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Table of Contents   
GUEST EDITORIAL  
Year : 2013  |  Volume : 24  |  Issue : 2  |  Page : 155-156
Antibiotic stewardship among dentists: The need of the hour!!!!!!


Department of Public Health Dentistry, Jaipur Dental College, Jaipur, Rajasthan, India

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Date of Web Publication20-Aug-2013
 

How to cite this article:
Manjunath B C. Antibiotic stewardship among dentists: The need of the hour!!!!!!. Indian J Dent Res 2013;24:155-6

How to cite this URL:
Manjunath B C. Antibiotic stewardship among dentists: The need of the hour!!!!!!. Indian J Dent Res [serial online] 2013 [cited 2020 May 28];24:155-6. Available from: http://www.ijdr.in/text.asp?2013/24/2/155/116668
A wide range of microbes are reported to have developed resistance to all known antibiotics. Wide-spread antimicrobial resistance (AMR) threatens to push us back into the preantibiotic era and it should therefore be a wake-up call for all healthcare personnel, including dentists. The fear of a major public health crisis is looming large. Superbugs like the New Delhi metallo-beta-lactamase-1 (NDM-1) has been detected in some hospitals in India as well as in public drinking water sources in New Delhi, which indicates the gravity of the situation. [1] Controlling infections like malaria, HIV, and tuberculosis, which are leading causes of death in India and the world, has also become a major challenge because of the emergence of drug resistance. The development of AMR is the result of wide-spread irrational use of antibiotics, poor infection control practices in hospitals, deficient sanitation, over-the-counter availability of drugs, poor compliance and frequent self-medication by patients, and the lack of monitoring by the government. [2] Realizing the seriousness of the situation and to increase awareness regarding AMR, the World Health Organization declared that the theme for World Health Day, 2011, should focus on combating drug resistance. [2]

According to one report, dentists account for 7% of all antibiotic prescriptions in the world, with each dentist estimated to write an average of 4-5 prescriptions per week. [3] Even though, this is small when compared to the number of prescriptions issued by medical specialists, antibiotics are among the most frequently prescribed drugs by dentists, who can therefore be said to significantly contribute to the global consumption of antibiotics. It has been reported that dentists overuse or misuse antibiotics due to reasons such as lack of knowledge regarding the indications of antibiotics, for convenience, and to meet patients' expectations. Such irrational use paves the way for the development of antibiotic-resistant oral microbial flora. [3],[4]

Development of resistance to drugs by microbes is a natural phenomenon but is enhanced by the irrational use of antimicrobials. A few strains that are naturally resistant and those with acquired resistance emerge as the dominant forms as a result of the selective pressure exerted due to exposure to antimicrobials. [5] Investigations have revealed that many oral microbes such as Streptococcus spp., Prevotella spp., Fusobacteria spp., Haemophilus spp., Veillonella spp., Porphyromonas gingivalis, Aggregatibacter actinomycetem comitans, and Actinomyces have developed resistance to many antibiotics. [3],[4],[6] Resistance is reported against all the beta-lactum antibiotics (including penicillin derivatives and cephalosporins), clindamycin, ciprofloxacin, erythromycin, and tetracycline. [6],[7] Beta-lactamase inhibitors like amoxicillin/clavulanate potassium are still effective against most of the pathogenic oral microorganisms and metronidazole continues to be effective against many oral anaerobes. These antimicrobials should be prescribed only in selected cases, preferably after confirmation with culture and sensitivity tests, to prevent emergence of AMR to these drugs also. [6],[7]

The time has come to stop irrational use of antibiotics in dentistry. Once the source of infection in the oral cavity is removed the need for prescription of antibiotics becomes less. Dentists can make a difference by the judicious use of antimicrobials - prescribing the correct drug, in the standard dosage and regimen - only when systemic spread of infection is evident. Asking for culture and sensitivity tests should be a priority.

This practice of prudent use of antimicrobials is termed as 'antimicrobial stewardship' and it is the need of the hour. [8] A record of the antibiotics that have been prescribed has to be maintained, and signs of resistance among patients must be looked for and identified. A standard infection control protocol has to be maintained at all levels. Patients should also be motivated to comply with prescriptions, and over-the-counter sale of antibiotics should be banned. [2],[3] All these efforts will reduce the risk of AMR and prevent the transformation of microorganisms into deadly strains.

 
   References Top

1.Walsh TR, Weeks J. Livermore DM, Toleman MA. Dissemination of NDM-1 positive bacteria in the New Delhi environment and its implications for human health: An environmental point prevalence study. Lancet Infect Dis 2011;11:355-62.  Back to cited text no. 1
    
2.WHO. World Health Day - 7 April 2011 Antimicrobial resistance: no action today, no cure tomorrow. Available from: http://www.who.int/world-health-day/2011/en/. [Last cited 2011 May 26].  Back to cited text no. 2
    
3.Epstein JB, Chong S, Le ND. A survey of antibiotic use in dentistry. J Am Dent Assoc 2000;131:1600-9.  Back to cited text no. 3
[PUBMED]    
4.Mainjot A, D′Hoore W, Vanheusden A, Van Nieuwenhuysen JP. Antibiotic prescribing in dental practice in Belgium. Int Endod J 2009;42:1112-7.  Back to cited text no. 4
[PUBMED]    
5.Antibiotic Resistance: An Ecological Perspective on an Old Problem. A report from the American academy of microbiology. 2009, American Academy of Microbiology. Available from: http://academy.asm.org/images/stories/documents/antibioticresistance.pdf. [Last cited 2012 Feb 6].  Back to cited text no. 5
    
6.Ready D, Bedi R, Spratt DA, Mullany P, Wilson M. Prevalence, proportions, and identities of antibiotic-resistant bacteria in the oral microflora of healthy children. Microb Drug Resist 2003;9:367-72.  Back to cited text no. 6
[PUBMED]    
7.Sweeney LC, Dave J, Chambers PA, Heritage J. Antibiotic resistance in general dental practice: A cause for concern? J Antimicrob Chemother 2004;53:567-76.  Back to cited text no. 7
[PUBMED]    
8.Fishman N. Antimicrobial stewardship. Am J Med 2006;119 (Suppl 1):S53-61.  Back to cited text no. 8
    

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Correspondence Address:
B C Manjunath
Department of Public Health Dentistry, Jaipur Dental College, Jaipur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.116668

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