Patterns of antifungal prescribing in general dental practice

Abstract

Objective To examine the current practice of antifungal prescribing by GDPs in the United Kingdom. Design A postal questionnaire circulated to a random selection of 400 dentists. Outcome measures The questionnaires were analysed and the responses expressed as absolute and relative frequencies. Results Responses to the questionnaire were received from 297 (74.3%) GDPs. Nystatin was the most popular choice of antifungal agent that GDPs would use, followed by miconazole, amphotericin B and fluconazole. The likelihood of use of miconazole was positively linked to recent date of graduation. Lack of knowledge regarding contraindications and problems with azole antibiotics was found in a significant minority of practitioners (36%). Conclusions The present study indicates that azole antifungal agents (especially miconazole) are becoming more widely used by GDPs, but that knowledge regarding potential problems with their use is suboptimal. Nystatin remains the most popular choice of antifungal agent.Much attention has been focused on the prescribing of antibiotics recently. Such interest has largely examined antibacterial prescribing but there has been less work examining antifungal prescribing. Given that there is increasing evidence of Candida species becoming resistant to some antifungal agents, particularly the azole group, 1 it is timely to examine the current prescribing habits in general dental practice.Lewis et al. 2 investigated the prescribing of antibiotics by general dental practitioners (GDPs) in the United Kingdom in 1987. Since that study, newer azole antifungals, namely fluconazole, have become available in general dental practice. However, the azoles, unlike the polyene antifungals, are absorbed from the gastrointestinal tract and thus have the potential for interactions with other drugs. They also have the potential to be hepatotoxic. Over the last few years four antifungal drugs in a number of formulations, have been available for GDPs to prescribe under NHS regulations. 3 Nysatin is available as pastilles, suspension and ointment for extra-oral use on the skin, while amphotericin is only available in lozenges and suspension for intra-oral use. Miconazole is available as an oral gel as well as an ointment and cream (combined with 1% hydrocortisone) for use on the skin. Fluconazole capsules and suspension are available for oral/systemic use.The aim of the present study was to establish the types and formulations of antifungal agents prescribed by a cross section of general dental practitioners during 1999/2000. We wanted to examine if prescribing habits were influenced by the time since graduation and the possession of postgraduate qualifications. Also, we wished to examine the awareness of practitioners regarding contraindications to, and problems with azole antifungals. MATERIALS AND METHODSThe postal addresses of dental practitioners were obtained from the 1999 UK Dental Register. An initial total of 400 practitioners were selected by choosing every 74th entry in the register. Each of these dentists ...

Current Antifungal Drug Prescribing to Treat Oral Thrush in Sulaimani City-Iraq

“…The first study was undertaken in the UK in 1987 and reported in 1989 [20]. The second study that conducted in the UK reported in 2004 [21].Furthermore, another study was undertaken in Jordan in 2015 [22].In accordance with those studies like the present study, nystatin was the most popular antifungal agent recommended (70.3%). In addition, nystatin oral suspension was selected by 73% of the respondents who suggested nystatin.…”

“…In addition, miconazole and nystatin were also the commonly employed antifungals in studies that have been done by other researchers [19], [21], [22]. This is because these drugs may cause less intestinal irritation and other side effects.…”

Antifungal prescribing pattern and attitude towards the treatment of oral candidiasis among dentists in Jordan

“…Furthermore, an Expert Panel of the Infectious Diseases Society of America has recently prepared guidelines for the management of patients with invasive and mucosal candidiasis, and recommended the treatment of oropharyngeal candidiasis according to the severity of disease; topical therapy with clotrimazole or nystatin for mild infections; fluconazole for moderate‐to‐severe infections; and itraconazole, voriconazole, posaconazole or amphotericin B suspension for refractory infections. However, systemic treatment, unlike topical treatment, has the potential for greater adverse systemic effects, such as hepatotoxicity and interactions with other drugs. Thus, the combination of topical and systemic treatment modalities would sometimes be advantageous for reducing the dose or duration of the systemic treatment.…”

“…Jordanian dental specialists had a tendency to overprescribe antibiotics, and a substantial proportion of dentists had a tendency to prescribe long courses of antibiotics, as well as to prescribe broad‐spectrum antibiotics. However, studies examining the attitude of dentists towards the treatment of oral candidiasis are scarce and the studies that are available show inconsistent methods in evaluating the influence of their socio‐professional factors. A review of literature published in the last 20 years showed that only three studies investigated the attitude of dentists towards the treatment of oral candidiasis and their antifungal‐prescribing habits: one was conducted in the USA, 20 years ago; one was conducted in the UK, 10 years ago; and a recent study was conducted in 2010 in Spain.…”

Miconazole Oral Gel Increases Exposure to Oral Oxycodone by Inhibition of CYP2D6 and CYP3A4

“…Due to its limited oral bioavailability and a high risk of drug interactions, the systemic use of miconazole is rare. However, miconazole is commonly used as a topical preparation (16,21). In vitro studies have shown miconazole to be a strong inhibitor of many drug-metabolizing cytochrome P450 (CYP) enzymes (CYP1A2, CYP2C9, CYP2C19, CYP2D6, CYP2E1, and CYP3A4) (19,20).…”