The prescribing of antibiotics for endodontic infections by dentists in Turkey: a comprehensive survey

Aim To investigate the antibiotic prescribing patterns for endodontic infections based on the reports of Turkish dentists. Methodology A survey consisting of 20 questions on general information and 13 questions on antibiotic prescribing patterns for endodontic cases was delivered to the e-mail addresses of general dentists and specialists via the database of the Turkish Dental Association. Collected data were analysed using Mc-Nemar-Bowker Test and multivariate ordinal logistic regression tests at the significance level of 0.05. Results A total of 1007 responses were obtained from 17 827 dentists. The majority of the participants were general dental practitioners (GDP, 80%) whilst 8% were Endodontists. Gender, clinical experience, affiliations and speciality were significant risk factors for antibiotic prescription (P < 0.05). GDPs prescribed antibiotics twice as much as all specialists and members of public hospitals prescribed antibiotics three times more than specialists and clinical academics (P < 0.05). Amoxicillin with clavulanic acid was the most prescribed antibiotic (90%), followed by Ornidazole (25%). Clindamycin was the drug of choice for the patients with penicillin allergy (59%). Infection and fever control (76%), prophylaxis (44%) and avoiding swelling and trismus during endodontic treatment (26%) were the most common reasons for antibiotic prescriptions. Completing a course of prescribed antibiotics was recommended by most (75%). Infective endocarditis, immunosuppression, artificial heart valve and mitral valve prolapse were the main causes of prophylaxis in descending order. Uncontrolled and extensive use of antibiotics by patients (62%) was mentioned as the most effective reason for antibiotic resistance. Up to 10% of participants prescribed antibiotics for symptomatic irreversible pulpitis, asymptomatic apical periodontitis with or without endodontic treatment (8, 12 and 11%, respectively). Up to 20% of dentists prescribed antibiotics for symptomatic apical periodontitis when the pulp was vital or necrotic (13 and 23%, respectively). Almost one third of the participants prescribed antibiotics for symptomatic apical periodontitis of previously treated teeth with or without radiographic lesions whilst 34% prescribed antibiotics for acute apical abscess with localized swelling without systemic involvement. Conclusions The majority of dentists reported they prescribed antibiotics inappropriately. It is necessary to improve the knowledge of dentists about antibiotics and their indications in endodontics

Patterns of drugs prescribed for dental outpatients in Nigeria: findings and implications.

There are concerns with inappropriate prescribing of medicines among dentists especially antimicrobials. It is more concerning if this increases resistance rates. This study aimed to address this by assessing patterns of drugs prescribed for outpatients attending a hospital dental clinic in Nigeria. The findings will be used to plan future interventions, particularly around antimicrobial prescribing, where there are concerns.Medical records of patients attending the dental clinic of a leading teaching hospital in Nigeria were evaluated. Patients referred for admission, without a prescription, or prescribed medicines without a documented diagnosis were excluded.Overall, 607 prescriptions were analysed, 314 (51.7%) were for females. Periodontal and gum diseases (414; 68.1%) were the most frequent diagnoses, followed by pulpitis (49; 8.2%), and dentoalveolar abscess (43; 7.1%). A total of 1798 medicines were prescribed for all patients with a mean of 3.0 ± 0.48 medicines per prescription. Antimicrobials (1178; 65.5%) and analgesics (620; 34.5%) were the two drug classes prescribed. Ascorbic acid and vitamin B complex were prescribed for 361 (59.5%) patients. Among antimicrobials, amoxicillin (564; 95.1%) either alone or combined with clavulanic acid was the most frequently prescribed, followed by metronidazole (561; 94.6%). Brand name prescribing was also appreciably higher than WHO recommendations.Polypharmacy, brand name prescriptions, and the frequent prescription of antimicrobials were common practices at the dental clinic of this teaching hospital in Nigeria. We suggest a review of the current standard treatment guidelines in Nigeria to guide dentists on current knowledge- and evidence-based treatment of common oral diseases

Enterococcus faecium and Enterococcus faecalis in endodontic infections: antibiotic resistance profile and susceptibility to photodynamic therapy

Introduction: Enterococcus faecium has become an important microorganism in nosocomial infections with great ability to acquire antibiotic resistance. However, little is known about their presence on the oral cavity. Therefore, our objective was to verify the presence of E. faecium and E. faecalis in endodontic infections and compare their susceptibility to conventional antibiotics and photodynamic therapy. Methods: We performed 38 collections from the root canals of different patients. Positive Enterococcus agar samples were submitted to phenotypic and genotypic testing for species-specific confirmation. The isolates identified as E. faecium and E. faecalis were tested for susceptibility to antibiotics by the E-test method. After that, the isolates were evaluated for susceptibility to photodynamic therapy (PDT) using methylene blue and gallium arsenide aluminum laser with a wavelength of 660 nm and fluence of 39.5 J/cm2 (energy of 15 J and time of 428 s). Results: Cultures positive for E. faecalis were found in 22 patients (58%). Among these patients, only two had E. faecium in mixed infections with E. faecalis. In the isolates of E. faecalis, 27% were resistant to antibiotics, including tetracycline, ciprofloxacin, and azithromycin. The isolates of E. faecium showed no resistance to the antibiotics tested. Both the isolates of E. faecium and E. faecalis exhibit significant susceptibility to PDT, including the isolates resistant to antibiotics. The reductions achieved by PDT ranged of 2.76 to 4.31 log10 for E. faecalis strains and of 3.93 to 4.33 log10 for E. faecium strains. Conclusion: E. faecium showed lower prevalence in endodontic infections and higher susceptibility to antibiotics when compared to E. faecalis. In in vitro assays, PDT had a significant antimicrobial activity for both strains.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Department of Biosciences and Oral Diagnosis Institute of Science and Technology UNESP–Univ Estadual Paulista, Francisco José Longo 777, São Dimas, SPDepartment of Restorative Dentistry Institute of Science and Technology UNESP–Univ Estadual Paulista, SPDepartment of Biosciences and Oral Diagnosis Institute of Science and Technology UNESP–Univ Estadual Paulista, Francisco José Longo 777, São Dimas, SPDepartment of Restorative Dentistry Institute of Science and Technology UNESP–Univ Estadual Paulista, SPFAPESP: 2011/10071-