The Pattern of Antibiotic Prescribing by Dental Practitioners in Zagreb, Croatia

Antibiotic Prescribing Trends in Dentistry during Ten Years' Period-Croatian National Study

Prescribing antibiotics is a regular part of daily dental practice. Antibiotics have a significant but a limited role in general dental practice due to the threat of emergence of antimicrobial resistance (AMR). As such, the aim of this study was to assess prescribing trends in dental antibiotics use from 2014-2023 in Croatia. Data on antibiotic prescribing practices for this study were provided by the Croatian Health Insurance Fund. The analysis included the number of prescriptions, packages, cost, and the World Health Organization's defined daily dose per 1000 inhabitants (DID) per day as an objective utilization for comparison. Over the 10-year period, dentists in Croatia prescribed an annual average of 357,875 antibiotic prescriptions, representing an annual average of 78.7% of all dental prescriptions. The most commonly prescribed antibiotic was the combination of amoxicillin and the beta-lactamase inhibitor clavulanic acid, which made up 58.54% of antibiotics and 46.1% of all dental prescriptions. This was followed by amoxicillin (12.61%), clindamycin (12.58%), and metronidazole (9.96%). The trend showed two discontinuations, the first for the pandemic years, and the second caused by disruption in amoxicillin production. The rise in the use of broad-spectrum antibiotics needs to be addressed and regulated to ensure patients and dentists understand that antibiotics are not a substitute for dental treatment. Dentists should always begin treatment with narrow-spectrum antibiotics regardless of possible exceptional circumstances.

Patterns of Antibiotic Prescription in Endodontic Therapy in the Republic of Croatia

In response to the global trend of decreasing antibiotic usage, this study aimed to evaluate the nature and frequency of antibiotic prescriptions in conjunction with endodontic therapy in Croatia and to assess the attitudes of Croatian dental practitioners towards the endodontic treatment of patients susceptible to bacterial endocarditis. A survey questionnaire was sent to all dental practitioners in Croatia, achieving a response rate of 27%. The most frequently prescribed antibiotic was penicillin with clavulanic acid (63.4%), while standalone penicillin was less prevalent (18.6%). For patients exhibiting penicillin allergies, 90% of respondents indicated clindamycin as their preferred alternative. Antibiotics were mostly prescribed for localized acute apical abscesses without fever, followed by prophylaxis for infectious endocarditis and cellulitis. Only 1.3% of the respondents reported frequent antibiotic prescriptions without accompanying local treatment. While a substantial proportion of surveyed practitioners professed familiarity with the latest guidelines for antibiotic prophylaxis, their choice of antibiotics did not consistently reflect this claim. Most respondents conducted endodontic procedures on patients at risk of bacterial endocarditis. The findings highlight a need for targeted continuing education for dental practitioners in the Republic of Croatia, ensuring their practices align with current guidelines and global trends in antibiotic prescription.

Antibiotics Prescribing Pattern and Quality of Prescribing in Croatian Dental Practices-5-Year National Study

PURPOSE

Antibiotic resistance is one of the biggest threats to global health today. The aim of this study was to analyze antibiotic prescribing patterns and quality of prescribing in Croatian dental practices over a 5-year period.

METHODS

This is a retrospective observational study based on the analysis of the electronic prescriptions (medicines in ATC groups J01 and P01) from dental practices in Croatia prescribed from 1 January 2015 to 31 December 2019. Prescriptions were retrieved from the Croatian Health Insurance Fund (HZZO). The analyses included the number of prescriptions, type and quantity of prescribed drugs, indication, and the patient's and prescriber's characteristics.

RESULTS

The consumption increased from 1.98 DID in 2015, to 2.10 DID in 2019. The most prescribed antibiotic was Amoxicillin with clavulanic acid followed by Amoxicillin, Clindamycin, Metronidazole and Cefalexin. The analyses showed that 29.79% of antibiotics were not prescribed in accordance with the contemporary guidelines for the proper use of antibiotics. Additionally, 22% of antibiotics were prescribed in inconclusive indications.

CONCLUSION

The research showed an increase in antibiotic consumption over five years along with unnecessary prescribing of antibiotics in cases with no indications for its use. The development of national guidelines for antibiotic use is necessary.

Antibiotic Over-Prescription by Dentists in the Treatment of Apical Periodontitis: A Systematic Review and Meta-Analysis

After pulp infection and necrosis, the passage of microbial antigens into the periapical space causes apical periodontitis (AP). Most of the clinical forms of AP can be managed without prescribing antibiotics, only with root canal treatment and abscess drainage or, where appropriate, tooth extraction. However, the scientific literature provides evidence of inappropriate antibiotic prescriptions by dentists in the management of apical disease.

OBJECTIVES

The aim of this systematic review and meta-analysis was to analyze the global pattern of antibiotic prescription in the treatment of apical disease.

