Table 2. Antibiotic prescription patterns among dental practitioners for selected clinical signs, symptoms and general considerations.
Number of dental
practitioners (%) who
Conditions
responded “yes”
Elevated temperature + evidence of systemic spread 87 (86.1)
Localized fluctuant swelling 56 (55.4)
Gross or diffused swelling 76 (75.2)
Unrestricted mouth opening 39 (38.6)
Difficulty in swallowing 57 (56.4)
Closure of the eye due to swelling 91 (90.1)
Convenience (e.g. prophylaxis against foreseen complication, patient’s demand) 45 (44.6)
Patient’s social background (e.g. patient’s economic condition, expectations, occupation etc.) 38 (37.6)
Prevention of post-operative complication 76 (75.2)
Delay of treatment 35 (34.7)
Uncertain diagnosis 26 (25.7)
prescribing guidelines are no less of significance.
Nearly 36% of the respondents thought that
antibiotic brand promotion by the pharmaceutical
companies is an important contributing factor
in antibiotic resistance development. About
27% of the practicing dental surgeons thought
prescribing antibiotics on patients’ demand is of
less or no significance in development of antibiotic
resistance.
4. Discussion
Antibiotic overuse among dental practitioners
is a global concern and it seems progressing
rapidly causing problems to the health care and
community settings.
Unfortunately, many practitioners are still
prescribing antibiotics inappropriately and
indiscriminately for no valid cause. 25 Most of the
conditions presented to the dentist are primarily
due to inflammation of the pulp causing pain and
discomfort. Thus, these conditions are treated
by local intervention rather than prescribing
antibiotics. The use of antibiotic in cases of
chronic inflammatory periodontitis per se is also
not indicated. Generally, systemic antimicrobial
therapy should be reserved for conditions where
the debridement is difficult to achieve or where
there is a sign of local spread, and for patients
suffering from systemic debilitating illnesses.
Although, similar studies have been conducted
in Saudi Arabia, 26-28 Hail district was not explored.
It is worth to further investigate and find out the
changes in the antimicrobial therapy trends among
dental practitioners.
In the current study, only approximately 15%
were females and this probably reflects the
predominance of males in this profession.
A substantial percentage of the surveyed
candidates were general practitioners or interns
and these are the main dental working force in
the community. Almost 60% of the respondents
have experience more than 5 years. Nevertheless,
long experience is not necessarily associated
with updated knowledge on antibiotic therapy.
Stomatology Edu Journal
Alkhabuli et al. 22 found that the practitioners with
less than 5 years’ experience had better knowledge
on antibiotic and prescribing guidelines compared
to those practicing for more than 5 years.
In principle, elimination of source of infection is the
primary approach for any odontogenic infection.
Therefore, where possible, incision and drainage
of abscesses should be instituted immediately and
antibiotics are basically adjunct and prescribed
in the light of the presented clinical signs and
symptoms.
Fever is a response of the host defense against
microbial invasion, which further instigate an
immune reaction. About 86% of the participants
would prescribe antibiotics for patients presented
with elevated temperature. These figures are in
line with the previous regional studies. 20,29,30 Facial
cellulitis, commonly associated with periapical
infection spread that may extend beyond midface
causing eye closure is obviously another condition
which mandates use of antibiotics. Over 90%
of the surveyed practitioners are aware of the
seriousness of the condition and the need for
immediate antibiotics cover. In fact, the previous
two conditions represent fundamental bases of
infection spread and its sequel, which are known
to all medical professionals. Therefore, lower
percentages of agreement would be unacceptable.
In contrast, it is alarming to see significant
percentages of practicing dentists who would
still prescribe antibiotics if they were unconfident
of the diagnosis or on patients’ request. This
tendency of antibiotic abuse is not uncommon and
well documented. 20,29 Such practices of antibiotic
abuse are unjustified and the dental surgeons
should be aware of the unforeseen effects on long
run.
It seems to be that management of localized
fluctuant swelling is still confusing among dental
practitioners including specialists. Although,
primarily drainage of such abscesses is what is
needed, over 55% of the respondents tend to
prescribe antibiotics. However, no differences were
KNOWLEDGE AND PATTERNS OF ANTIBIOTIC PRESCRIPTION
AMONG DENTAL PRACTITIONERS IN HAIL, SAUDI ARABIA
257