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

Mathur Apoorva¹, Gupta Yogendra Kumar²,  
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

Correspondence Address:
Dr. Mathur Apoorva
Indian Council for Medical Research, New Delhi
India

Full Text



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.

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