METHODS

PRISMA Guidelines were followed to carry out this systematic review. The research question was as follows: What is the pattern of antibiotic prescription by dentists in the treatment of the different clinical forms of apical periodontitis? A systematic search was conducted on MEDLINE/PubMed, Wiley Online Database, Web of Science and Scopus. All studies reporting data about the pattern of antibiotic prescription by dentists in the treatment of apical disease were included. The meta-analyses were calculated using the Open Meta Analyst version 10.10 software. Random-effects meta-analyses were performed. The risk of bias was assessed using the Newcastle-Ottawa Scale. The certainty of evidence was assessed using GRADE.

RESULTS

The search strategy identified 96 articles and thirty-nine cross-sectional studies fulfilled the inclusion criteria. The overall percentage of antibiotic prescriptions by dentists in cases of symptomatic AP was 25.8%, and 31.5% in cases of asymptomatic AP with sinus tract present. The percentage of dentists prescribing antibiotics in cases of acute apical abscess with no/mild symptoms was 47.7%, whereas, in cases of acute apical abscess with moderate/severe symptoms, 88.8% of dentists would prescribe antibiotics. Endodontists prescribe antibiotics at a lower rate than general practitioners. The total risk of bias was considered moderate, and the final rating for the certainty of the evidence was low.

CONCLUSIONS

Dentists worldwide are over-prescribing antibiotics in the management of apical disease. It is necessary to improve antibiotic prescribing habits in the treatment of endodontic infections, as well as educational initiatives to encourage the rational and appropriate prescription of antibiotics in periapical diseases.

Antibiotic prescribing practices for prophylaxis and therapy of oral/dental infections in pediatric patients - results of a cross-sectional study in Turkey

Aim

Antibiotics are often prescribed for the treatment of various infections and prophylactic purposes in dental practice. Their improper use can cause microbial resistance to antibiotics, which poses a world-wide threat. The aim of this cross-sectional study was to evaluate the knowledge and attitudes of dentists and dentistry students about antibiotic prescription practices for prophylaxis and the treatment of dental infections in pediatric patients.

Methods

A questionnaire was e-mailed to 2,100 dentists and 300 senior dentistry students. The questionnaire was filled out by the participants within a 2-month period (May-June 2020). A 30-point scoring system was developed to assess the knowledge levels of the dentists according to the guidelines. Descriptive statistical analyses were performed. One-way ANOVA test and the Chi-Squared test were used to compare qualitative variables.

Results

The response rate was found to be 24.2% for dentists and 49% for senior dentistry students. 19.4% of the participants were found to be moderately knowledgeable and 80.6% of them were highly knowledgeable. Students' knowledge scores were found to be higher than the general dentists and other specialists (p<0.05). There was no significant difference between students and pedodontists.

Conclusion

Dentists were found to have sufficient knowledge about the usage of antibiotics in children, but there is still a lack of information about circumstances under which antibiotics should not be prescribed. Dentists and dentistry students should attend continuing education programs to keep their information up-to-date and should also prescribe antibiotics in adherence with the current guidelines to prevent antibiotic resistance.

Evaluation of antibiotic prescribing for ambulatory patients seeking primary dental care services in a public hospital in Ghana: a clinical audit study

Background

One in 10 of all antibiotic prescriptions globally are for dental conditions with 80% of them being inappropriate, making it a potential driver of antimicrobial resistance.

Objectives

To evaluate the appropriateness of antibiotic use among ambulatory patients seeking dental care services in a public hospital in Ghana.

Methods

A retrospective clinical audit was conducted by extracting the medical records of all patients seeking dental care at the ambulatory care clinic of Keta Municipal Hospital (KMH) from January 2020 to December 2020 using the hospital’s electronic database. Descriptive statistics, bivariate and multivariate analysis were performed on the data collected.

Results

Overall, 1433 patient medical records were extracted from the database within the study period. The mean age of the patients identified was 39.9 years with almost two-thirds being female. The majority (91.1%, n = 1306) of them were attended to by a dental nurse. In total, 88.6% (n = 1269) of the patients received antibiotics and 87.5% (n = 1254) of antibiotics prescribed were non-compliant with Ghana Standard Treatment Guidelines. Three-quarters of the dental conditions were managed with dual antibiotics comprising amoxicillin and metronidazole. Antibiotic prescription was associated with age, gender, type of prescriber and type of dental condition diagnosed.

Conclusions

There is a high usage of antibiotics for dental conditions managed at the outpatient section of the hospital and most are inappropriate. Development of local guidelines supported by education of dental clinicians on empirical use of antibiotics is a suitable target for the antimicrobial stewardship team to address in KMH.

Antibiotic utilization in emergency dental care in Stockholm 2016: a cross sectional study

OBJECTIVES

To investigate systemic antibiotics utilization in emergency dental care and to determine the most common treatment measures performed during emergency visits in public versus private emergency care in Sweden.

MATERIAL AND METHODS

Two questionnaires were answered by dentists at one large public and one large private emergency dental clinic in Stockholm, Sweden. The first questionnaire pertained to the emergency care provided to patients (n = 1023) and the second concerned the dentists' (n = 13) own knowledge and attitudes towards antibiotic treatment and oral infections. The results of the questionnaires were tested using a Chi-square test.

