Open
Abstract
AIMS Antibiotic resistance is a global public health problem. Around 55% of dental antibiotic prescribing is deemed inappropriate. The aim of this multimodal interventional pilot study was to assess the effect on prescribing of education and a dentally designed prescribing website. METHODS Twenty-six dentists were recruited for the 12-week study using a pre-post design. Dentists self-recorded their prescribing of antibiotics, analgesics and anxiolytics for 6 weeks. After dentists were provided education and website access, they recorded their prescribing for a further 6 weeks. Four outcomes were measured comparing the prescribing before and after the intervention: (i) the number of inappropriate indications for which antibiotics were prescribed; (ii) the number of prescriptions; (iii) accuracy of the prescriptions according to the Australian therapeutic guidelines; and (iv) the confidence of practitioners towards the prescribing website. Participants were interviewed for feedback. RESULTS There was a substantial reduction of 44.6% in the number of inappropriate indications for which antibiotics were prescribed after the intervention and a decrease of 40.5% in the total number of antibiotics. Paracetamol with codeine substantially reduced by 56.8%. For the 3 most commonly prescribed antibiotics (amoxicillin, phenoxymethylpenicillin and metronidazole), there was the improvement in the accuracy of the prescriptions ranging from 0-64.7 to 74.2-100%. CONCLUSION This pilot study showed the intervention of targeted education and the prescribing tool was effective in improving dental prescribing, knowledge and confidence of practitioners, as well as providing an effective antibiotic stewardship tool. This context-specific intervention shows substantial promise for implementation into dental practice.
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Affiliation(s)
- Leanne Teoh
- Melbourne Dental School, University of Melbourne, Carlton, Victoria, Australia
| | - Kay Stewart
- Centre for Medicine Use and Safety, Monash University, Parkville, Victoria, Australia
| | - Rodrigo J Marino
- Melbourne Dental School, University of Melbourne, Carlton, Victoria, Australia
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Cummins J, McCarthy M, Esterman A, Karve A, Lee A. Knowledge and Compliance of Dentists' and Dental Students' With Respect to Relevant Guidelines for Prescribing Antibiotic Prophylaxis for the Prevention of Infective Endocarditis: A Systematic Review. J Evid Based Dent Pract 2020; 20:101311. [DOI: 10.1016/j.jebdp.2019.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 01/17/2019] [Accepted: 01/23/2019] [Indexed: 12/26/2022]
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Thornhill MH, Dayer MJ, Durkin MJ, Lockhart PB, Baddour LM. Oral antibiotic prescribing by NHS dentists in England 2010-2017. Br Dent J 2020; 227:1044-1050. [PMID: 31873263 DOI: 10.1038/s41415-019-1002-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Introduction Dentists prescribe a significant proportion of all antibiotics, while antimicrobial stewardship aims to minimise antibiotic-prescribing to reduce the risk of developing antibiotic-resistance and adverse drug reactions.Aims To evaluate NHS antibiotic-prescribing practices of dentists in England between 2010-2017.Methods NHS Digital 2010-2017 data for England were analysed to quantify dental and general primary-care oral antibiotic prescribing.Results Dental prescribing accounted for 10.8% of all oral antibiotic prescribing, 18.4% of amoxicillin and 57.0% of metronidazole prescribing in primary care. Amoxicillin accounted for 64.8% of all oral antibiotic prescribing by dentists, followed by metronidazole (28.0%), erythromycin (4.4%), phenoxymethylpenicillin (0.9%), clindamycin (0.6%), co-amoxiclav (0.5%), cephalosporins (0.4%) and tetracyclines (0.3%). Prescriptions by dentists declined during the study period for all antibiotics except for co-amoxiclav. This increase is of concern given the need to restrict co-amoxiclav use to infections where there is no alternative. Dental prescribing of clindamycin, which accounted for 43.9% of primary care prescribing in 2010, accounted for only 14.6% in 2017. Overall oral antibiotic prescribing by dentists fell 24.4% as compared to 14.8% in all of primary care.Conclusions These data suggest dentists have reduced antibiotic prescribing, possibly more than in other areas of primary-care. Nonetheless, opportunities remain for further reduction.
