Antibacterial agents, Antibiotic prophylaxis, Dentists’, Drug resistance, Practice patterns
Citation Information :
Suresan V, Das S, Verma RK, Dash B, Banka A, Suresh A. Antibiotic Prescribing Practices amongst the Dental Practitioners of Bhubaneswar City: A Cross-sectional Study. World J Dent 2022; 13 (5):520-526.
Aim: To assess the antibiotic prescribing practices and knowledge of current antibiotic regimens amongst the dental practitioners of Bhubaneswar City, Odisha.
Materials and methods: A descriptive, e-mail-based, cross-sectional study was conducted amongst 905 dental practitioners of Bhubaneswar city. A pretested, validated, a self-structured questionnaire was designed to assess the demographic data (age, gender, specialty, and years of experience) and 17 questions assessing the usual prescription patterns (type, dosage, and duration of antibiotics prescribed for selected diseases and prophylaxis). The knowledge-based questions were 10 in number and framed with a single correct response. The questionnaire was prepared in Google Forms and a link was generated. This link was e-mailed to the dental practitioners with a cover letter explaining the need for the survey. The study was conducted for a period of 6 months (December 2020 to May 2021).
Results: A total of 826 subjects participated in this study. The commonest age group was 41–50 years (n = 363, 43.9%). A total of 367 (44.4%) BDS, 450 (54.5%) MDS, and nine (1.1%) PhD subjects formed the study sample. A combination of amoxicillin + clavulanic acid was their preferred first-line drug of choice. Similarly, the commonest second-line drug prescribed was cephalexin. Half of the study population (n = 413, 50%) prescribed antibiotics for their patients having endo-perio lesions. There were a mere 138 (38.8%) BDS, 170 (37.8%) MDS, and zero (0%) PhD subjects with adequate knowledge scores. Pedodontists (n = 104, 96.3%) prescribed the highest antibiotics as compared to other specialties. Endodontists (n = 33, 30.6%) prescribed the most adjunct medication in their practice.
Conclusion: Inadequate knowledge was reported amongst the practicing dentists, therefore the study calls for the improvement of their knowledge through periodic dental education on the betterment of clinical practice and in turn reducing the occurrence of antimicrobial resistance (AMR).
Clinical significance: AMR is a major concern for developing countries like India where there is an increased prevalence of self-medication and over-the-counter drug availability. Treating local odontogenic infections in regular dental practice with systemic antibiotics has received a red signal.
Hwang AY, Gums JG. The emergence and evolution of antimicrobial resistance: impact on a global scale. Bioorg Med Chem 2016;24(24):6440–6445. DOI: 10.1016/j.bmc.2016.04.027
Gandra S, Tseng KK, Arora A, et al. The mortality burden of multidrug-resistant pathogens in India: a retrospective, observational study. Clin Infect Dis 2019;69(4):563–570. DOI: 10.1093/cid/ciy955
Komolafe OO. Antibiotic resistance in bacteria - an emerging public health problem. Malawi Med J 2003;15(2):63–67. DOI: 10.4314/mmj.v15i2.10780
Faizi N, Kazmi S. Universal health coverage - there is more to it than meets the eye. J Family Med Prim Care 2017;6(1):169–170. DOI: 10.4103/jfmpc.jfmpc_13_17
Stein K, Farmer J, Singhal S, et al. The use and misuse of antibiotics in dentistry: a scoping review. J Am Dent Assoc 2018;149(10):869–884.e5. DOI: 10.1016/j.adaj.2018.05.034
Marra F, George D, Chong M, et al. Antibiotic prescribing by dentists has increased: why? J Am Dent Assoc 2016;147(5):320–327. DOI: 10.1016/j.adaj.2015.12.014
Swift JQ, Gulden WS. Antibiotic therapy–managing odontogenic infections. Dent Clin North Am 2002;46(4):623–633, vii. DOI: 10.1016/s0011-8532(02)00031-9
Kaul R, Angrish P, Jain P, et al. A survey on the use of antibiotics among the dentists of Kolkata, West Bengal, India. Int J Clin Pediatr Dent 2018;11(2):122–127. DOI: 10.5005/jp-journals-10005-1497
Sahoo KC, Tamhankar AJ, Johansson E, et al. Community perceptions of infectious diseases, antibiotic use and antibiotic resistance in context of environmental changes: a study in Odisha, India. Health Expect 2014;17(5):651–63. DOI: 10.1111/j.1369-7625.2012.00789.x
Gambhir RS, Brar P, Singh G, et al. Utilization of dental care: an Indian outlook. J Nat Sci Biol Med 2013;4(2):292–297. DOI: 10.4103/0976-9668.116972
Teoh L, Stewart K, Marino RJ, et al. Perceptions, attitudes and factors that influence prescribing by general dentists in Australia: a qualitative study. J Oral Pathol Med 2019;48(7):647–654. DOI: 10.1111/jop.12909
Seager JM, Howell-Jones RS, Dunstan FD, et al. A randomised controlled trial of clinical outreach education to rationalise antibiotic prescribing for acute dental pain in the primary care setting. Br Dent J 2006;201(4):217–222; discussion 216. DOI: 10.1038/sj.bdj.4813879
Poveda Roda R, Bagan JV, Sanchis Bielsa JM, et al. Antibiotic use in dental practice. A review. Med Oral Patol Oral Cir Bucal 2007;12(3):E186–192.