RESULTS

Sixteen percent of all patients seeking emergency dental treatment received antibiotics. The most common overall reason for visiting an emergency clinic was pain (52%, n = 519). The most common diagnoses made by the participating dentists in the public clinic were tooth/filling fracture (17%, n = 91) and gingivitis (14%, n = 76), while in the private clinic they were tooth fracture (29%, n = 146) and symptomatic apical periodontitis (15%, n = 72). Although the number of patients with infection was higher in the public care clinic, there was no significant difference in total number of antibiotic prescriptions between the two clinics. The rate of patients receiving antibiotic prescription as sole treatment was 41% (n = 34) in private care and 31% (n = 18) in public care. Thirty-one percent (n = 4) of dentists prescribed antibiotics for patients with diagnoses normally not requiring antibiotics, citing reasons such as time limitation, patient request, patient travel, patient safety, and follow-up not possible.

CONCLUSION

Although antibiotic prescription frequency among the Swedish emergency care dentists participating in this study was low, areas for improvement could include providing education to improve dentists' knowledge on both antibiotic prescription in emergency dental care and treatment of acute oral infections.

Public healthcare practitioners' knowledge, attitudes and practices related to oral antibiotic prescriptions for dental use in Pietermaritzburg, KwaZulu-Natal

Background

There is limited published evidence on health workers' perspectives on trends in oral antibiotic prescription for dental conditions in the public health sector.

Aim

This study set to determine healthcare practitioners' knowledge, attitudes and practices related to oral antibiotic prescriptions for dental use.

Setting

This included two public hospitals in Pietermaritzburg.

Methods

This was a cross-sectional study using quantitative data. Purposive sampling was used to select medical and dental practitioners from Institution A and B (n = 122). A self-administered questionnaire was developed using open and close-ended questions. Data were collected and analysed using the Statistical Package for Social Sciences (IBM SPSS version 25R).

Results

The response rate for the study was 72.1%. The majority of study participants (n = 72, 81.8%) indicated awareness of an antibiotic stewardship programme in their respective institutions. However, a significant number (n = 42; 47.7%) of participants were unsure of whether this programme was active. Most participants (n = 80, 90.9%) indicated the need for improving oral antibiotic prescription for dental conditions. Participants indicated prescription of antibiotics for orofacial swellings (n = 52; 59.0%) and dental pain related to irreversible pulpitis (n = 29; 32.9%), reversible pulpitis (n = 33; 37.5%) and dental fillings (n = 15; 17.0%). Antibiotics were also prescribed for pericoronitis (n = 58; 65.9%), periodontitis (n = 57; 64.7%) and impacted teeth (n = 21; 23.8%). All dental practitioners (n = 14) supported the need for antibiotic cover for pericoronitis and periodontitis.

Conclusion

The results indicated inconsistencies in healthcare practitioners' reported knowledge, attitudes and practices related to antibiotic prescription patterns.

Contribution

This study highlights the need for clear evidence-based guidelines for antibiotic prescription for dental conditions.

Administration of Systemic Antibiotics for Dental Treatment in Kosovo Major Dental Clinics: A National Survey

OBJECTIVE

 Antibiotics misuse and a high level of antibiotics resistance is observed worldwide, but particularly in developing countries. Kosovo in the last decade is facing challenges regarding antimicrobial resistance. The purpose of the present study was to investigate patterns of antibiotics prescriptions of dentists in Kosovo's major dental clinics.

MATERIALS AND METHODS

 For Kosovo's prescribing pattern, data collection was obtained from 10 Regional Dental Clinics and a Tertiary Health Center regarding patients who were prescribed antibiotics in the years 2015 to 2019. Data analysis was performed by using descriptive statistics and was processed by using MS Excel.

RESULTS

 Most prescribed antibiotic during the observed period from 2015 to 2019 in Kosovo was amoxicillin, although a drastic increase of amoxicillin with clavulanic acid-as a broad-spectrum antibiotic-is observed. The trend of antibiotics use in tertiary health institutions is in an overall decrease in Kosovo with an exception in the year 2017. Despite this overall decrease, inconsistency in prescribing is observed when the pattern is analyzed for each region separately. The highest number of patients in health care dental clinics received antibiotics for maxilla-related health conditions and the lowest number of them for oncologic ones.

CONCLUSION

 The patterns of antibiotics prescriptions by dental practitioners in Kosovo during the years 2015 to 2019 are fluctuating. Compared with the global health care standards, the irrational use of antibiotics in dental health care clinics in Kosovo still exist and this issue should be further addressed by respective actors.

Knowledge and attitudes of Croatian Dentists Regarding Antibiotic Prescription in Endodontics: A Cross-sectional Questionnaire-based Study

OBJECTIVES

To assess dentists' level of knowledge and practice concerning antibiotic usage in endodontics using the European Society of Endodontology position statement as a reference.

MATERIALS AND METHODS

A cross-sectional study was conducted in the form of an electronic questionnaire consisting of 23 questions, including dentists' demographic and professional characteristics, attitudes as well as experiences regarding antibiotics in endodontics. Data were evaluated by the Mann-Whitney test or the Kruskal Wallis 1-way ANOVA, α = 5%.

