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 Table of Contents  
ORIGINAL ARTICLES
Year : 2015  |  Volume : 2  |  Issue : 3  |  Page : 127-129

Knowledge regarding antibiotic drug action and prescription practices among dentist in Jaipur city, Rajasthan


Department of Public Health Dentistry, NIMS Dental College, Jaipur, Rajasthan, India

Date of Web Publication19-Nov-2015

Correspondence Address:
Dushyant Pal Singh
Department of Public Health Dentistry, NIMS Dental College, Jaipur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2348-2915.169827

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  Abstract 

Introduction: Dentists prescribe antibiotics routinely to manage oral and dental infections. Unscrupulous antibiotic prescriptions can be associated with unfavorable side effects and the development of resistance. Thus, the aim of this study was to assess the level of knowledge regarding antibiotic prescription use among dentists in Jaipur City, Rajasthan. Materials and Methods: A questionnaire survey was conducted among 300 dentists in Jaipur city. A validated, self-designed, 21-item, closed-ended questionnaire was used to collect data on knowledge regarding antibiotic prescription. Descriptive statistics were calculated. Results: A total of 300 dental practitioners were included in the study. The majority of the respondents seem to prescribe antibiotics that are broad spectrum or the ones that are commonly used. A considerable percentage of the respondents were not aware of the pregnancy drug risk categories by Food and Drug Administration. The most of the respondents said that they prescribe antibiotics on the basis of the diagnosis, whereas more than two-thirds of the respondents said that they never advise culture sensitivity test before prescribing the antibiotics. Conclusion: Our findings suggest the knowledge of dentists regarding antibiotic prescription is inadequate and more focus should be given to the ongoing training regarding the pharmacological aspects, pertinent medical conditions, and prophylactic use of antibiotics in dentistry.

Keywords: Antibiotics, dentists, microbial resistance


How to cite this article:
Singh DP, Sampath N, Mahuli AV, Yadav H, Mahuli SA, Yadav R. Knowledge regarding antibiotic drug action and prescription practices among dentist in Jaipur city, Rajasthan. J Dent Res Rev 2015;2:127-9

How to cite this URL:
Singh DP, Sampath N, Mahuli AV, Yadav H, Mahuli SA, Yadav R. Knowledge regarding antibiotic drug action and prescription practices among dentist in Jaipur city, Rajasthan. J Dent Res Rev [serial online] 2015 [cited 2019 Oct 23];2:127-9. Available from: http://www.jdrr.org/text.asp?2015/2/3/127/169827


  Introduction Top


Antibiotics play a vital role in dental practice for prevention of disease and therapeutic use. Antibiotics prevent diseases caused by various microorganisms at host sites in the oral cavity or distant sites due to spread of infection. In most cases, therapeutic antibiotics are prescribed to treat diseases of oral cavity (hard and soft tissue) after local treatment has failed. Endodontic, oral surgical, and periodontal infections call for the use of antibiotics. Rational of use of antibiotics in dental practice needs reasoning and knowledge regarding the selection of right antibiotics for the cause.[1],[2]

In dentistry, antibiotics are used for the prevention of life-threatening disease and to cease postoperative infections. Penicillin is the first line of drug in treating odontogenic infections as they are sensitive to Gram-positive aerobes, intraoral anaerobes, organisms found in alveolar abscess, periodontal abscess, and necrotic pulps. Aerobic and anaerobic microorganisms are sensitive to penicillin.[3]

The prescription of antibiotics by the majority of the dentists is vastly on empirical basis without the need for antibiotics many times just to prevent unpleasant complications and prophylactic purpose. Belief that most of the oral diseases are infectious stimulates dentists for prescribing of antibiotics.[4]

The right choice of antibiotic during anaerobic or aerobic infections is another major cause of concern in general practice. There is evidence that antibiotics are prescribed inappropriately in general dental practice with the increasing worldwide problem of antimicrobial resistance, and the threat to public health, there is a need to rationalize the prescribing of antibiotics.[5] The understanding of rational for the use of antibiotics in pregnant females is important for the safety of the fetus.[5],[6]

This study was carried out to assess the knowledge regarding antibiotic prescription use among dental practitioners in Jaipur city, Rajasthan.