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Affiliation(s)
- Martin H Thornhill
- Unit of Oral & Maxillofacial Medicine Surgery and Pathology, School of Clinical Dentistry, University of Sheffield, Sheffield, UK; Department of Oral Medicine, Carolinas Medical Centre, Charlotte, NC, USA.
| | - Mark J Dayer
- Department of Cardiology, Taunton and Somerset NHS Trust, Taunton, Somerset, UK
| | - Michael J Durkin
- Division of Infectious Diseases, Washington University in St. Louis School of Medicine, MO, USA
| | - Peter B Lockhart
- Department of Oral Medicine, Carolinas Medical Centre, Charlotte, NC, USA
| | - Larry M Baddour
- Division of Infectious Diseases, Department of Medicine and the Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
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Sukumar S, Martin FE, Hughes TE, Adler CJ. Think before you prescribe: how dentistry contributes to antibiotic resistance. Aust Dent J 2019; 65:21-29. [PMID: 31613388 DOI: 10.1111/adj.12727] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2019] [Indexed: 01/02/2023]
Abstract
Antibiotic resistance presents a daunting challenge to health professionals worldwide and has the potential to create major problems for modern health care, resulting in more medical expenditure, extended hospital stays and increased morbidity and mortality. Advanced genome sequencing technologies present a complex picture of resistance, extending our understanding beyond the pharmacotherapeutic interface between pathogens and antibiotics. This review discusses the global scope and scale of antibiotic resistance and contextualizes it for the dental practitioner, emphasizing the role we must play in limiting the progression of resistance through antibiotic stewardship and disease prevention.
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Affiliation(s)
- S Sukumar
- Faculty of Medicine and Health, Sydney Dental School, University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Institute of Dental Research, Sydney Dental School, University of Sydney, Sydney, New South Wales, Australia
| | - F E Martin
- Faculty of Medicine and Health, Sydney Dental School, University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Institute of Dental Research, Sydney Dental School, University of Sydney, Sydney, New South Wales, Australia
| | - T E Hughes
- Faculty of Health and Medical Sciences, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - C J Adler
- Faculty of Medicine and Health, Institute of Dental Research, Sydney Dental School, University of Sydney, Sydney, New South Wales, Australia
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Bansal R, Jain A, Goyal M, Singh T, Sood H, Malviya HS. Antibiotic abuse during endodontic treatment: A contributing factor to antibiotic resistance. J Family Med Prim Care 2019; 8:3518-3524. [PMID: 31803645 PMCID: PMC6881914 DOI: 10.4103/jfmpc.jfmpc_768_19] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 09/16/2019] [Accepted: 09/30/2019] [Indexed: 12/24/2022] Open
Abstract
Antibiotic resistance is one of our most serious global health threats. The adverse effects of overusing and misusing antibiotics are highly publicized in the health professional literature. Antibiotic abuse occurs during routine endodontic treatment and there are deficiencies in knowledge regarding prescribing antibiotic and appropriate prophylactic antibiotic use. Multidisciplinary coordination and cooperation among dentists, pharmacists, and patients is needed to curb antibiotic abuse. As endodontists, we can become part of the solution to the antibiotic resistance crisis and deal with it conclusively. This review article discusses antibiotic resistance resulting from antibiotic abuse during endodontic treatment, various factors contributing to it, and measures required for stopping antibiotic abuse in endodontic treatment. A web-based research on MedLine was performed with terms Review Articles published in the last 10 year's dental journals in English for literature researching, extracting, and synthesizing data. Relevant articles were shortlisted. Important cross-reference articles were also reviewed.