RESULTS

The overall mean self-reported knowledge of antibiotics usage in endodontics was 11.7±2.5 points, out of a maximum possible score of 23. The factors associated with a higher knowledge were: age (P≤0.001), clinical experience (P≤0.001), specialist training (P=0.008), and adherence to the guidance on the use of systemic antibiotics in endodontics (P=0.006). Dentists who specialized in endodontics (16.1±2.2) achieved higher levels of knowledge.

CONCLUSION

Knowledge on antibiotic usage in endodontics among dentists in Croatia is insufficient. There is a need for continuing education on the use of antibiotics among general dentists.

Dentists' practice and compliance with current guidelines of infective endocarditis prophylaxis- National survey study

Background

The objective of this study was to assess the attitude, practice, and knowledge of Croatian dentists regarding infective endocarditis (IE) prophylaxis.

Material and Methods

A cross-sectional, self-reporting questionnaire survey was conducted with the participation of 348 Croatian dentists. The questionnaire was designed to collect information on participants’ work experience, place of work, their attitudes related to the treatment of IE-risk patients, knowledge and adherence to IE antibiotic prophylaxis guidelines.

Results

Knowledge and adherence to the current guidelines decreased with the higher years of experience. Compliance with the current guidelines varied, mostly because of respondents’ insecurity regarding which guidelines to follow. AHA guidelines have been most frequently the first choice (25% participants). Surprisingly, 23% of dentists didn’t follow any of the official guidelines. The majority of participants (68%) have declared a lack of preparedness or willingness to treat the patients at risk of IE. Dentists with specialty or working at university/hospital have shown a higher level of knowledge and preparedness to treat IE-risk patients.

Conclusions

The lack of knowledge of guidelines and consequent inconsistencies in IE antibiotic prophylaxis in Croatian dental practice indicates the need for urgent improvement.

Key words:Antibiotic prophylaxis, dentistry, infective endocarditis.

Antibiotics Prescription by Spanish General Practitioners in Primary Dental Care

The aim of this study was to analyze the antibiotics prescription habits, both prophylactically and therapeutically, of Spanish general dental practitioners in the management of endodontic infections in primary care. Two hundred Spanish general dental practitioners were asked to respond to a survey on indications for antibiotics prescription in the treatment of endodontic infections, being 190 general dentists (95%) included in the study. Data were analyzed using descriptive statistics and the chi-square test. The average duration of antibiotics therapy was 6.5 ± 1.0 days. In patients without medical allergies, most of them (97%) selected amoxicillin as the antibiotic of the first choice, alone (51.1%) or associated with clavulanic acid (45.8%); in patients with penicillin allergies, the drug of choice was clindamycin 300 mg (70%). For cases of symptomatic irreversible pulpitis, 44% of the respondents prescribed antibiotics, in the scenario of prophylactic antibiotic prescription, up to 27% of the general dentists prescribe according to non-current guidelines (1 g 1 h before or 1 g 1 h before and 1 g 1 h after) in non-indicated cases (16% in patients taking oral bisphosphonates). It is necessary to improve the antibiotic prescription habits of Spanish general dentists in endodontics.

Antibiotic Prescribing Habits and Antimicrobial Resistance Awareness of Dental Practitioners in Primorsko-Goranska County, Croatia

Purpose: The goal of this study was to investigate the differences in dentists' knowledge, attitudes, and practice regarding antibiotic use and resistance among two areas of Primorsko-Goranska County (P-GC), Croatia. Materials and Methods: A cross-sectional study based on a structured questionnaire that was given to 230 dental practitioners in outpatient settings of P-GC in 2018. Results: The overall response rate was 68.3% (157/230) and 72.2% (83/115) in the city of Rijeka and 64.3% (74/115) in the rest of P-GC. Dentists from two areas of P-GC held similar knowledge about prescribing antibiotics and attitudes regarding antibiotic use (p > 0.05). Most of the dental practitioners chose penicillins (65.0% amoxicillin with clavulanic acid and 33.1% amoxicillin) as the first-choice antibiotic in patients with no medical allergies. The trend of prescribing amoxicillin decreases with the age of the dentists (p = 0.046). Clindamycin (86.6%) was the first choice for patients allergic to penicillin. Postgraduate education changed the attitude toward taking more time to consider whether or not an antibiotic is needed. Croatian dentists had a high awareness of antimicrobial resistance (99.4%). The most common situations for which dentists would prescribe antibiotics were periapical abscess (84.7%), periodontal abscess (72.6%), and implant placement (59.9%). Patient request or expectation (43.4%) and treatment uncertainty (41.5%) were found to be the main factors for prescribing antibiotics with more frequency. Conclusions: Although there is a high level of antimicrobial resistance awareness among dental practitioners, there is still too much overuse of antibiotics and personal responsibility for prudent antibiotic use should be increased. The results of this study indicate that antibiotics are frequently prescribed for indications where surgical treatment should be the first option and the broad spectrum antibiotic is the preferred treatment option.

Medication Prescribing Practices in Croatian Dental Offices and Their Contribution to National Consumption

Objectives

The objective of this study was to analyse the pattern of medication prescribing among dental practitioners in the Republic of Croatia and to compare it with general medical practice patterns at the national level.