  Materials and Methods Top


A cross-sectional study was conducted to assess the knowledge regarding antibiotic drug action and prescription practices among dentist in Jaipur city, Rajasthan. A total sample size of 300 was calculated based on the pilot study conducted. A pilot study was conducted on a sample size of 20 subjects to check the feasibility of the study. Convenient sampling technique was used. Practicing dentist in Jaipur city registered with Indian Dental Association and dentists in the academic institution were considered as study samples. Incomplete questionnaires were excluded from the study sample. A closed-ended questionnaire with 21-item including the demographic details of the study subjects was designed. The self-designed questionnaire was checked for face, content, and construct validity (Cronbach's alpha value 0.91). There was a single investigator.

Ethical clearance for the study was obtained by the Institutional ethical committee. The study took place approximately for a period of 3 months. Voluntary informed written consent was obtained from participant dentist after explanation of the nature of the study. Descriptive statistics were used to assess the knowledge of the respondents.


  Results Top


The filled questionnaires were collected with a response rate of 93%. A total of 159 (57%) of the respondents were MDS (had Master degree in Dental Specialty), 54.8% of the participants were male, 63.8% of the dental practitioners prescribed broad-spectrum antibiotics [Table 1], amoxicillin, and metronidazole were the most commonly prescribed antibiotics. 40.5% of the practitioners preferred erythromycin when patients were allergic to amoxicillin. Doxycycline and metronidazole were the antibiotics of choice for periodontal infections. Amoxicillin and metronidazole are the preferred antibiotics for apical periodontitis [Graph 1]. 53.3% preferred amoxicillin during pregnancy as a safer antibiotic [Graph 2]. More than 40% of the practitioners were ignorant about the Food and Drug Administration (FDA) categories of safe drugs in pregnancy. Amoxicillin was the most commonly used antibiotic for prophylactic measures. Around 45.5% of practitioners reported self-medication being done by their patients [Graph 3]. 84.2% of the dental practitioners were aware about the antibiotic drug resistance. However, the knowledge on the choice of antibiotics in Gram-positive were 51.6% used amoxicillin + metronidazole and Gram-negative microorganisms were 34.4% used amoxicillin + metronidazole thus the empirical line of treatment was followed. When asked about the prescription of antibiotics in pediatrics 81.4% responded, on the basis of weight/age. Less than 40% advised culture sensitivity [Table 2]. 53.4% of practitioners felt the patients actually compile with the instructions of taking antibiotics and report cases of adverse events. 97.8% of the dentist was aware of the drug interactions and antibiotics to be or not to be prescribe during systemic conditions.
Table 1: Distribution of prescribe according to antibiotics/antibiotics regime

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Table 2: Distribution of culture sensitivity test before prescribing the antibiotics

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  Discussion Top


The questionnaire investigated the dentists' knowledge of antimicrobial usage in clinical dentistry. Al-Huwayrini et al., have suggested that 29% of antimicrobial usage in clinical dentistry has no rational basis.[7] As indicated by Epstein et al., conscientious utilization of antibiotics is basic for all experts, particularly when considering the quick advancement of antibacterial resistance and the disturbing outcomes of this pattern.[8]

The greater part of the dental practitioner utilized broad spectrum antibiotics (63.8%) in this study. There is impressive assertion that the beta-lactam derivatives are the antibiotics agents of choice for these procedures gave there are no allergy or intolerances. However, there is a fewer consensus regarding which drug belonging this family should be prescribed.

Amoxicillin + metronidazole were recommended antibiotics for apical periodontitis by the dental practitioner. Berini and Gay consider the regular and semisynthetic penicillins (amoxicillin) to be the choices of the first decision, others Maestre-Vera lean toward the association amoxicillin-clavulanate, because of the developing number of bacterial resistance, and additionally its broad spectrum, pharmacokinetic profile, tolerance, and dosing attributes.[7],[8],[9]

In this study, more than half of the dental specialist recommended amoxicillin antibiotic agents as a more secure medication during pregnancy. According to FDA pregnancy safety category, most antibiotic agents that are generally endorsed by dental specialists are class B drugs (amoxicillin), except for tetracycline and its subordinates (e.g., doxycycline), which are in classification D as a result of their impacts on developing teeth and bone. Ciprofloxacin, a broad spectrum fluoroquinolone antibiotic used to treat periodontal disease associated with Actinobacillus actinomycetemcomitans, is in class C. Its utilization in pregnancy has been limited in view of arthropathy and adverse effect in cartilage development observed in immature animals. There is insufficient information to absolutely focus its security in humans. Metronidazole is in class B. A few authors alert against its utilization in the first trimester as a result of potential harm to the embryo; recent studies show no teratogenic effects.[10],[11]

