KNOWLEDGE AND PATTERNS OF ANTIBIOTIC PRESCRIPTION AMONG DENTAL PRACTITIONERS IN HAIL, SAUDI ARABIA conventional techniques. 4 Dentists prescribe medications for the management of several oral conditions, mainly orofacial infections. 5 Since most human orofacial infections originate from odontogenic infections 6 prescribing antibiotics by dental practitioners has become an important aspect of dental practice. Thus, antibiotics account most medicines prescribed by dentists. 7 Dentists prescribe between 7 % and 11 % of all common antibiotics( betalactams, macrolides, tetracyclines, clindamycin, metronidazole). 8 For instance, in the United Kingdom, dentists accounted for 7 % of all community prescriptions of antimicrobials. 9 On the other hand, the National Center for Disease Control and Prevention estimate that approximately one-third of outpatient antibiotic prescriptions are unnecessary. 10 Antibiotic prescribing may be associated with unfavorable side effects ranging from gastrointestinal disturbances to fatal anaphylactic shock and development of resistance. The increasing resistance problems of recent years are probably related to over- or misuse of broad-spectrum agents such as cephalosporins and fluoro-quinolones. 11 We have now entered an era where some bacterial species are resistant to the full range of antibiotics presently available, with the methicillin-resistant Staphylococcus aureus being one of the most widely known example of extensive resistance. 7 Understanding the enemy is the best way to win the battle. Thus, the rational choice and use of antimicrobial agents begins with the knowledge of the microorganisms most likely responsible for the common dental infections. It is well known that the oral microbial flora is dynamic and subject to changes continuously throughout life. In dentistry antibiotics are mainly used to manage or prevent spread of odontogenic infection. Other uses; may include prophylaxis against infective endocarditis, selected joint surgery and in conditions related to systemic diseases, such as diabetes mellitus. Hence, the number of dental conditions that need use of systemic antibiotics remain limited. In fact, most of the dental emergencies, including acute dental pain need only local intervention. 12 Pain associated with acute pulpitis for example is not a justification for antibiotic therapy. The latter should be reserved for more serious conditions associated with evidence of systemic spread. 13 The literature shows strong evidences that the dental surgeons have immensely contributed to antibiotic abuse and development of bacterial resistance. 14-16 Several authors have widely examined the multiple factors related to improper prescription of antibiotics including but not limited to uncertainty or failure of making definite diagnosis, lack of knowledge of adverse reactions, over-prescription, selfmedication, and lack of time for immediate treatment( convenience) or inability to find out the causative agent. 17-21 The rationale behind carrying out this preliminary study is the increasing number of dental patients who are unnecessarily prescribed antibiotics. In developed countries, not a single dose of antibiotics can be obtained without prescription, whereas in developing countries, including Middle East region, except narcotics, most of drugs including antibiotics are obtainable without prescription from any community pharmacy. Despite of the available reports on the rationale use of antibiotics by the practicing dental surgeons in Saudi Arabia, the available information are still inadequate. Therefore, our objectives are to explore the knowledge and attitude of the dental surgeons practicing in Hail towards antibiotic therapy and its resistance.
2. Methodology The study has obtained approval from the Research Ethics Committee, University of Hail, reference No.( H-2016-051). In the current study, a validated self-administered questionnaire used by Alkhabuli et al. 22 in a similar study was utilized to collect information from the practicing dental surgeons in district of Hail, Saudi Arabia. A hundred and fifty questionnaires were printed and distributed randomly to the practicing dentists including general dental practitioners( GDPs), specialists and consultants working in various sectors, such as government hospitals, private clinics and dental centers and were recollected after 10 days. In addition to the demographic information, the questionnaire inquired about the clinical and non-clinical parameters including symptoms and treatment modalities related to their patients, which dictates the dental practitioner’ s decision of prescribing antibiotics. The practitioners were asked how would they assess the various clinical signs and symptoms such as pain, fever, swelling, limitation of mouth opening, difficulty in swallowing and closure of eyes due to swelling in prescribing antibiotics. Dental surgeons may prescribe antibiotics for conditions other than infection, just to mention few, delay of treatment, convenience, social background and prevention of post-operative complications. Moreover, the participants were requested to provide their opinion and judgment about prescribing antibiotics for specific clinical conditions, such as acute and chronic pulp diseases related to dental caries, gingivitis, periodontal abscesses, routine extraction and surgical extraction as well as tooth replantation and trismus. The questionnaire also investigated the favored antibiotics by the dental surgeons in cases of cellulitis, periapical infection, pericoronitis, apicectomy, trismus and other dental infections. The suggested antibiotics were amoxicillin, amoxicillinclavulanate( such as Augmentin), erythromycin, metronidazole, tetracycline and cephalosporin. In addition, the study sought the participants’ opinion about the factors contributing to development of antibiotics resistance. These factors are the wide use of antibiotics particularly the broad-spectrum antibiotics, poor access to culture and sensitivity
Original Articles
Stomatology Edu Journal
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