Methods

Data on drug prescriptions were obtained from the Croatian Health Insurance Fund. The number of dentist prescriptions, the cost of medicine denominated in the national currency (Croatian Kuna [HRK]), and the number of packages and days prescribed have been included in the analysis.

Results

Results indicate that there was an increase in medication prescribing(+5.7%) by dentists, with antimicrobials comprising the majority, whereas national medical antimicrobial prescribing had slightly decreased. Antibiotics accounted for 80% of all dentists’ prescriptions, with penicillins being the most commonly prescribed. In particular, amoxicillin with clavulanic acid accounted for 56.4% of all antibiotics prescribed. Such broad-spectrum antibiotics were prescribed more frequently than those of narrow-spectrum. Antibiotics were followed by nonsteroidal anti-inflammatory drugs, with prescribing frequency for ibuprofen increasing by 75%.

Conclusion

Current trends show an increase in the overall prescription rate for all medications prescribed by dentists. The largest increase was observed for the broad-spectrum amoxicillin with clavulanic acid, and ibuprofen. As the apparent widespread use of broad-spectrum antibiotics by dentists in Croatia is in contrast to national and international recommendations for antibiotic stewardship, there is a need for further prospective investigation and possible provider education and guidelines.

Antibiotic Prescribing Practices in Endodontic Infections: A Survey of Dentists in Serbia

The study goal was to provide an overview of antibiotic prescribing practices of Serbian dentists when treating endodontic infections and to disseminate the current ESE (European Society of Endodontology) recommendations to the study participants. A link to an online questionnaire was sent to 628 Serbian dentists whose email addresses were publicly available on the Internet, 158 of whom responded to the survey, resulting in a 25.16% response rate. The significance of possible associations was assessed via the Chi-squared test and Cramer’s V measure of association, with p < 0.05 considered as statistically significant. According to the study findings, 55.7% of respondents prescribed a 5-day antibiotic course. Moreover, Amoxicillin 500 mg was the first-choice antibiotic for 55.1% of the respondents, followed by Clindamycin 600 mg (18.4%). For patients allergic to penicillin, 61.4% of respondents prescribed Clindamycin. Statistically significant differences emerged only in relation to acute apical abscess with systemic involvement, whereby dentists aged 46–55 were least likely to prescribe antibiotics in these clinical situations (p = 0.04). Analyses further revealed that recommendations for safe antibiotic prescribing practices were not always followed, as in certain cases, patients were given antibiotics even when this was not indicated. These findings highlight the need for additional education on responsible antibiotic use to prevent bacterial resistance.

Drug Prescribing Practices in Dental Care Patients at a Dental and Maxillofacial Surgery Clinic in Oman

Objectives

We sought to assess medications prescribed to patients attending the Dental and Maxillofacial Surgery (DMS) clinic at Sultan Qaboos University Hospital (SQUH), Oman.

Methods

This was a retrospective cross-sectional study covering a six-month period from January to June 2018 including a sample of patients attending the DMS clinic. Drug utilization data like drug name, type, administration route, dosage frequency, and anatomical and therapeutic class were assessed.

Results

The study included 400 patients, of which 190 (47.5%) were males and 210 (52.5%) were females. A total of 88 different drugs were prescribed. Only 140 (35.0%) patients were prescribed drugs for their dental conditions or other comorbidities per visit, and the rest 260 (65.0%) were not prescribed any drugs. The dentists prescribed drugs only in 116 (29.0%) patients. The most common diagnosis was dental caries (n = 177, 44.3%) followed by chronic gingivitis (n = 15, 3.8%). The most common comorbidities in patients were anemia (n = 45, 11.3%) and diabetes (n = 21, 5.3%). The most common drugs prescribed were chlorhexidine mouthwash (n = 43, 37.1%) and paracetamol (n = 36, 31.0%) followed by ibuprofen (n = 10, 8.6%) and amoxicillin/clavulanate (n = 5, 4.3%).

Conclusions

Drugs prescribing pattern was within the international norms. Sixty-five percent of the patients were not prescribed any drug by the dentist. Oral antiseptics, analgesics, and antibiotics were the most common drugs prescribed by dentists.

Trends in Systemic Antibiotic Therapy of Endodontic Infections: a Survey among Dental Practitioners in Lithuania

Objectives

Prescription trends to certain antibiotic classes in Lithuania have been observed. Considering the potential contribution to antimicrobial resistance and the evidence of inappropriate prescriptions highlights, the periodical assessment of antibiotic consumption trends is required. The aim of this study was to assess prescription behaviours of Lithuanian general dental practitioners concerning the systemic antibiotic therapy of endodontic infections.

Material and Methods

A sample of 198 Lithuanian dentists, registered on the database of the Lithuanian Dental Chamber, provided anonymous information about their clinical work by means of an online questionnaire.

Results

Among the participants, antibiotics were prescribed in less than 20% of endodontic cases. Most common diagnosis for the prescription was symptomatic apical periodontitis with periostitis (90%) and apical abscesses with systemic involvement (54%). Amoxicillin and co-amoxiclav were the preferred choices for the antimicrobial therapy. The preference of clavulanic acid combination over simple usage of amoxicillin is increasing relative to the participants age (P = 0.016) and working experience (P = 0.008). Clindamycin is prescribed in cases of allergy to beta-lactams. Practitioners with less years of clinical activity were more likely to prescribe antibiotics for spreading infections, than their associates with more than 10 years of practice (P < 0.001).

