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Antimicrobial stewardship in dental practice

Dr. Alina Bogomolova, Maxillofacial surgeon, Arkhangelsk Regional Clinical Hospital, Russia

ArkhangelskRegionalClinicalHospital

Arkhangelskregionalclinicaldentalpolyclinic

} Arkhangelskregionalclinicaldentalpolyclinicconsistsofthemainbuildingand2branches.Alltypesofdentalaidarerepresentedintheclinicexceptpedodontics.Therearedentaltherapy,oralsurgeryandprostheticdepartments.Alsotherearespecialistsintreatmentofthediseasesoforalmucosaandprophylaxisoforaldiseases.InadditiontothemedicalaidtheclinicistheeducationalbaseforstudentsoftheNSMU.

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Background

-Antibioticresistanceisaseriousproblemforpatientsandhealthsystemsbecauseinfectionscausedbyantibiotic-resistantbacteriacanleadtohigherratesofillnessanddeath.-Resistancetoantibacterialmedicinesoftenoccursbecauseantibioticsareusedwhentheyarenotneeded.

- Antibioticsareusedtotreatbacterialinfectionsindentalpracticealso.Manybacteriahavebecomeresistanttoantibioticsovertime.

Aimofthestudy

Toanalyzeusingofantibioticsindentalpractice bydentistsofvariousspecialtiesintheCircumpolarRegion

MethodsandmaterialsThisstudywasconductedduringMarch2018. Atotalof63dentistsofvariousspecialties(dentists,oralsurgeons,maxillofacialsurgeons),whovolunteeredforthisstudy,wasinterviewed byquestionnaireinRussian,whichwasdesignedbyresearchersthemselves.Thequestionnairehadthreesections.Thefirstpresentedsocialstatusofrespondents,thesecondsectionanalyzed tacticsoftreatment andthethirdsectionassessedtheknowledgeoftherespondentsaboutantibioticprescribingpractices.

Sample ofthestudy

33,9%

64,4%

1,7%

Belongingtoamedicalorganization

Private clinic State clinic University clinic

28,8%

71,2%

Distributionbygender

Male Female

23,8%

36,5%

25,4%

9,5%

4,8%

Distributionbyage

20-24 y.o.

25-29 y.o.

30-39 y.o.

40-49 y.o.

> 50 y.o.

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Sample ofthestudyDentalspecialty

45,80%

25,40%

16,90%

11,90%General practice dentist

Dental therapist

Oral surgeon

Maxillofacial surgeon

43,3%

18,3%5,1%

14,0%

10,0%

8,3%

Seniorityinspecialty

1-2 years 3-5 years

6-9 years 10-14 years

15-20 years > 20 years

Resultsofthestudy

GuideforprescribingantibioticsTrainingprogramRecommendationsofexperiencedcolleaguesRecommendationsofpharmacistDatafrommedicalliteratureOwnexperienceoftreatmentAdvertisementofmedicinesOthers

23 (37,1%)7 (11,3%)

13 (21%)

11 (17,7%)7 (11,3%)

3 (4,8%)

0 5 10 15 20 25

University program

Internship

Residency

Training program

Thematic seminars

Never

Trainingforprescribingantibiotics

Resultsofthestudy

Dentistry MaxillofacialSurgery

Therapeuticdentistry

Diffuseinflammation

Acutepurulentperiostitis

Acuteulcerativegingivitis

Lymphadenitis Fractureofthemandible

Acuteperiapicalprocess

Afever withcommonsymptomsofinflammation

Phlegmones andabscessesofthemaxillofacialarea

Chronicperiodontitis intheacutestage

Antibiotictreatmentisnecessary

Resultsofthestudy} Non-clinicalfactorsrequiringantibioticsprescribing} Preventionofinflammatorycomplicationsbeforesurgery} Deferredtreatment

} Dentalinterventionsrequiringprescriptionofantibacterialmedicaments

} Complicatedtoothextraction} Dentalimplantation} Endodontictreatment(inthepresenceofcomplications)

