Oral contraceptives and antibiotics: important considerations for dental practice

Abstract

This paper considers the possible interactions between oral contraceptive pills and antibiotics, in the context of modern dental practice. A review of the literature on such interactions leads to the conclusion that current national guidelines on the use of alternative contraceptive measures during a course of broad spectrum antibiotics in women also using the oral contraceptive pill should be emphasised and encouraged as part of good clinical practice. A patient information leaflet may be considered as a useful way of presenting such advice to female patients.

Advice given to women who are prescribed antibiotics while taking the oral contraceptive pill

“…3,6,8 In the USA, a patient filed a lawsuit against her dentist on behalf of her newborn child, alleging that she became pregnant despite taking the OCP, shortly after an antibiotic was prescribed by her dentist. The court ruled in favour of the woman and held that the dentist was responsible for child support payments.…”

“…5 The most common causes of unintended pregnancy are thought to be missed pills, drug interactions, and malabsorption as a result of vomiting or diarrhoea, either of which may be a side effect of concurrent antibiotic administration. 6 There has been considerable debate as to whether antibiotics truly interact with the OCP or if the apparent link is just coincidence. There is evidence that rifampicin (like other drugs which induce hepatic enzyme activity) interacts with OCP sufficient to impair the latter's efficacy.…”

Drug interactions important for periodontal therapy

“…A more controversial interaction is the potential interaction of antibiotics with estrogen-containing products, including oral contraceptives. Reports supporting and disputing this interaction exist (15,19,83). The proposed mechanism involves the enterohepatic recycling of the conjugated estrogen excreted in the bile, reactivated by the gastrointestinal flora and reabsorbed as active drug.…”

Antibiotics and oral contraceptives: new considerations for dental practice

“…In 1994, the British Dental Journal published a paper reviewing the possible interactions between antibiotics and oral contraceptives emphasising the need for dentists to follow current national guidelines as part of good dental practice. 1 At the time the guidance was that as a dentist you needed to warn the patient that the antibiotics The aim of this paper is to highlight a change in guidance relating to possible interactions between antibiotics and oral contraceptives. Until recently, dentists have been advised to warn women taking the combined oral contraceptive pill of the routine need to use additional contraceptive measures while taking courses of broad spectrum antibiotics.…”

“…1 This advice was based on our understanding at the time and further publications reminded dentists of their professional obligations in this area and the possible medico-legal implications of not following current guidance. 2 Various mechanisms for delivering the advice to patients, including a patient information leaflet, were suggested.…”