Home' News Bulletin : ADA News Bulletin February 2016 Contents You would have to be living under a rock to be unaware of
worldwide concern with overuse of antibiotics and escalating
resistance. Talk of this as a major public health problem has
abounded for over 50 years. Current thinking is that if antibiotic
overuse continues, effectiveness of these vital medicines will be lost
within the next 10-15 years.
The problem is that Australia is one of the highest antibiotic
users in the developed world, with approximately 29 million PBS
prescriptions generated in 2014.
Although 75% of these scripts
were written by medical practitioners, antibiotics are frequently
prescribed by dentists as well, adding further pressure on bacteria
to become resistant.
So what can dentists do to limit antibiotic use in our community?
ANTIBIOTIC USE BY DENTISTS
The first and most important step is for dentists to only prescribe
antibiotics in situations where they will provide substantial benefit,
Tips to curb
and to follow the recommendation in the Therapeutic Guidelines: Oral
and Dental which state “...antibiotics should not be used for dental
pain, pulpitis or infection localised to the teeth, or to delay providing
dental treatment.” Close attention should be paid to the current
recommendations for antibiotic prophylaxis which, for example, no
longer include patients with orthopaedic joint replacements.
Dentists are encouraged to resist the temptation to prescribe
antibiotics as back-up to diagnostic uncertainty or in response to
perceived patient pressure. Research conducted in general practice
has shown that even demanding consumers will accept non-
antibiotic treatment if it is thoroughly explained why no antibiotic
is most appropriate. If you don’t have time to fully explain things to
the patients, a pre-written fact sheet may suffice.5
If prescribing an antibiotic is unavoidable then do so judiciously.
This means prescribing the most appropriate drug, at the right dose
for the right duration. Although the duration of antibiotic therapy
needs to be sufficient to control the infection, prevent relapse and
limit development of resistance, there are few indications for which
the optimal duration of antibiotic treatment is evidence-based. So
the good news is you can relax the mantra that the patient must
always finish the course.
The NPS Medicinewise module on Duration of Antibiotic Therapy and
Resistance states: “There does not appear to be strong evidence
to support the notion that stopping antibiotics before the end of
the recommended treatment contributes to increasing resistance.
Indeed several trials have demonstrated that longer antibiotic
courses are more likely to induce resistance than shorter courses.
So if patients wish to stop their antibiotic early because they are
feeling better, there is probably little harm in them doing so as long
as they are monitored for relapse of their infection.”
It would also help if antibiotic prescribing were guided by culture
and sensitivity tests to ensure the most appropriate antibiotic is
chosen for the specific infection. However, it is understood this is
not always achievable in the dental setting.
Finally, we can limit the presence of antibiotics in the community by
restricting when they can be dispensed. Several tactics can be used
to achieve this, including delaying the script, applying an expiry
date, limiting leftovers and not dispensing them yourself.
Delayed prescriptions are those endorsed with a date after which
you are happy for it to be dispensed. This time delay, usually one
to several days, corresponds to the expected natural history of the
condition during which time the patient might get better anyway.
The patient is advised to wait until that date before having the
prescription dispensed. This strategy has been shown to reduce
dispensing of antibiotic prescriptions by ~60% and to diminish
patients’ beliefs they could only recover with antibiotics.
Ordinarily prescriptions are valid for 12 months from the date
of writing, but by giving it a shorter expiry date such as one
REGULAR | PHARmAADVICE
Open to opportunities
in rural Australia?
TAKE A CLOSER LOOK.
Government grants are available for registered general dentists
who want to work in private practice in a location more regional,
rural or remote than their current location.
Look what’s on offer:
• Relocation grants of $15,000 to $120,000
• Infrastructure grants up to $250,000
The 2016 funding round is open from
22 February–24 March 2016
Dental Relocation and Infrastructure Support Scheme is funded by the
Australian Government and administered by Rural Health Workforce Australia.
To see if you’re eligible:
Freecall: 1800 475 433
28 | ADA NEWS BULLETIN | FEBRUARY 2016
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