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Trends of usage of antimicrobial agents in dental practice on the basis of prescription analysis

Analyzing prescription data from 6 months to understand antimicrobial trends in treating oral cavity infections, including dental caries, abscesses, and periodontal diseases. Comparing institutional and private practice trends, dosage adequacy, and prophylactic measures.

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Trends of usage of antimicrobial agents in dental practice on the basis of prescription analysis

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  1. Trends of usage of antimicrobial agents in dental practice on the basis of prescription analysis

  2. Oral cavity organisms • more than 400 species • Aerobic as well as anaerobic • Anerobic 10 – 100 times more • Spirochetes, Candida, viral

  3. To deal with - • Dental Caries • Dentoalveolar abscess, pulp infection, periapical abscess • Gingivitis • Periodontitis – pericoronitis, periodontal abscess, osteomyelitis, peri-implantitis • Deep fascial infection

  4. Indications for Chemotherapeutic Agents • Orodental Infections • To prevent other infections – bacterial endocarditis • To prevent postoperative infection • Improve healing

  5. Aims of study • To get general idea of prescribing trends • Comparing the trends in institutional practice and private practice • To analyze the prescriptions in order to determine - • The rationale - indications, adequacy of dosage, and duration of treatment • The adequacy for prophylaxis • The attention given to - contraindications and precautions

  6. Period of study: 01/01/05–06/30/05: 6 months Material: OPD antimicrobial Prescriptions • Data collected from – • TEACHING INSTITUTES: 03 • PRIVATE CLINICS: 30 ¤ SPECIALISTS: 10 ¤ GDP: 20 (General Dental Practitioners)

  7. TEACHING INSTITUTES

  8. PRIVATE CLINICS

  9. TRENDS – Institutes Vs Private

  10. Trends

  11. Other remarkable observations • CIPRO IN CHILDREN • Ciprofloxacin ( up to 5 years): 1.3% • Ciprofloxacin ( 5-10 years): 2.7% • Ciprofloxacin ( > 10 years): 3% • Inadequate frequency of admn • Amoxicillin: 250 mg bid: 16.7% • Ampicillin: 250 mg bid: 15%

  12. Timing of treatment/prophylaxis • Inadequate duration: 19.4% Ciprofloxacin single dose, Amoxicillin 2 days, Ampicillin 2 days • Antibiotic started after the procedure: 61.3%

  13. ORO DENTAL INFECTIONS • Periapical/Periodontal Abscess • Acute Suppurative pulpitis/Toxic cellulitis. • Salivary Gland Sepsis/Sinusitis • Post Surgical/Post Traumatic. • Oro-antral/Oro-nasal Fistula. • Ludwig’s angina/Purulent osteitis • Pericoronitis/Mucositis/Pemphigus

  14. SPECTRUM

  15. Prophylaxis (Prevention) • Bacterial Endocarditis. • Prosthetic Joint Infections. • Immuno-Compromised Hosts. • Procedures and others.

  16. SBE PROPHYLAXIS RECOMMENDED • Extractions, Periodontal procedures • Prophylactic cleaning • Implant placement, Re-implantation • Endodontic Instrumentation/Surgery beyond root apex, Placement or removal of orthodontic bands • Intraligamentary LA

  17. SBE PROPHYLAXIS - 1 (1 hr before procedure) • STANDARD REGIMEN Amoxicillin 2 g • PENICILLIN ALLERGY Clindamycin 600 mg Cephalexin/Cefadroxil 2 gm Clarithromycin/Azithromycin 500 mg

  18. SBE PROPHYLAXIS - 2 30 mins before procedure) • Failure to take P/O Ampicillin 2 gm IM/IV • Penicillin allergy & Failure to take P/O Clindamycin 600 mg IV Cefazolin 1 gm IM/IV

  19. PREFER • CIDAL AGENT, SUSCEPTIBILITY • NARROWEST SPECTRUM • CORRECT DOSING AND ADEQUATE DURATION OF TREATMENT

  20. Inferences • Most commonly prescribed antimicrobials were quinolones in combination with metronidazole and tinidazole (51% ). • Amongst the quinolones, ciprofloxacin and ofloxacin were the quinolones chosen by 95% of the prescribers. • Quinolones – ciprofloxacin, ofloxacin were prescribed alone by 10% prescribers.

  21. 4. Inadequacy of the frequency of administration was found in 15-17% prescriptions. • 5. Inadequate duration of treatment was observed in 19.4% prescriptions. • 6. First generation quinolones were prescribed to the children in the range of 1-3% of the prescriptions given for quinolones. • 7. The antimicrobial agent was started AFTER THE PROCEDURE in about 61% cases.