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Affiliation(s)
- Ramta Bansal
- Department of Conservative Dentistry and Endodontics, Desh Bhagat Dental College and Hospital, Mandi Gobindgarh, District Fatehgarh Sahib, Punjab, India
| | - Aditya Jain
- Department of Physiology, Government Medical College, Patiala, Punjab, India
| | - Mehak Goyal
- Department of Oral and Maxillofacial Surgery, Desh Bhagat Dental College and Hospital, Mandi Gobindgarh, District Fatehgarh Sahib, Punjab, India
| | - Tejveer Singh
- Department of Oral and Maxillofacial Surgery, Desh Bhagat Dental College and Hospital, Mandi Gobindgarh, District Fatehgarh Sahib, Punjab, India
| | - Himanshu Sood
- Department of Conservative Dentistry and Endodontics, Desh Bhagat Dental College and Hospital, Mandi Gobindgarh, District Fatehgarh Sahib, Punjab, India
| | - Harjeet Singh Malviya
- Department of Conservative Dentistry and Endodontics, Geetanjali Dental and Research Institute, Udaipur, Rajasthan, India
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Thornhill M, Dayer M, Durkin M, Lockhart P, Baddour L. Risk of Adverse Reactions to Oral Antibiotics Prescribed by Dentists. J Dent Res 2019; 98:1081-1087. [PMID: 31314998 PMCID: PMC8256247 DOI: 10.1177/0022034519863645] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Dentists prescribe a large portion of all oral antibiotics, and these are associated with a risk of adverse drug reactions (ADRs). The aim of this study was to quantify the risk of ADRs associated with oral antibiotics commonly prescribed by dentists. NHS Digital Prescribing data and Yellow Card Drug Analysis data for 2010 to 2017 were abstracted to quantify dental antibiotic prescribing in England, and the rate and types of ADRs associated with them. During the period of study, the mean number of actively practicing dentists in England was 23,624. Amoxicillin accounted for 64.8% of dental antibiotic prescribing and had the lowest reported rate of fatal ADRs (0.1/million prescriptions) and overall ADRs (21.5/million prescriptions). Indeed, amoxicillin was respectively 6 and 3 times less likely to cause an ADR than the other penicillins, penicillin V and amoxicillin + clavulanic acid, and appears to be very safe in patients with no history of penicillin allergy. In contrast, clindamycin, which is often used in patients with penicillin allergy, had the highest rate of fatal (2.9/million prescriptions) and overall (337.3/million prescriptions) ADRs, with Clostridiodes (formerly Clostridium) difficile infections pivotal to its ADR profile. Other amoxicillin alternatives, clarithromycin and metronidazole, while significantly worse than amoxicillin, were 3 and nearly 5 times less likely to cause an ADR than clindamycin. Ranked from least to most likely to cause an ADR, antibiotics most commonly prescribed were as follows: amoxicillin < cephalosporins < erythromycin < tetracyclines < azithromycin < metronidazole < amoxicillin + clavulanic acid < clarithromycin < penicillin V < clindamycin. This study confirmed the high level of safety associated with use of amoxicillin by dentists and the significantly worse rates of fatal and nonfatal ADRs associated with other penicillins and alternatives to amoxicillin for those who are penicillin allergic. In particular, clindamycin had the highest rate of fatal and nonfatal ADRs of any of the antibiotics commonly prescribed by dentists.
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Affiliation(s)
- M.H. Thornhill
- Unit of Oral and Maxillofacial Medicine
Surgery and Pathology, School of Clinical Dentistry, University of Sheffield,
Sheffield, UK
- Department of Oral Medicine, Carolinas
Medical Center, Charlotte, NC, USA
| | - M.J. Dayer
- Department of Cardiology, Taunton and
Somerset NHS Trust, Taunton, Somerset, UK
| | - M.J. Durkin
- Division of Infectious Diseases,
Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - P.B. Lockhart
- Department of Oral Medicine, Carolinas
Medical Center, Charlotte, NC, USA
| | - L.M. Baddour
- Division of Infectious Diseases,
Department of Medicine and the Department of Cardiovascular Medicine, Mayo Clinic
College of Medicine, Rochester, MN, USA
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Teoh L, Marino RJ, Stewart K, McCullough MJ. A survey of prescribing practices by general dentists in Australia. BMC Oral Health 2019; 19:193. [PMID: 31438922 PMCID: PMC6704722 DOI: 10.1186/s12903-019-0882-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 08/09/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Numerous studies of dental antibiotic prescribing show that overprescribing is a worldwide occurrence. The aim of this study was to assess prescribing practices of general dentists in Australia for antibiotics, analgesics and anxiolytics and to determine the extent to which prescribing is in accordance with current guidelines. METHODS A structured questionnaire was sent to 1468 dentists in Victoria and Queensland in July-August 2018. The questionnaire covered demographics, clinical conditions where dentists prescribe antibiotics, non-clinical factors which influence prescribing, and medicines for anxiolysis and pain relief. Responses were scored using a system based on the current Australian therapeutic guidelines. Logistic regression was used to determine the relative importance of independent variables on inappropriate prescribing. RESULTS Three hundred eighty-two responses were received. Overall, 55% of overprescribing of antibiotics was detected, with a range of 13-88% on a routine or occasional basis depending on the scenario. Between 16 and 27% of respondents inappropriately preferenced analgesics over anti-inflammatories for dental pain; 46% of those who prescribed anxiolytic medicines did so inappropriately, with varying regimens and choices outside the guidelines. Years of practice was the main demographic factor influencing prescribing, with recent graduates (0-5 years) generally scoring better than their colleagues for antibiotic prescribing (p < 0.05). CONCLUSIONS Future interventions could be directed towards the appropriate role and use of antibiotics, shortfalls in knowledge and appropriate choices of medicines for pain relief and anxiolysis. Given that the most overprescribing occurred for localised swellings (88%), this area could be focused on in continuing education as well as ensuring it is addressed in undergraduate teaching. Continuing education on the appropriate use of medicines can be targeted at more experienced dentists as well as patients, especially those who expect antibiotics instead of treatment. TRIAL REGISTRATION University of Melbourne Human Ethics Sub-Committee; ID: 1750768.1 .
