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
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