I’ve got Toothache, I need Antibiotics: a UK Perspective on Rational Antibiotic Prescribing by Dentists

Abstract

Antibiotics do not cure toothache. This headline message of the United Kingdom’s (UK) Dental Antimicrobial Stewardship (AMS) toolkit’s posters and leaflets is aimed at patients; clinicians are expected to know this already. Evidence based clinical guidelines exist to set clear standards for good clinical practice yet there are barriers to compliance. The national AMS audit tool is designed for clinicians to review their management of acute dental conditions, including but not limited to the prescription of antibiotics. In this article we aim to help dental teams protect their patients and themselves from adverse events related to antibiotic prescription. It explores the emergent problem of Clostridium difficile, antibiotic resistance and severe sepsis, and considers some of the barriers, which clinicians have suggested, contribute to the unjustified prescription of antibiotics. Dentists must weigh the risks against the benefits before prescribing any antibiotic.

What we know about antibiotics prescribed by dentists in a Brazilian southeastern state

“…9,11,20,21,22 It is worth noting that there is no current evidence that antibiotics are effective in managing inflammatory conditions such as acute apical periodontitis, alveolar osteitis and irreversible pulpitis. 22,23,24 Only in select situations when same day definitive treatment cannot be provided, an American Dental Association panel recommended antibiotics be considered for management of urgent pulpal and periapical pain and swelling. 25 There is a clear relationship between humans, animals, plants and the environment, which is discussed by the One Health approach.…”

Prescription pattern in public specialized dental care centers in Brazil

“…The evidence in support antibiotic use for these procedures is minimal and inconsistent. Moreover, the maintenance of aseptic conditions, combined with the surgical principles of atraumatic tissue manipulation, should not be overlooked in favor of oral antibiotics (Hupp, Ellis III & Tucker, 2015;Stein et al 2018;Thompson et al 2018;Wannmacher, & Ferreira, 2007).…”

“…Indiscriminate drug use can cause harm to patients without necessarily achieving their therapeutic goal. In the use of antibiotics, this concern is even greater due to the development of drug resistance, where it is considered by the WHO one of the most serious public health problems in the world (Ahsan et al, 2020;Lisboa, Martins, Castilho, Souza e Silva, & Abreu, 2015;Thompson, Rios, Fedorowicz, Dailey, & Douglas, 2018;World Health Organization, 2018). About 40% of dentists in England prescribe prophylactic antibiotics to patients with no relevant clinical history to prevent postoperative infection .…”

Antibiotic Resistance: What is there in Past, Present and Future?

“…In India it was estimated that around 50% of antibiotic use in the health care systems was inappropriate and in order to prevent the irrational use national center for disease control issued a publication called national treatment guidelines to promote rational use. 11,12 A study conducted in France showed that out of 122 antibiotic treatments it was found that 34% of treatments are misdiagnosed and 30% treatments are not used appropriately. 13 There is need to set proper guidelines and antibiotic policies towards the rational prescription of drugs…”