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Affiliation(s)
- L Teoh
- Melbourne Dental School, The University of Melbourne, 720 Swanston Street, Carlton, VIC, 3010, Australia.
| | - R J Marino
- Melbourne Dental School, The University of Melbourne, 720 Swanston Street, Carlton, VIC, 3010, Australia
| | - K Stewart
- Centre for Medicine Use and Safety, Monash University, Parkville, VIC, Australia
| | - M J McCullough
- Melbourne Dental School, The University of Melbourne, 720 Swanston Street, Carlton, VIC, 3010, Australia
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Teoh L, Stewart K, Marino RJ, McCullough MJ. Perceptions, attitudes and factors that influence prescribing by general dentists in Australia: A qualitative study. J Oral Pathol Med 2019; 48:647-654. [PMID: 31254315 DOI: 10.1111/jop.12909] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 06/07/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Longitudinal studies of dental prescribing in Australia show that dentists make some inappropriate prescribing choices; literature has shown that dentists tend to overprescribe antibiotics and prescribe for incorrect indications. The unnecessary use of antibiotics is a contributing factor towards the development of antibiotic resistance. The aims of the study were to obtain a greater understanding of the perceptions, attitudes and factors that influence dental prescribing for all major relevant drug classes. METHOD Semi-structured interviews of 15 purposively sampled dentists practising in Victoria, Australia were conducted from June-September 2018. Two dentists practised in rural areas and the remainder in urban locations. The range of clinical experience varied from 2.5 to 37 years, with a mean of 13 years. The transcripts were analysed thematically. RESULTS Dentists generally preferred amoxicillin as first-line therapy for odontogenic infections, with some confusion about the spectrum and uses of antibiotics. Overprescribing was evident, mostly due to basing judgement for use of antibiotics on symptoms rather than clinical signs. Other factors, such as time pressure, patient expectations, pressure from assistant staff, concern about online criticism and medico-legal considerations, influenced prescribing. Of the dentists who prescribed anxiolytics, most did not have a care protocol for their sedated patients. CONCLUSION A variety of prescribing practices were described, and future interventions should target misconceptions around the appropriate use and choice of antibiotics, resources to address the shortfall in knowledge of therapeutics, patient education and staff training, as well as appropriate care and monitoring of sedated patients.
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Affiliation(s)
- Leanne Teoh
- Melbourne Dental School, The University of Melbourne, Carlton, Victoria, Australia
| | - Kay Stewart
- Centre for Medicine Use and Safety, Monash University, Parkville, Victoria, Australia
| | - Rodrigo J Marino
- Melbourne Dental School, The University of Melbourne, Carlton, Victoria, Australia
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Teoh L, Moses G, McCullough MJ. A review and guide to drug‐associated oral adverse effects—Dental, salivary and neurosensory reactions. Part 1. J Oral Pathol Med 2019; 48:626-636. [DOI: 10.1111/jop.12911] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 06/07/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Leanne Teoh
- Melbourne Dental School The University of Melbourne Carlton Victoria Australia
| | - Geraldine Moses
- School of Pharmacy University of Queensland Woolloongabba Queensland Australia
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Haque M, Sartelli M, Haque SZ. Dental Infection and Resistance-Global Health Consequences. Dent J (Basel) 2019; 7:dj7010022. [PMID: 30823670 PMCID: PMC6473604 DOI: 10.3390/dj7010022] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/03/2019] [Accepted: 02/20/2019] [Indexed: 12/15/2022] Open
Abstract
Antibiotics are widely used in dental caries and another dental related issues, both for therapeutic and prophylactic reasons. Unfortunately, in recent years the use of antibiotics has been accompanied by the rapid emergence antimicrobial resistance. Dental caries and periodontal diseases are historically known as the top oral health burden in both developing and developed nations affecting around 20⁻50% of the population of this planet and the uppermost reason for tooth loss. Dental surgeons and family practitioners frequently prescribed antimicrobials for their patients as outpatient care. Several studies reported that antibiotics are often irrationally- and overprescribed in dental diseases which is the basis of antimicrobial resistance. The aim of this review is to evaluate the use of antibiotics in dental diseases. Almost certainly the promotion of primary oral health care (POHC) in primary health care program especially among the least and middle-income countries (LMIC) may be the answer to ensure and promote rational dental care.
