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
255