Investigations have revealed that many oral microbes such as Streptococcus spp., Prevotella spp., Fusobacterium spp., Haemophilus spp., Veillonella spp., Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, and Actinomyces have developed resistance to many antibiotics.[12] 54.5% patients were not self-medicated, 84.2% of dentist were aware of antibiotic resistance.

Self-medication is an alarming concept. In developing country such as India where we have poor economic status, education status, as well as poor health care facilities. People have less knowledge regarding risks associated with their self-medication.[13]


  Conclusion Top


This study emphasizes the rationale of the use of antibiotics in the dental practice, there are many areas in which the practitioners needs to be educated and have to be made aware of various guidelines. The following are the outcomes of the study:

  • The majority of the dentist used broad spectrum antibiotics based on the diagnosis of the condition, rather than microorganism specific antibiotics
  • The knowledge on the safe antibiotics to be used during pregnancy was not satisfactory
  • Practitioners reported a large number of patients doing self-medication.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Demirbas F, Gjermo PE, Preus HR. Antibiotic prescribing practices among Norwegian dentists. Acta Odontol Scand 2006;64:355-9.  Back to cited text no. 1
    
2.
Ocek Z, Sahin H, Baksi G, Apaydin S. Development of a rational antibiotic usage course for dentists. Eur J Dent Educ 2008;12:41-7.  Back to cited text no. 2
    
3.
Ramu C, Padmanabhan TV. Indications of antibiotic prophylaxis in dental practice- review. Asian Pac J Trop Biomed 2012;2:749-54.  Back to cited text no. 3
    
4.
Löffler C, Böhmer F, Hornung A, Lang H, Burmeister U, Podbielski A, et al. Dental care resistance prevention and antibiotic prescribing modification-the cluster-randomised controlled DREAM trial. Implement Sci 2014;9:27.  Back to cited text no. 4
    
5.
Palmer NA, Dailey YM, Martin MV. Can audit improve antibiotic prescribing in general dental practice? Br Dent J 2001;191:253-5.  Back to cited text no. 5
    
6.
Kumar KP, Kumar PU. Antibiotic prescribing habits of dental surgeons in Hyderabad city, India, for pulpal and periapical pathologies: A survey. Adv Pharmacol Sci 2013;26:1-4.  Back to cited text no. 6
    
7.
Al-Huwayrini L, Al-Furiji S, Al-Dhurgham R, Al-Shawaf M, Al-Muhaiza M. Knowledge of antibiotics among dentists in Riyadh private clinics. Saudi Dent J 2013;25:119-24.  Back to cited text no. 7
    
8.
Epstein JB, Chong S, Le ND. A survey of antibiotic use in dentistry. J Am Dent Assoc 2000;131:1600-9.  Back to cited text no. 8
    
9.
Poveda Roda R, Bagan JV, Sanchis Bielsa JM, Carbonell Pastor E. Antibiotic use in dental practice. A review. Med Oral Patol Oral Cir Bucal 2007;12:E186-92.  Back to cited text no. 9
    
10.
Köhler M, Meyer J, Linder M, Lambrecht JT, Filippi A, Kulik Kunz EM. Prescription of antibiotics in the dental practice: A survey of dentists in Switzerland. Schweiz Monatsschr Zahnmed 2013;123:748-59.  Back to cited text no. 10
    
11.
Giglio JA, Lanni SM, Laskin DM, Giglio NW. Oral health care for the pregnant patient. J Can Dent Assoc 2009;75:43-8.  Back to cited text no. 11
    
12.
Manjunath BC. Antibiotic stewardship among dentists: The need of the hour! Indian J Dent Res 2013;24:155-6.  Back to cited text no. 12
    
13.
Bennadi D. Self-medication: A current challenge. J Basic Clin Pharm 2013;5:19-23.  Back to cited text no. 13
    



 
 
    Tables

  [Table 1], [Table 2]



 

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