Conclusions

Clinicians of higher age were found to be more likely to prescribe broad-spectrum antibiotic combinations compared to their younger associates. The majority of practitioners were aware of the clinical recommendations.

Antibiotics in Dentistry: A Narrative Review of Literature and Guidelines Considering Antibiotic Resistance

Background:

Antibiotic resistance is an important issue for public health.

Objective:

The aim of this work is to investigate the clinical situations which require the administration of antibiotics in dentistry.

Methods:

The authors want to do a review of the literature and a comparison of guidelines in dentistry among different countries. The research method was based on the use of Pubmed and the research of indexed articles and documents published by authorities and boards about the antibiotic prescription in dentistry. The paper is an analysis deep inside the physiological and pathological situations that, according to different guidelines, require the use of antimicrobics. The spirit is a clinical one because this paper wants to be a guide for dentists, especially before the administration, in order to moderate the use of antimicrobials. We must remember that the World Health Organisation organizes each year the World Antibiotic Awareness Week, in order to fight against the improper administration of antibiotics in medicine, dentistry, veterinary medicine, and industrial livestock.

Results:

Different guidelines converge on a very calibrate and proper administration of antibiotics. Antibiotics should be used only in recommended situations for risk patients. The authorities and boards should investigate the habits of antibiotic administration, which according to some papers seem to be large and diffused use, not only limited to situations described in guidelines.

Conclusion:

Dentists, together with the General Practitioners and Paediatricians, should be cautious and accurate and should administrate antibiotics only if recommended by guidelines and effective and safe.

The use and misuse of antibiotics in dentistry: A scoping review

BACKGROUND

To describe antibiotic prescribing behaviors in dentistry, including clinical and nonclinical indications for their use, the type and regimen of antibiotics prescribed, and factors influencing their prescription, the authors conducted a scoping review.

TYPES OF STUDIES REVIEWED

The authors conducted a scoping review of published literature by searching multiple databases. Key search terms included dentist, antibiotic, antimicrobial, antibacterial, prophylaxis, prescription, pattern, habit, knowledge, and practice. Two authors independently reviewed titles and abstracts by using detailed eligibility criteria. The authors placed no restrictions on study design or publication year. The authors qualitatively assessed studies by using a modified version of the Center for Evidence-Based Management's critical appraisal of a survey checklist.

RESULTS

The authors identified 1,912 studies but considered only 118 studies eligible for review. Most included studies were either cross-sectional surveys (81 studies) or prescription audits (25 studies) from various geographic locations. Publication dates ranged from 1982 through 2017. The authors examined prophylactic and therapeutic antibiotic use in 48 and 29 studies, respectively. Another 29 studies examined the use of both prophylactic and therapeutic antibiotics in dentistry. Overall, dentists prescribed a wide variety of antibiotic regimens for various clinical and nonclinical indications. Dentists have acquired their prescribing knowledge from a variety of sources and have changed their antibiotic prescribing practices throughout their careers for various reasons.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Considering the seriousness of antibiotic resistance, the authors highlight trends in antibiotic prescribing practices, characterize factors contributing to the use and misuse of antibiotics in dentistry, provide insight into the importance of antibiotic stewardship in the oral health setting, and encourage dentists to reflect on their antibiotic prescription practices.

Does the use of amoxicillin/amoxicillin-clavulanic acid in third molar surgery reduce the risk of postoperative infection? A systematic review with meta-analysis

The objectives of this systematic review were to investigate the efficacy of amoxicillin/amoxicillin-clavulanic acid for reducing the risk of postoperative infection after third molar surgery and to evaluate the adverse outcomes in these patients, as well as in healthy volunteers. A systematic search of four databases was performed on May 26, 2017. Eleven studies qualified for the qualitative analysis and eight were found suitable for meta-analysis. The results suggest that both amoxicillin-clavulanic acid and amoxicillin significantly reduce the risk of infection after third molar extraction (overall relative risk (RR) 0.25, P<0.001). However, with the exclusion of randomized controlled trials with a split-mouth design (due to an inadequate crossover period after antibiotic treatment), only amoxicillin-clavulanic acid was found to be effective (RR 0.21, P<0.001). The risk of adverse effects was significantly higher in the amoxicillin-clavulanic acid group (RR=4.12, P=0.023) than in the amoxicillin group (RR 1.57, P=0.405). In conclusion, amoxicillin-clavulanic acid and amoxicillin may significantly reduce the risk of infection after third molar extraction. However, their use in third molar surgery should be viewed with caution, as recent clinical trials on healthy volunteers have shown evidence of the negative impact of amoxicillin use on bacterial diversity and antibiotic resistance.

Use of antibiotics by spanish dentists receiving postgraduate training in endodontics

BACKGROUND

The incidence of endodontic infections is high. The contribution of Endodontics to the global problem of antibiotic resistance could be significant. The ESE, together with the World Health Organization, are promoting the World Antibiotic Awareness Week (13-19 November 2017) to promote the appropriate use of systemic antibiotics in Endodontics. The objective of this study was to determine the prescription pattern of antibiotics in the treatment of endodontic infections of Spanish dentists attending specialization programs in Endodontics.

