Clinical
Antibi
s part of this year’s Euro- pean Antibiotic Awareness Day on ı9 November, dentists were asked to make a pledge to become Antibi-
otic Guardians – Scotland’s ‘superheroes’ in the fight against antibiotic resistance. While a recent report by the Scottish Antimicrobial Prescribing Group (SAPG, based within the Scottish Medicines Consortium) showed that Scotland is working hard to reduce the number of prescriptions for antibiotics, with a decrease of 6.5 per cent in 20ı3-ı4, there is still much work to be done. “Antibiotic resistance is a major public
health issue and a threat to the future of healthcare,” said Dr Jacqueline Sneddon, project lead for SAPG. “The World Health Organisation has warned of a post-antibi- otic era in which common infections and minor injuries can kill. Far from being an apocalyptic fantasy, this is a very real possi- bility in the next few decades. “Without effective antibiotics, safe and
effective healthcare will become increas- ingly difficult. And while Scotland has made substantial progress in improving the quality of antibiotic prescribing, we still have more to do to.” Dr Sneddon’s view is shared by Dr
Alexander Crighton, consultant in oral medicine at Glasgow Dental Hospital and School and the SAPG dental representative. “Dental prescribing accounts for 8.9 per
cent of all antibiotics dispensed in Scot- land,” explained Dr Crighton.
54 Scottish Dental magazine
tic
guardians A
European Antibiotic Awareness Day may have been and gone, but antibiotic resistance is something dentists need to bear in mind
“That might sound like a small number,
but each unnecessary antibiotic prescribed is important to the entire population. Dentists must remember that an antibi- otic will only be effective if the patient has an infection and where the infection is sensitive to the drug chosen. Although it may seem obvious to say that if there is no infection present an antibiotic is not appropriate, unfortunately the ‘decision to prescribe’ is still the biggest prescribing error made by dentists. Examples include giving an antibiotic ‘just in case it helps’ or on some occasions, to postpone surgery until more clinical time is available.” While prescribing medicines is an
essential part of dental care, Dr Crighton points out that the decision to prescribe is a complex one, as the dentist has to under- stand not only the possible benefits to the patient but also the potential risks. This is particularly the case with antibiotics. “Inflammatory diseases of the pulp, such
as pulpitis, will have no treatable infective cause and are not indications for antibiotics. The dentist should be able to tell from the patient’s history and clinical examination whether an infection is likely. “To justify issuing an antibiotic, there
must be a clear diagnosis of an infection such as ‘a periapical abscess’ or ‘acute ulcerative gingivits’ where other forms of treatment cannot be used or have failed,” says Dr Crighton. “If a dental abscess is drained or the
tooth extracted, there is usually no need to prescribe an antibiotic as the healthy
patient’s immune system can deal with most residual infection as long as the source is removed. It is only when there is a spreading or systemic infection with pyrexia or if a patient that has an immune deficiency that supplemental antibiotics should be used.” The dentist should always consider
alternatives to systemic antibiotics or other antimicrobials. If there is an acute mucosal condition such as a denture stomatitis, it may resolve spontaneously if the trigger is removed by the patient being instructed in better denture hygiene. Dr Crighton advises that antiseptics such as chlorhex- idene can often be as effective as giving an antiviral or antifungal for minor mucosal infections. When dental infections do require an antibiotic, most can be adequately treated using standard doses of amoxicillin or metronidazole. Antibiotic prescribing protocols for dentistry are outlined in the Scottish Dental Clinical Effectiveness Programme (SDCEP) Drug Prescribing for Dentistry booklet and dentists in
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84