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 Table of Contents    
LETTER TO THE EDITOR
Year : 2021  |  Volume : 53  |  Issue : 2  |  Page : 180-181
 

Antimicrobial prescribing in dental practice during COVID 19: Its impact on antimicrobial resistance


1 Scientist C, Div. of RBMCH, Indian Council of Medical Research (ICMR), New Delhi, India
2 Principal Advisor India Strategy Development – Global Antibiotic Research and Development Partnership (GARDP), Drugs for Neglected Diseases Initiative (DNDi), New Delhi, India

Date of Submission17-Apr-2021
Date of Decision01-May-2021
Date of Acceptance10-May-2021
Date of Web Publication26-May-2021

Correspondence Address:
Dr. Mathur Apoorva
Indian Council for Medical Research, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijp.ijp_303_21

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How to cite this article:
Apoorva M, Kumar GY. Antimicrobial prescribing in dental practice during COVID 19: Its impact on antimicrobial resistance. Indian J Pharmacol 2021;53:180-1

How to cite this URL:
Apoorva M, Kumar GY. Antimicrobial prescribing in dental practice during COVID 19: Its impact on antimicrobial resistance. Indian J Pharmacol [serial online] 2021 [cited 2021 Jun 15];53:180-1. Available from: https://www.ijp-online.com/text.asp?2021/53/2/180/316946




India has one of the highest incidences of bacterial infections in the world. The threat of antimicrobial resistance (AMR) has been brewing for several years and has emerged as a public health emergency in India. AMR, if not managed effectively, and on priority, will wipe out all gains over decades of scientific innovations and advances. Inappropriate and irrational antibiotic prescribing are major drivers of AMR.[1]

Antimicrobial agents are frequently prescribed by dental practitioners for conditions like osteomyelitis, acute necrotizing ulcerative gingivitis, maxillofacial fractures, space infections, acute dentoalveolar abscess with signs of systemic involvement.[2] However, many prescribe antibiotics even in conditions which may not necessitate their use such as chronic periodontitis, uncomplicated dental extractions, acute pulpitis, gingivitis, dry socket, and tooth fractures.[3] Such unwarranted use of antimicrobials because of the dentist's perception of preventing infection, reducing post-operative complications, or as an alternative to providing aseptic conditions during dental procedures, can contribute to increase in AMR.[4]

The COVID-19 has become the worst global pandemic of the century. This has also influenced the pattern of patients seeking dental treatment and dentists providing dental care.[5] An anonymized questionnaire-based survey was conducted, inviting responses from 200 dental practitioners from different cities across the country (National Capital Region; Mumbai; Calcutta; Chennai; Hyderabad; Lucknow; Manipal; Chandigarh; Guwahati; Jammu; Jaipur; Trivandrum and Pondicherry) to study the impact of COVID-19 pandemic on the pattern of antibiotic prescription. Some were also telephonically interviewed. The survey form consisted of open-ended questions pertaining to two domains: Part A consisted of questions related to conditions were antibiotics were prescribed; most commonly prescribed antibiotics; and what determined their choice with respect to its dose, duration, and frequency. Part B consisted of, questions related to antimicrobial prescribing during the ongoing COVID -19 pandemic. Dental practitioners were asked if there was any change in choice of antibiotic, frequency, dose, and duration of prescribing antibiotics and how frequently were the medications prescribed (including antibiotics) based on virtual consultations if any.

Of the 200 dental practitioners, 38% (76) responded. This small survey revealed no perceptible change in the choice of antibiotic prescribed. The commonly prescribed antibiotics in order of frequency were amoxicillin + clavulanic acid (47%), amoxicillin (32%), and metronidazole (12%). Lesser prescribed antibiotics included ofloxacin, ornidazole, azithromycin, and cefixime (<10%). However, the frequency of antibiotic prescribing was significantly increased.

It was interesting to note that, there have been dental consultations through the virtual medium (telephonic/video calls) owing to the COVID-19 restrictions in the country. In such cases, the dental practitioners mainly prescribed analgesic and anti-inflammatory drugs. However, 15% also prescribed antimicrobial agents. Furthermore, most of the dental practitioners said they had not considered the issue of AMR at the time of prescribing.

In conclusion, we can say that the rational use of antibiotics by dentists can play an important role in minimizing the development of AMR. Moreover, this concept has gained more importance during the current pandemic, as it is evident, that antibiotic prescribing has increased significantly. An “antibiotic stewardship program” using the synergistic approach of creating awareness is required among dental practitioners, along with patient education and strengthening of the regulatory system by following appropriate guidelines for antimicrobial prescribing.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kumar SG, Adithan C, Harish BN, Sujatha S, Roy G, Malini A. Antimicrobial resistance in India: A review. J Nat Sci Biol Med 2013;4:286-91.  Back to cited text no. 1
    
2.
Fine DH, Hammond BF, Loesche WJ. Clinical use of antibiotics in dental practice. Int J Antimicrob Agents 1998;9:235-8.  Back to cited text no. 2
    
3.
Konde S, Jairam LS, Peethambar P, Noojady SR, Kumar NC. Antibiotic overusage and resistance: A cross-sectional survey among pediatric dentists. J Indian Soc Pedod Prev Dent 2016;34:145-51.  Back to cited text no. 3
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4.
Oberoi SS, Dhingra C, Sharma G, Sardana D. Antibiotics in dental practice: How justified are we. Int Dent J 2015;65:4-10.  Back to cited text no. 4
    
5.
Bhanushali P, Katge F, Deshpande S, Chimata VK, Shetty S, Pradhan D. COVID-19: Changing Trends and Its Impact on Future of Dentistry. Int J Dent; [8817424] 2020. Available from: https://doi.org/10.1155/2020/8817424. [cited in 2021 May 17].  Back to cited text no. 5
    




 

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