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KNOWLEDGE AND PATTERNS OF ANTIBIOTIC PRESCRIPTION AMONG DENTAL PRACTITIONERS IN HAIL, SAUDI ARABIA 260 Figure 1. Percentages of dental practitioners’ assessment of factors contributing to antibiotic resistance. was raised, amoxicillin remained the most commonly used antibiotic in treatment of odontogenic infection for non-penicillin allergic patients (Table 4). Amoxicillin-clavulanate was the second drug of choice after amoxicillin, particularly in treatment of cellulitis. Clindamycin is also a good alternative drug for penicillin allergic individuals. In this study, erythromycin would barely be prescribed by the dental surgeons. The predominant microorganisms involved in odontogenic infections are the viridans streptococci and the anaerobic bacteria, such as: Prevotella, Peptostreptococcus, Porphyromonas and Fusobacterium. Some recent studies demonstrated that many oral bacterial isolates showed resistance to erythromycin and questioned the benefit of this antibiotic in the treatment of severe orofacial infection. 45 Some authors believe that erythromycin is a historical antimicrobial drug in treatment of odontogenic infections and no more exists on the list of the antibiotics to be prescribed for such infections. 46 Metronidazole is one of the drugs of choice in treatment of pericoronitis, however, only 18% of the practitioners would recommend its use and a similar percentage was reported by Salako et al. 20 Metronidazole is only effective against anaerobes. Therefore, it should be used in infections where anaerobic strains are expected. 47 Tetracycline and cephalosporins were the least prescribed antimicrobials. Cephalosporins are not the first-line of treatment of odontogenic infection. 46 Therapy with more than one antibiotic is not uncommon, particularly in treatment of periapical infection, cellulitis and trismus cases. Odontogenic infection is mostly a mixture of facultative and anaerobic microorganisms. Therefore, combination of antibiotics is advocated in certain conditions. Most of the antibiotics used by the dental practitioners are broad spectrum in nature and this enhances the prevalence of antibiotic resistance. It is interesting to see that some dental practitioners, Norwegian dentists for example, rely on narrow spectrum antibiotics and their prescription is conservative and relatively low compared to physicians. 48 Antimicrobials drug resistance is a critical issue for dental professionals. Out of the eight-listed potential contributing factors, widespread use of antibiotics was rated as the most important factor in developing antibiotic resistance (65%). This is followed by the inappropriate duration of antibiotic course and use of broad spectrum antibiotics in order. More than 50% of the respondents thought lack of prescribing guidelines is another significant factor. Despite the inconsistency, recently several guidelines have been published, 49-52 but lack of follow up and updates by the dental practitioners is unfortunately the prevailing scenario. About 41% of the surveyed dental surgeons thought poor access to culture and sensitivity test is another factor. Dental clinics rarely send samples from patients to microbiological laboratory for cultures and antimicrobial susceptibility testing. However, a vast recent retrospective study of odontogenic infections revealed no significant change in the microbiological picture over the last 3-4 decades, 53 and therefore, the current Stoma Edu J. 2017;4(4): 254-263 http://www.stomaeduj.com