[Study9] The Dental Professional’s Role in the Prevention of Antibiotic Resistance and Adverse Antibiotic Reactions

Antibiotic resistance

Dental pain and swelling are common

• Dentists are one of the largest groups prescribing antibiotics #3

• Most not necessary

Adverse drug reactions

• Allergic reactions or medication side effects

Disruption of normal/ commensal flora

• Allows opportunistic infections to develop

Antibiotic resistance

• Bacteria develops resistance

• Antibiotics no longer work / hard to treat

• Due to inappropriate prescription, poor patient compliance/ adherence

Inappropriate prescription

Dental diseases

• Caries, pulpal inflammation, pulp necrosis, periapical disease/ abscess

→ Need definitivie dental treatment

• upto 85% prescription inappropriate

Multi-drug resistance

Antibiotic resistance = global problem

• WHO monitors resistance through GLASS (Global Antimicrobial Resistance Surveillance System)

• 2.8+ mil people infected with antibiotic resistance bacteria

• Penicillin discovered in 1928

• Resistant E.coli discovered in 1940

Can lead to

• Longer hospital stays, expensive, toxic meds, more infections

2019 ADA Clinical Practice Guidelines

• Evidence based rec for dentist on when to prescribe antibiotics

Symptomatic irreversible pulpitis (SIP)

SIP ± symptomatic apical periodontitis

For immunocompetent adults

• Don’t prescribe systemic antibiotics

• Refer definitive conservative dental treatment (DCDT)

• Monitor patient

SIP ± SAP → NO antibiotics

Pulp Necrosis + Symptomatic Apical Periodontitis (PN-SAP)

For immunocompetent adults

• Don’t prescribe antibiotics

• Do definitive conservative dental treatment

• Interim monitoring

If definitive treatment isn’t feasible

• Delayed prescription can be used if worsened symptoms or definitive treatment not begun after 24-48 hrs

PN-SAP → generally NO antibiotics

Pulp Necrosis + Localized Acute Apical Abscess (PN-LAAA)

If immediate definitive dental treatment is NOT available:

• Antibiotics ARE recommended

PN-LAAA + no immediate DCDT → antibiotics

Antibiotics as an Adjunct to Definitive Dental Treatment

For immunocompetent adults with:

• PN-SAP

• PN-LAAA

• SIP ± SAP

Antibiotics generally should NOT be routinely added to definitive conservative dental treatment

Source control > unnecessary antibiotics

How long to prescribe antibiotics

7-10 day

• >5 days should be exception

• Re-evaluate every 3 days

• Stop antibiotics 24 hrs after complete resolution of symptoms .

Evidence-Based Comparisons of Antibiotics

• 10% report penicillin allergy but <1% have true penicillin allergy

True severe allergy includes

• Anaphylaxis

• Angioedema

• Hives

→ Use Azithromycin for penicillin allergy

• Clindamycin not alternative for penicillin anymore

If first line antibiotics not working

Add metronidazole

Change to

• Amoxicillin + calvulanate

Antibiotic Prophylaxis

Treatment

• Patient has infection → antibiotics may be used

Prophylaxis

• Patient don’t have infection → antibiotics given to prevent one