Alexander Fleming warned the world against Antimicrobial Resistance (AMR) as early as 1945. Sadly, it seems that his words went widely unheeded until the turn of the century, when the threat of AMR became very real and started spreading from healthcare settings to communities.
There are several factors that contribute to the escalation of AMR, such as globalisation, the routine feeding of antibiotics to livestock, and the pharmaceutical industry’s disinclination to invest in the development of newer antimicrobials. But one major contributing factor to AMR that healthcare professionals have direct influence over is the prescription of antibiotics.
In the chief medical officer’s Annual Report published in 2013, it was stated that evidence clearly links the widespread use of antibiotics to the selection of resistant organisms.
Although not all antibiotic prescriptions are provided by dental practitioners, the existing inappropriate prescription of antibiotics in dentistry still needs to be addressed.
In 2004, a survey of over 6,000 GDPs revealed that 40 per cent of dentists prescribe antibiotics on at least three occasions every week, and that 15 per cent prescribe such medications on a daily basis.
Another study conducted with more than 1,500 GDPs from England’s NHS roster suggested that a significant number of dentists routinely and inappropriately prescribe antibiotics for prophylactic use. Evidence from the same study also showed that a number of GDPs prescribe antibiotics for clinical procedures and medical conditions for which there is little evidence.
The fight against AMR needs to be a consolidated, global effort, as the UK Five Year Antimicrobial Resistance Strategy published in 2013 recognises.
As prescribers of antibiotics, dental care professionals have a major role to play in the implementation of the strategy’s main points of action:
? Improve the knowledge and understanding of AMR.
? Conserve and steward the effectiveness of existing treatments.
There are several ways in which dental care professionals can cut down on their prescription of antibiotics. On November 20, 2013, the FGDP sent out a press release urging practitioners to apply a responsible approach to antibiotic prescribing.
Through this bulletin the organisation also reminded dental practitioners that the majority of uncomplicated dental swellings can be resolved by drainage of the associated abscess, and that dental surgical skills should always be considered before defaulting to antibiotic prescription.
Another example in which routine antibiotic prescription can be cut down is in the treatment of periodontitis. Most dentists will automatically prescribe metronidazole or amoxicillin as adjuncts to scaling and root planing (SRP) in the treatment of advanced gum disease. But in light of the grave threats of AMR it may be time for other therapies to be considered.
Dental care professionals who are looking for effective non-antibiotic adjuncts to periodontal treatment can turn to effective alternatives such as PerioChip, a small, rounded device indicated for insertion in periodontal pockets that are at least 5mm deep.
There is no alternative product in the market that can match the high local concentrations of chlorhexidine that PerioChip delivers. The broad-spectrum antiseptic in this formulation is clinically effective at eliminating 99 per cent of subgingival periopathogenic bacteria without the risk of antibiotic resistance.
Dental care professionals have an important role to play in the fight against AMR. By looking to their clinical skills and considering antibiotics only when absolutely necessary, the overuse of the drugs can slowly be stopped, and AMR arrested in its rapid and alarming development.
References available on request.