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Resultsofthestudy

Highrisk ofspreadofinfection

Moderaterisk ofspreadofinfection

Lowrisk ofspreadofinfection

Infectiousendocarditisinanamnesis (64,5%)

HIV/AIDS (28,3%) Presenceofapacemaker(23,7%)

HIV/AIDS (48,4%) Infectiousendocarditis inanamnesis (26,7%)

HIV/AIDS (22%)

Patientsonimmunosuppressivetherapy (38,7%)

Patientsonimmunosuppressivetherapy (23,3%)

Patientswithdifferenttransplants(23.3%)

Coronaryarterybypassgraft(20,3%)

Compliantdiseasesofpatientsrequiring theprescriptionofantibioticsResultsofthestudy} Antibacterialmedicinesthatshouldbeusedwithaprovenallergytopenicillinantibiotics} Modernmacrolides (57,4%)} Cephalosporins 3-5generations (31,1%)} Lincosamides (27,9%)} Fluoroquinolones (27,9%)} Cephalosporins 1-2 generations (8,2%)} Vancomycin (8,2%)} Carbapenems (6,6%)} Difficulttoanswer (21,3%)

ResultsofthestudyPatientswhichhaveahighriskofantibioticresistance

Intakeofanantibioticinthelast3monthsIntakeofanantibioticwithinthelast6monthsPresenceofinfectiousdiseasesDiabetesCardiovasculardiseasesSurgicalinterventions(operations)carriedoverthelast3monthsDifficulttoanswer

Resultsofthestudy

Penicillins Macrolides Fluoroquinolones

Dyspepticphenomena(72,1%)

Dyspepticphenomena(46,7%)

Neurotoxicity(52,5%)

Fungaldiseases(37,7%)

Difficulttoanswer(38,3%)

Fungaldiseases(40,7%)

Hepatotoxicity(27,9%)

Hepatotoxicity(33,3%)

Difficulttoanswer(40,7%)

Sideeffects

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Resultsofthestudy} Thedurationofantibiotictherapy

} 5-7days (68,9%)} alwaysdifferent (19,7%)} 7-10 days (16,4%)

} Theneedformicrobiologicalanalysis} iftheinitialantibacterialtherapyisineffective (55,7%)} Always (32,8%)

Resultsofthestudy} Antibacterialtherapyisineffective

} nopositivedynamicsduring48hours (47,5%)} nopositivedynamicsduring72 hours (39,3%)} nopositivedynamicsduring24 hours (11,5%)

} Actionsiftheinitialantibacterialtherapyisineffective} Changethestartingantibiotictoamedicineofanothergroup (63,9%)

ResultsofthestudyCombinationsofantimicrobialmedicines

Fluoroquinolonesandnitrofurans

Penicillins andaminoglycosides

Penicillins andpenicillins

Aminoglycosidesandaminoglycosides

Cephalosporins andmetronidazole

Сephalosporins andfluoroquinolones

Difficulttoanswer

Conclusions} Theeducationinprescriptionofantibacterialmedicinesisincludedintheuniversityprogram,inpostgraduateperiodknowledgebecomefragmental

} Generalpracticedentistsprescribeantibiotics(accordingtoobtaineddata)incasesofdiffuseinflammation,lymphadenitis,feverwithcommonsymptomsofinflammation.Dentaltherapists– incaseofacuteulcerativegingivitis,acuteperiapicalprocess,chronicperiodontitisintheacutestage.Maxillofacialsurgeonsassumethatantibioticsshouldbegivenincaseofacutepurulentperiostitis,fractureofthemandible,phlegmones andabscessesofthemaxillofacialarea

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} Questionsrelatedtogroupsofantibacterialmedicines,theircombinationsandsideeffectscausedthemostofdifficultiesinanswering

} Practicingdentistsgobymedicalliteraturedataandrecommendationsofthemoreexperiencedcolleaguestouseantibioticsintheirdailywork

} Inaccordancewithobtaineddata,wecandeducethatthereisaneedfordevelopmentofunifiedclinicalrecommendationsinantibioticsprescription

Thank you for attention!