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Affiliation(s)
- Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Sungai Besi, 57000 Kuala Lumpur, Malaysia.
| | - Massimo Sartelli
- Department of Surgery, Macerata Hospital, via Santa Lucia 2, 62100 Macerata, Italy.
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Mansour H, Feghali M, Saleh N, Zeitouny M. Knowledge, practice and attitudes regarding antibiotics use among Lebanese dentists. Pharm Pract (Granada) 2018; 16:1272. [PMID: 30416630 PMCID: PMC6207361 DOI: 10.18549/pharmpract.2018.03.1272] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/20/2018] [Indexed: 01/15/2023] Open
Abstract
Objectives: Explore antibiotic use, assess conformity with evidence-practice guidelines, and describe knowledge and attitudinal factors among Lebanese dentists. Methods: National cross-sectional telephonic survey, using a standardized questionnaire addressing demographic, educational and professional data, usual antibiotics prophylactic and curative prescription pattern and influential factors, knowledge concerning antibiotics use in selected patient-populations, and attitude regarding antimicrobial resistance. Analyses used descriptive statistics, and bivariate analysis to observe predictors of higher knowledge. Results: the overall response rate for the study was around 21%. 322 dentists participated. On average, 17.51% of consultations resulted in antibiotic use; previous antibiotic experience mostly influenced prescriptions (81.3%). Referral of pregnant and lactating women and cardiac patients, when antibiotics are needed, was high (26.9%, 28.5% and 79.4%, respectively). Macrolides were the dominant first-line antibiotics in penicillin allergy (47.4%). Penicillins were most common for pregnant and lactating women. Penicillins (95.0%), 2g (63.9%), and 1 hour pre-procedure (34%) were the main components of prophylaxis for cardiac patients. Prophylactic and curative use varied widely; few dentists exhibited guideline-conform prescriptions. Mean knowledge scores of prophylaxis for cardiac and non-cardiac patients, and antibiotics’ side effects were predominantly poor (46.75±14.82, 39.21±33.09 and 20.27±18.77, respectively over 100). Practicing outside Beirut, undergraduate qualification in Lebanon, and post-graduate qualification predicted higher knowledge. 75.9% acknowledged the contribution of dentistry-based prescribing to antibiotic resistance and 94.7% knew at least one cause of resistance. Conclusions: Dentists show positive attitude towards antimicrobial resistance. Yet, they lack uniformity in antibiotic stewardship. Poor knowledge and guideline-incongruent prophylactic and therapeutic prescribing are observed. Development of targeted interventions is needed to promote judicious antibiotic use within Lebanese dentistry.
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Affiliation(s)
- Hicham Mansour
- Department of Restorative and Esthetic, Faculty of Dentistry, Lebanese University. Beirut (Lebanon).
| | - Mireille Feghali
- Department of Restorative and Esthetic, Faculty of Dentistry, Lebanese University. Beirut (Lebanon).
| | - Nadine Saleh
- Division of epidemiology and biostatistics - Faculty of Public Health - Lebanese University, Beirut (Lebanon).
| | - Mona Zeitouny
- Department of Restorative and Esthetic, Faculty of Dentistry, Lebanese University. Beirut (Lebanon).
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40
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Current prescribing trends of antibiotics by dentists in Australia from 2013 to 2016. Part 1. Br Dent J 2018. [DOI: 10.1038/sj.bdj.2018.784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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41
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Teoh L, Stewart K, Marino R, McCullough M. Antibiotic resistance and relevance to general dental practice in Australia. Aust Dent J 2018; 63:414-421. [DOI: 10.1111/adj.12643] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2018] [Indexed: 12/20/2022]
Affiliation(s)
- L Teoh
- Melbourne Dental School; University of Melbourne; Carlton Victoria Australia
| | - K Stewart
- Centre for Medicine Use and Safety; Monash University; Parkville Victoria Australia
| | - R Marino
- Melbourne Dental School; University of Melbourne; Carlton Victoria Australia
| | - M McCullough
- Melbourne Dental School; University of Melbourne; Carlton Victoria Australia
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