Download ANTIBIOTIC REVOLUTION

Trends of usage of antimicrobial
agents in dental practice on the
basis of prescription analysis
Oral cavity organisms

more than 400 species

Aerobic as well as anaerobic

Anerobic 10 – 100 times more

Spirochetes, Candida, viral
To deal with 




Dental Caries
Dentoalveolar abscess, pulp infection,
periapical abscess
Gingivitis
Periodontitis – pericoronitis,
periodontal abscess, osteomyelitis,
peri-implantitis
Deep fascial infection
Indications for
Chemotherapeutic Agents




Orodental Infections
To prevent other infections – bacterial
endocarditis
To prevent postoperative infection
Improve healing
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
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)
INSTITUTES
Prescriptions
VPDC, Sangli
1805
TKDC, Kolhapur
910
GMC, Miraj
903
Total 
PRIVATE
CLINICS
Specialists
1235
GDP
2740
Total
3618
Total
3975
TOTAL
7593
TEACHING INSTITUTES
DRUG
1
Penicillins
222
Pen + clavulanate
2
3
Total ( %)
120
419
761 (21%)
215
52
137
404 (11.16%)
Cephalosporin
52
16
37
105 (2.9%)
Quinolone
237
135
123
495 (13.68%)
Quino + metro/T
820
475
95
1390 (38.4%)
Macrolide
118
63
45
226 (6.24%)
Sulfa/cotrimoxazole 95
19
22
136 (3.7%)
Tetra
37
20
5
62 (1.71%)
Clindamycin
9
10
20
39 (1.07%)
PRIVATE CLINICS
DRUG
Penicillins
Pen+ clavulanate
Cephalosporin
Quinolone
Quino + metro/T
Macrolide
Sulfa/cotrim
Tetra
Clindamycin
SPE
75
77
95
97
805
34
16
8
28
GDP
247
260
67
164
1661
230
62
44
5
TOTAL
322
337
162
261
2466
264
78
52
33
(%)
(8.10%)
(8.47%)
(4.07%)
(6.56%)
(62.3%)
(6.64%)
(1.96%)
(1.3%)
(0.83%)
TRENDS – Institutes Vs Private
DRUG
Penicillins
Pen+clavulanate
Cephalosporin
Quinolone
Quino+metro/T
Macrolide
Sulfa/cotrim
Tetra
Clindamycin
INSTI
761
404
105
495
1390
226
136
62
39
PRI
322
337
162
261
2466
264
78
52
33
TOTAL (%)
1083 (14.4%)
741
(9.83%)
267
(3.54%)
756
(10%)
3856 (51.2%)
490
(6.5%)
214
(2.84%)
114
(1.51%)
72
(0.95%)
Trends
INSTITUTES
PRIVATE TOTAL
Quinolone +
38.41%
metronidazole/T
Penicillins
21%
62.3%
51.18%
8.10%
14.37%
Quinolone alone
13.68%
6.56%
10.03%
Penicillin +
clavulanate
Macrolides
11.16%
8.47%
9.83%
6.24%
6.64%
6.5%
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%
Timing of
treatment/prophylaxis
Inadequate duration: 19.4%
Ciprofloxacin single dose,
Amoxicillin 2 days, Ampicillin 2
days


Antibiotic started after the
procedure: 61.3%
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
SPECTRUM
PEN G/
PEN V
AMPI/
AMOXY
MACROLIDE
ORODENTAL
INFECTIONS
CLINDA
CEPHA
Prophylaxis (Prevention)
1.
2.
3.
4.
Bacterial
Endocarditis.
Prosthetic Joint
Infections.
Immuno-Compromised
Hosts.
Procedures and others.
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
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
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
PREFER

CIDAL AGENT, SUSCEPTIBILITY

NARROWEST SPECTRUM

CORRECT DOSING AND
ADEQUATE DURATION OF
TREATMENT
Inferences
1.
2.
3.
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.




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.
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