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

Abstract

Background: Antimicrobial resistance is a global problem driven by the overuse of antibiotics. Dentists are responsible for about 10% of antibiotics usage across healthcare worldwide. Factors influencing dental antibiotic prescribing are numerous, with some differences in low- and middle-income countries compared with high-income countries. This study aimed to explore the antibiotic prescribing behaviour and knowledge of teams treating dental patients in two Ghanaian hospitals. Methods: Qualitative interviews were undertaken with dentists, pharmacists, and other healthcare team members at two hospitals in urban and rural locations. Thematic and behaviour analyses using the Actor, Action, Context, Target, Time framework were undertaken. Results: Knowledge about ‘antimicrobial resistance and antibiotic stewardship’ and ‘people and places’ were identified themes. Influences on dental prescribing decisions related to the organisational context (such as the hierarchical influence of colleagues and availability of specific antibiotics in the hospital setting), clinical issues (such as therapeutic versus prophylactic indications and availability of sterile dental instruments), and patient issues such as hygiene in the home environment, delays in seeking professional help, ability to access antibiotics in the community without a prescription and patient’s ability to pay for the complete prescription. Conclusions: This work provides new evidence on behavioural factors influencing dental antibiotic prescribing, including resource constraints which affect the availability of certain antibiotics and diagnostic tests. Further research is required to fully understand their influence and inform the development of new approaches to optimising antibiotic use by dentists in Ghana and potentially other low- and middle-income countries.

Engaging the Global Dental Profession to Help Tackle Antibiotic Resistance

“…FDI intends to produce awareness-raising posters, leaflets and videos which can be used globally. Template resources for member National Dental Associations and other partners will also be provided, which can be adapted to address local problems, such as over-the-counter access to antibiotics [17].…”

Antibiotics in Dentistry: A Narrative Review of the Evidence beyond the Myth

“…Factors influencing antibiotic prescriptions in dentistry were identified as clinical context-related (dentists working in different sectors exhibited variations in antibiotic prescribing practices [41,48]), patient-related [25,26,52,58], social-political context-related [61], and clinician-related (dentists with fewer years of practice tend to exhibit lower rates of antibiotic prescription abuse [60]).…”

“…Knowing how to communicate with one's patient is vital to improve adherence [58], and it is essential that the patient understands the recommendations and the prescribed therapy and that the dentist knows how to communicate them. Indeed, there is a risk that the instructions dentists give to their patients will be misunderstood, forgotten, or even ignored [129].…”

Interview study exploring how global health partnership principles are enacted and recommendations for practice

“…1 Global health partnerships can be defined as long-term established collaborations between high-income countries (HICs) such as the UK, and low-to-middle-income countries (LMICs) that work together to achieve a common goal. 2 The long-term aims of health partnerships vary greatly and previous examples have addressed antibiotic use in healthcare settings, 3 helped prioritise mental well-being in communities, as well as enabling educating and training of workforces to further build capacity. 4 5 …”