MATERIAL AND METHODS

Dentists from five Spanish endodontic postgraduate programs were requested to answer a one-page questionnaire surveying about antibiotics indications. Seventy-three dentists were required to participate in this investigation, and 67 (91.2%) fulfilled satisfactorily the survey and were included in the study. Data were analyzed using descriptive statistics and chi square test.

RESULTS

The average duration of antibiotic therapy was 6.8±1.2 days. All respondents chose amoxicillin as first choice antibiotic in patients with no medical allergies, alone (40%) or associated to clavulanic acid (60%). The first drug of choice for penicillin allergic patients was clindamycin (72%). For cases of irreversible pulpitis, 22% of respondents prescribed antibiotics. For the scenario of a necrotic pulp, symptomatic apical periodontitis and no swelling, 37% prescribed antibiotics. A quarter of dentists prescribed antibiotics for necrotic pulps with asymptomatic apical periodontitis and a sinus tract.

CONCLUSIONS

The results of this study show that postgraduate training in Endodontics provides greater awareness of the correct indications of antibiotics. Dentists who have received specialized training in Endodontics have a prescription pattern of antibiotics more adjusted to the guidelines recommended by international organizations and by scientific societies. Key words:Antibiotics, apical periodontitis, dental curriculum, endodontic infections, postgraduate endodontic training.

The effect of interventions aiming to optimise the prescription of antibiotics in dental care-A systematic review

BACKGROUND

Abundant evidence in dentistry suggests that antibiotics are prescribed despite the existence of guidelines aiming to reduce the development of antibiotic resistance. This review investigated (1) which type of interventions aiming to optimise prescription of antibiotics exist in dentistry, (2) the effect of these interventions and (3) the specific strengths and limitations of the studies reporting on these interventions.

METHOD

Literature search was based on Medline, Embase, Global Health, Cochrane CENTRAL, ClinicalTrials.gov and Current Controlled Trials. Studies with one of the two primary outcomes were included: (1) The number of antibiotics prescribed and/or (2) the accuracy of the prescription, commonly measured as a percentage of adherence to local clinical guidelines.

RESULTS

Nine studies met these inclusion criteria. Five studies reported on the prescription of antibiotics in primary dental care and four studies focused on outpatient dental care. Interventions used in primary dental care included a combination of audit, feedback, education, local consensus, dissemination of guidelines and/or academic detailing. Trials in the outpatient setting made use of expert panel discussions, educational feedback on previous acts of prescribing, the dissemination of guidelines and the establishment of internal guidelines. All studies successfully reduced the number of antibiotics prescribed and/or increased the accuracy of the prescription. However, most studies were confounded by a high risk of selection bias, selective outcome reporting and high variance across study groups. In particular, information relating to study design and methodology was insufficient. Only three studies related the prescriptions to the number of patients treated with antibiotics.

CONCLUSIONS

This systematic review was able to offer conclusions which took the limitations of the investigated studies into account. Unfortunately, few studies could be included and many of these studies were confounded by a low quality of scientific reporting and lack of information regarding study methodology. High-quality research with objective and standardised outcome reporting, longer periods of follow-up, rigorous methodology and adequate standard of study reporting is urgently needed.

Explicit definitions of potentially inappropriate prescriptions of antibiotics in older patients: a compilation derived from a systematic review

Potentially inappropriate prescriptions (PIPs) of antibiotics (antibiotic-PIPs) are generally detected by applying implicit definitions based on expert opinion. Explicit definitions are less frequently used, even though this approach would enable the automated detection of antibiotic-PIPs in electronic health records. Here, explicit definitions of antibiotic-PIPs used in studies of older adults were systematically reviewed. The MEDLINE^®, Scopus^® and Web of Science^TM core collection databases were searched with a combination of three terms and their synonyms: 'potentially inappropriate prescription' AND 'antibiotic treatment' AND 'older patients'. Following standardised selection of publications, explicit definitions of antibiotic-PIPs were extracted and were classified into infectious diseases domains and subdomains. A total of 600 search queries identified 4270 records, 93 of which were selected for review. A total of 160 mentions of antibiotic-PIPs were found, corresponding to 62 distinct definitions in 19 infectious diseases domains. Nearly one-half of the definitions were related to upper respiratory tract infections (n = 11 definitions; 17.7%), lower respiratory tract infections (n = 8; 12.9%) and drug-drug interactions (n = 11; 17.7%). Almost 75% of definitions (n = 46) were mentioned in a single study only. Only three definitions concerned critically important antibiotics such as third-generation cephalosporins and fluoroquinolones. This systematic review identified 62 explicit definitions of antibiotic-PIPs. Most of the definitions were not found in more than one study and they varied in the degree of precision. We advocate the implementation of an expert consensus on explicit definitions of antibiotic-PIPs that correspond to today's challenges in public health.

Rational use of medicine in dentistry: do dentists prescribe antibiotics in appropriate indications?

