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Antimicrobial resistance and antibiotic prescribing in dental practice

From Volume 43, Issue 10, December 2016 | Pages 954-960

Authors

Nikolaus O A Palmer

BDS, MFGDP(UK), PhD, FDS RCSEng, FFGDP(UK)

Research Fellow and Clinical Adviser in Dental Education Health Education England North West, Honorary Lecturer, School of Dentistry, University of Liverpool, Pembroke Place, Liverpool L3 5PS, UK (nikolaus.palmer@me.com)

Articles by Nikolaus O A Palmer

Abstract

The purpose of this paper is to review the principles of antibiotic prescribing in light of the increasing worldwide problem of antimicrobial resistance and the evidence of inappropriate use of antibiotics in dentistry. Guidance on the management of dental infections and antibiotic prophylaxis based on a review of the scientific evidence will be given to ensure good patient care.

CPD/Clinical Relevance: To discuss the relevance of legislation around antimicrobial prescribing and antimicrobial stewardship for dentists.

Article

Dentists prescribe antibiotics to manage oral and dental infections. The benefits of prescribing antibiotics are, however, limited by a number of problems associated with their use, eg side-effects, allergic reactions, toxicity and the development of resistant strains of microbes.1

Within the last few decades antimicrobial resistance (AMR) has become a worldwide problem and constitutes a major threat to public health. The Chief Medical Officer recently highlighted the level of this threat by describing it as ‘a ticking time bomb’ that should be put on the government's national risk register along with terrorism.2 AMR has increased as a result of widespread use providing greater opportunity for bacteria to exchange genetic material, so that resistant genes can spread between bacterial populations. The indiscriminate prescribing of antibiotics by healthcare professions continues to be targeted as a major factor to be addressed,2 especially as fewer and fewer new antibiotics are being developed. Although there are new agents in development, no new class of antibiotic has been brought into clinical use since the 1980s. As antibiotics become less effective, the healthcare gains such as organ/stem cell transplants, major surgery and chemotherapy, will be lost, leaving these patients with a higher risk of mortality. It is estimated that 700,000 people die of antibiotic resistant infections each year and that, by 2050, the cumulative global cost will be 30 million lives and between $60 and $100 trillion.3

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