Antibiotic Use and Misuse in Dentistry in India—A Systematic Review

Abstract

Background: Infections caused by antibiotic resistance pose a serious global health threat, undermining our ability to treat common infections and deliver complex medical procedures. Antibiotic misuse, particularly in low-–middle-income countries, is accelerating this problem. Aim: The aim of this systematic review was to investigate the use and misuse of antibiotics in dentistry in India. Method: We included studies carried out on Indian populations evaluating the prescription of prophylactic or therapeutic antibiotics by dental practitioners or other healthcare providers, along with antibiotic self-medication by the general population. The primary outcome measure was prescription rate/use of antibiotics for dental/oral problems. The secondary outcome measures included indications for antibiotic use in dentistry, their types and regimens, factors influencing practitioners’ prescription patterns and any differences based on prescriber and patient characteristics. Multiple databases were searched with no restrictions on language or publication date. The quality assessment of all included studies was carried out using the AXIS tool for cross-sectional studies and the Joanna Briggs Institute checklist for qualitative studies. Results: Of the 1377 studies identified, 50 were eligible for review, comprising 35 questionnaire surveys, 14 prescription audits and one qualitative study (semi-structured interviews). The overall quality of the included studies was found to be low to moderate. The proportion of antibiotic prescriptions amongst all prescriptions made was found to range from 27% to 88%, with most studies reporting antibiotics in over half of all prescriptions; studies also reported a high proportion of prescriptions with a fixed dose drug combination. Worryingly, combination doses not recommended by the WHO AWaRe classification were being used. The rate of antibiotic self-medication reported for dental problems varied from 5% to 35%. Conclusions: Our review identified the significant misuse of antibiotics for dental diseases, with inappropriate use therapeutically and prophylactically, the use of broad spectrum and combination antibiotics not recommended by WHO, and self-medication by the general population. There is an urgent need for targeted stewardship programmes in this arena.

Exploring the Use of Antibiotics for Dental Patients in a Middle-Income Country: Interviews with Clinicians in Two Ghanaian Hospitals

“…As per the FDI World Dental Federation white paper on antibiotic resistance, spreading awareness about antibiotic resistance in this way is an important role which all members of the dental team can play in tackling this global problem [4]. Interestingly, pressure from pharmaceutical companies to prescribe in certain ways has also been reported in several studies undertaken in LMICs across both dental and medical settings [7,32], but this was not a finding of this study.…”

“…The concept of a course of antibiotics has been challenged in the literature [30] and in some countries, the guidelines for dental antibiotic prescribing now advise stopping the patient from taking antibiotics once the symptoms have resolved [31]. The use of antibiotics in the community without a prescription is also reported in other studies of dental antibiotic prescribing in LMICs, [32] with some of the participants keen to highlight that they would advise patients against this practice. As per the FDI World Dental Federation white paper on antibiotic resistance, spreading awareness about antibiotic resistance in this way is an important role which all members of the dental team can play in tackling this global problem [4].…”

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

“…Alongside this, the prescribing of more than one antibiotic as adjunct treatment to dental procedures is said to be unnecessary and also lacks evidence of benefit in preventing surgical site infection, swelling or post-operative pain. 2 , 6 , 7 This again needs to be carefully looked at since unnecessary prescribing of antibiotics is a major driver of AMR. 15–17 It is however welcoming to note that 100% of the antibiotics prescribed at the ambulatory clinic were in the WHO Access category with none in the reserve category, even though their use in this case was mostly inappropriate and therefore a potential threat to AMR development.…”

“…There has been an increase in the use of antibiotics for dental care worldwide. 1 , 2 Despite evidence suggesting that a greater proportion of dental diseases could be effectively managed by surgical and other interventions requiring no antibiotic prescriptions, there is appreciable inappropriate prescribing of antibiotics by dentists especially in low- and middle-income countries (LMICs) with limited patient benefits. 1–4 …”

Summarizing Antibiotics in Dentistry

“…Common types of penicillin that are being administered for treatment of odontogenic infections are penicillin V, amoxicillin, and amoxicillin/clavulanic acid. Penicillin is considered to be the first-line drug and the gold standard for the treatment of odontogenic infections (3) because of its cost-effectiveness and appropriate antimicrobial activity. Despite these benefits, the drug might cause various side effects including rash, nausea, gastric irritation, diarrhea, and hypersensitivity reactions such as skin reactions .…”