Dormoy J, Vuillemin MO, Rossi S, et al. Perceptions of antibiotic use and resistance: are antibiotics the dentists’ anxiolytics? Antibiotics (Basel) 2021;10(6):735. DOI: 10.3390/antibiotics10060735
Laxminarayan R, Matsoso P, Pant S, et al. Access to effective antimicrobials: a worldwide challenge. Lancet 2016;387(10014):168–75. DOI: 10.1016/S0140-6736(15)00474-2
Ramu C, Padmanabhan TV. Indications of antibiotic prophylaxis in dental practice- review. Asian Pac J Trop Biomed 2012;2(9):749–54. DOI: 10.1016/S2221-1691(12)60222-6
Laxminarayan R, Chaudhury RR. Antibiotic resistance in India: drivers and opportunities for action. PLoS Med 2016;13(3):e1001974. DOI: 10.1371/journal.pmed.1001974
Gowri S, Mehta D, Kannan S. Antibiotic use in dentistry: a cross-sectional survey from a developing country. J Orofac Sci 2015;7:90–94. DOI: 10.4103/0975-8844.164310
Buonavoglia A, Leone P, Solimando AG, et al. Antibiotics or no antibiotics, that is the question: an update on efficient and effective use of antibiotics in dental practice. Antibiotics (Basel) 2021;10(5):550. DOI: 10.3390/antibiotics10050550
Ahmadi H, Ebrahimi A, Ahmadi F. Antibiotic therapy in dentistry. Int J Dent 2021;2021:6667624. DOI: 10.1155/2021/6667624
Naveen N, Guru Suhas P, Vanishree N, et al. Current trends in prescription of antibiotics among dentists working in various dental colleges of Bangalore City, India- a cross sectional study. Int J Oral Health Med Res 2015;2(2):8–14. ISSN 2395–7387. [acessed 23 April 2022]. Available from: http://www.ijohmr.com/upload/Trends%20in%20antibiotic%20prescription%20among%20Dentists.pdf
Lockhart PB, Tampi MP, Abt E, et al. Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling: a report from the American Dental Association. J Am Dent Assoc 2019;150(11): 906–921.e12. DOI: 10.1016/j.adaj.2019.08.020
Tariq K, Hassan M, Wajahat M, et al. Awareness of antibiotic use and antibiotic resistance amongst dental students. Awareness of antibiotic use and antibiotic resistance amongst dental students. Braz Dent Sci 2021;24(3). DOI: 10.14295/bds.2021.v24i3.2470
Wicha SG, Märtson AG, Nielsen EI, et al. From therapeutic drug monitoring to model-informed precision dosing for antibiotics. Clin Pharmacol Ther 2021;109(4):928–941. DOI: 10.1002/cpt.2202
Malika S, Singh A. Liberal Use of Antibiotics in Dentistry. Annals of RSCB [Internet]. 2021.2 [cited 2021.22];7615–23. Available from: https://www.annalsofrscb.ro/index.php/journal/article/view/2304
Konde S, Jairam LS, Peethambar P, et al. Antibiotic overusage and resistance: a cross-sectional survey among pediatric dentists. J Indian Soc Pedod Prev Dent 2016;34(2):145–151. DOI: 10.4103/0970-4388.180444
Bansal R, Jain A, Goyal M, et al. Antibiotic abuse during endodontic treatment: a contributing factor to antibiotic resistance. J Family Med Prim Care 2019;8(11):3518–3524. DOI: 10.4103/jfmpc.jfmpc_768_19
Malhotra-Kumar S, Lammens C, Coenen S, et al. Effect of azithromycin and clarithromycin therapy on pharyngeal carriage of macrolide-resistant streptococci in healthy volunteers: a randomised, double-blind, placebo-controlled study. Lancet 2007;369(9560):482–490. DOI: 10.1016/S0140-6736(07)60235-9
Yingling NM, Byrne BE, Hartwell GR. Antibiotic use by members of the American Association of Endodontists in the year 2000: report of a national survey. J Endod 2002;28(5):396–404. DOI: 10.1097/00004770-200205000-00012
Pallasch TJ. Global antibiotic resistance and its impact on the dental community. J Calif Dent Assoc 2000;28(3):215–233.
Mansour H, Feghali M, Saleh N, et al. Knowledge, practice and attitudes regarding antibiotics use among Lebanese dentists. Pharm Pract (Granada) 2018;16(3):1272. DOI: 10.18549/PharmPract.2018.03.1272 Epub 2018. PMID: 11326536.
Hajj A, Azzo C, Hallit S, et al. Assessment of drug-prescribing perception and practice among dental care providers: a cross-sectional Lebanese study. Pharm Pract (Granada) 2021;19(1):2234. DOI: 10.18549/PharmPract.2021.1.2234
Köhler M, Meyer J, Linder M, et al. Prescription of antibiotics in the dental practice: a survey of dentists in Switzerland. Schweiz Monatsschr Zahnmed 2013;123(9):748–59. [acessed 23 April 2022]. https://www.swissdentaljournal.org/fileadmin/upload_sso/2_Zahnaerzte/2_SDJ/SMfZ_2013/SMfZ_09_2013/smfz-09- research.pdf