  22. BIBLIOGRAPHY 1. Sudha P et al: Journal of Indian society of Pedodontics and preventive dentistry 23-2 (2005) 74-79 2. Studervant et al: JIDA 64 (1993) 389-392 3. Damle et al: Community dental oral epidemiol:22 (1994) 62-63 4. Dajani et al: Prevention of bact endocarditis recommendations by AHA: JAMA: 277-1997-1794-1801 5. Oral health and morbidity - implications of oral infections on the elderly - Jukka H. Meurman, Piia Hämäläinen GerodontologyVol. 23 Issue 1 Page 3 March 2006

  23. 5. Lin LJ, Chiu GK, Corbet EF. Are periodontal diseases risk factors for certain systemic disorders-what matters to medical practitioners? Hong Kong Med J. 2003;9:31-37. 6. Loesche WJ. Association of the oral flora with important medical diseases. Curr Opin Periodontol. 1997;4:21-28. 7. 1989 World Workshop in Clinical Periodontics. Ann Periodontol. 1999;4:1-112. • 1999 International Workshop for a Classification of Periodontal Diseases and Conditions. Papers. Ann Periodontol. 1999;4:1-112. 8. Evaldson G, Heimdahl A, Kager L, Nord CE. The normal human anaerobic microflora. Scand J Infect Dis Suppl. 1982;35:9-15. 9. Heimdahl A, von Konow L, Satoh T, Nord CE. Clinical appearance of orofacial infections of odontogenic origin in relation to microbiological findings. J Clin Microbiol. 1985;22:299-302. 10. Brook I, Frazier EH, Gher ME. Aerobic and anaerobic microbiology of periapical abscess. Oral Microbiol Immunol. 1991;6:123-125.

  24. 11. Brook I, Hunter V, Walker RI. Synergistic effect of Bacteroides, Clostridium, Fusobacterium, anaerobic cocci, and aerobic bacteria on mortality and induction of subcutaneous abscesses in mice. J Infect Dis. 1984;149:924-928. 12. Namavar F, Verweij-van Vught AMJJ, Vel WAC, Bal M, MacLaren DM. Polymorphonuclear leukocyte chemotaxis by mixed anaerobic and aerobic bacteria. J Med Microbiol. 1984;18:167?172. 13. Namavar F, Verweij AMJJ, Bal M, Martijn van Steenbergen TJ, de Graaf J, MacLaren DM. Effect of anaerobic bacteria on killing of Proteus mirabilis by human polymorphonuclear leukocytes. Infect Immun. 1983;40:930-935. 14. Gibbons RJ, MacDonald JB. Hemin and vitamin K compounds as required factors for the cultivation of certain strains of Bacteroides melaninogenicus. J Bacteriol.1960;80:164-170. 15. Mouton, C., Hammond PG, Slots J, Genco RJ. Serum antibodies to oral Bacteroides asaccharolyticus (Bacteroides gingivalis): relationship to age and periodontal disease. Infect Immun. 1981;31:182-192. 16. Slots J. Microbial analysis in supportive periodontal treatment. Periodontol. 2000;12:56-59.  

  25. 17. Gronbaek Frandsen EV. Bacterial degradation of immunoglobulin A1 in relation to periodontal diseases. APMIS Suppl. 1999.87:1-54. 18. Duerden BI. Virulence factors in anaerobes. Clin Infect Dis. 1994;Suppl 4:S253-S259. 19. Brook I. The role of beta-lactamase-producing bacteria in the persistence of streptococcal tonsillar infection. Rev Infect Dis. 1984;6:601-607. 20. Roos K, Grahn E, Holn SE. Evaluation of beta-lactamase activity and microbial interference in treatment failures of acute streptococcal tonsillitis. Scand J Infect Dis. 1986;18:313-319. 21. Brook I, Gober AE. Emergence of beta-lactamase-producing aerobic and anaerobic bacteria in the oropharynx of children following penicillin chemotherapy. Clin Pediatr. 1984:23:338-341. 22. Tuner K, Nord, CE. Emergence of beta-lactamase producing microorganisms in the tonsils during penicillin treatment. Eur J Clin Microbiol. 1986;5:399-404. 23. Brook I, Gober A. Prophylaxis with amoxicillin or sulfisoxazole for otitis media: effect on the recovery of penicillin-resistant bacteria from children. Clin Infect Dis. 1996;22:143-145.

  26. 24. Brook I, Gober AE. Monthly changes in the rate of recovery of penicillin-resistant organisms from children. Pediatr Infect Dis J. 1997;16:255-257. 25. Brook I, Douma M. Antimicrobial Therapy Guide for the Dentist. Newtown, Pa: Handbooks in Health Care Co.; 2003. 26. Stanford Guide to Antimicrobial Therapy. 33rd ed. Vermont: Antimicrobial Therapy, Inc; 2002. 27. Ehrenfeld M. Clindamycin in the treatment of dental infections. In: Zumbrano D, ed. Clindamycin in the Treatment of Human Infections. 2nd ed. Kalamazoo, Mich: Pharmacia and Upjohn; 1997. 28. Bartlett JG. Clinical practice. Antibiotic-associated diarrhea. N Engl J Med. 2002;346:334-339. 29. Conrads G. DNA probes and primers in dental practice. Clin Infect Dis. 2002;1(Suppl 1):S72-S77. 30. Craig WA. Pharmacokinetic/pharmacodynamic parameters: rationale for antibacterial dosing of mice and men. Clin Infect Dis. 1998;26:1-12. 31. Longman LP, Preston AJ, Martin MV, Wilson NH. Endodontics in the adult patient: the role of antibiotics. J Dent. 2000;28:539-548. 32. Isla A, Canut A, Gascon AR, et al. Pharmacokinetic/pharmacodynamic (PK/PD) analysis of antimicrobial treatment of orofacial odontogenic infections. Clin Pharm. 2003.

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