PURPOSE

There are concerns regarding appropriate use of antibiotics in dentistry practice. Data on dental antibiotic prescribing patterns by dentists is relatively limited. This nationwide study aimed to examine dentists' antibiotic prescriptions in a diagnosis-based manner in Turkey.

METHODS

This retrospective study on utilization of systemic antibiotics for dental problems was based on the national health data of the dentists obtained from Prescription Information System between January 2013 and August 2015. Only those prescriptions containing single diagnosis and at least one systemic antibiotic were included in the study. Antibiotic prescribing was compared by diagnoses and expertise of dentists.

RESULTS

A total of 9,293,410 antibiotics were detected in 9,214,956 prescriptions that contained "single diagnosis and at least one antibiotic." The number of antibiotics per prescription was 1.01. "Periapical abscess without sinus" (28.1%), "dental examination" (20.7%), and "dental caries" (16.2%) were the three most common indications in which antibiotics were prescribed by dentists. While only 3.4% of antibiotics were prescribed upon the single and appropriate "cellulitis and abscess of mouth" diagnosis, the remaining 96.6% was prescribed for irrational/uncertain indications. Consistent in all diagnoses, "amoxicillin + enzyme inhibitor" (58.6%) was the mainly prescribed antibiotic. Analysis of the most preferred "amoxicillin + enzyme inhibitor" prescriptions by expertise of dentists showed significantly much higher prescription rates among Group A specialists and Group B specialists (67.0 and 67.8%, respectively) than those in unidentified dental practitioners (58.2%, p < 0.0001).

CONCLUSIONS

This study showed that dentists prescribed antibiotics in an arbitrary and mostly unnecessary manner. In general, their antibiotic choices for examined diagnoses could be regarded as irrational. These results indicate the urgent need for improvement of rational antibiotic prescribing habits of dentists.

Worldwide pattern of antibiotic prescription in endodontic infections

BACKGROUND

Odontogenic infections, and especially endodontic infections, are polymicrobial, involving a combination of Gram-positive and Gram-negative facultative anaerobes and strictly anaerobic bacteria. Therefore, antibiotics can be used as an adjunct to endodontic treatment. However, most chronic and even acute endodontic infections can be successfully managed by disinfection of the root-canal system, which eliminates the source of infection, followed by abscess drainage or tooth extraction, without the need for antibiotics. The literature provides evidence of inadequate prescribing practices by dentists. The aim of this concise review was to analyse the worldwide pattern of antibiotic prescription in endodontic infections.

METHODS

Comprehensive searches were conducted in MEDLINE/PubMed, Wiley Online Database, Web of Science and Scopus. The databases were searched up to 13 March 2016 for studies in which dentists used systemic antibiotics to treat endodontic lesions and which reported data on the type of antibiotic prescribed and on the diagnosis of the endodontic disease treated.

RESULTS

The electronic and hand searches identified 69 titles, of which 25 were included in the final analysis. Amoxicillin was reported as the drug of choice for endodontic infections in most countries, and clindamycin and erythromycin were the choice for patients allergic to penicillin. Dentists worldwide prescribe antibiotics for non-indicated conditions, such as pulpitis.

CONCLUSION

Antibiotics are overprescribed for the management of endodontic infections. It is necessary to improve antibiotic-prescribing habits in the treatment of endodontic infections, as well as to introduce educational initiatives to encourage the coherent and proper use of antibiotics in such conditions.

Endodontic treatment-related antibiotic prescribing patterns of South African oral health professionals

AIM

To assess the antibiotic prescribing patterns of South African dentists for patients undergoing endodontic treatment.

METHODOLOGY

This study used data from 2013 health insurance claims submitted by South African oral health professionals to determine the antibiotic prescribing patterns related to endodontic treatment. A logistic regression model was used to test the fully adjusted statistical significance of the association between the exploratory variables (gender, age group, event type, abscess treatment, chronic health) and the dependent variable (antibiotic prescription). Odds ratios with 95% confidence intervals (CI) are reported, and a 95% CI excluding 1 was considered statistically significant.

RESULTS

Almost 10% of endodontic treatments were prescribed an antibiotic. There were no significant differences in prescribing patterns by gender, age and chronic health status. Prescriptions were more common at the preparatory stage (9.4%) of root canal treatment compared to the therapy (4.7%) and canal filling (2%) stages. Patients who received apical surgery (OR = 2.28; 95% CI 1.38-3.76) and treatment of an abscess (OR = 2.57; 95% 1.82-3.63) had a significantly increased odds of being prescribed an antibiotic. Almost three-quarters of prescriptions were for narrow spectrum antibiotics.

CONCLUSION

The frequency of antibiotic prescribing by South African dental practitioners for patients undergoing endodontic treatment is relatively low and predominantly involved narrow spectrum antibiotics. It, however, remains important that antibiotics are only prescribed when clinically essential, such as when there are obvious systemic effects. These include fever above 37 degrees, malaise, lymphadenopathy, trismus, increase swelling, cellulitis, osteomyelitis and persistent infection. The wider dissemination and adherence to clear evidence-based prescribing guidelines for antibiotics in this clinical area are important.