5c507c75-trends of antimicrobial usage in dental practice

8/8/2019 5c507c75-Trends of Antimicrobial Usage in Dental Practice

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Trends of usage of antimicrobial

agents in dental practice on the

basis of prescription analysis


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Oral cavity organisms

more than 400 species

Aerobic as well as anaerobic

Anerobic 10 100 times more

Spirochetes, Candida, viral


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To deal with -

Dental Caries Dentoalveolar abscess, pulp infection,

periapical abscess

Gingivitis

Periodontitis pericoronitis,

periodontal abscess, osteomyelitis,

peri-implantitis

Deep fascial infection


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Indications for

Chemotherapeutic Agents

OrodentalInfections

To prevent other infections bacterial

endocarditis

To prevent postoperative infection Improve healing


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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 todetermine -

The rationale - indications, adequacy

of dosage, and duration of treatment The adequacy for prophylaxis

The attention given to -

contraindications and precautions


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Period of study: 01/01/0506/30/05:

6 months

Material: OPD antimicrobial Prescriptions

Data collected from

TEACHING INSTITUTES: 03

PRIVATE CLINICS: 30 SPECIALISTS: 10

GDP: 20 (General Dental Practitioners)


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INSTITUTES Prescriptions Total

VPDC, Sangli 1805

TKDC, Kolhapur 910

GMC, Miraj 903

Total 3618

PRIVATE

CLINICS

Specialists 1235

GDP 2740

Total 3975

TOTAL 7593


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TEACHINGINSTITUTES

DRUG 1 2 3 Total ( %)

Penicillins 222 120 419 761 (21%)

Pen + clavulanate 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%)


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PRIVATECLINICS

DRUG SPE GDP TOTAL (%)Penicillins 75 247 322 (8.10%)

Pen+ clavulanate 77 260 337 (8.47%)

Cephalosporin 95 67 162 (4.07%)Quinolone 97 164 261 (6.56%)

Quino + metro/T 805 1661 2466 (62.3%)

Macrolide 34 230 264 (6.64%)

Sulfa/cotrim 16 62 78 (1.96%)

Tetra 8 44 52 (1.3%)

Clindamycin 28 5 33 (0.83%)


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TRENDS Institutes Vs Private

DRUG INSTI PRI TOTAL (%)

Penicillins 761 322 1083 (14.4%)

Pen+clavulanate 404 337 741 (9.83%)

Cephalosporin 105 162 267 (3.54%)Quinolone 495 261 756 (10%)

Quino+metro/T 1390 2466 3856 (51.2%)

Macrolide 226 264 490 (6.5%)Sulfa/cotrim 136 78 214 (2.84%)

Tetra 62 52 114 (1.51%)

Clindamycin 39 33 72 (0.95%)


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Trends

INSTITUTES PRIVATE TOTAL

Quinolone +

metronidazole/T

38.41% 62.3% 51.18%

Penicillins 21% 8.10% 14.37%

Quinolone alone 13.68% 6.56% 10.03%

Penicillin +

clavulanate

11.16% 8.47% 9.83%

Macrolides 6.24% 6.64% 6.5%


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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%


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Timing of

treatment/prophylaxis Inadequate duration: 19.4%

Ciprofloxacin single dose,Amoxicillin 2 days, Ampicillin 2days

Antibiotic started after theprocedure: 61.3%


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ORO DENTALINFECTIONS Periapical/Periodontal Abscess

Acute

Suppurative pulpitis/

Toxiccellulitis.

Salivary Gland Sepsis/Sinusitis

PostSurgical/PostTraumatic.

Oro-antral/Oro-nasal Fistula.

Ludwigs angina/Purulent osteitis

Pericoronitis/Mucositis/Pemphigus


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SPECTRUM

MACROLIDE

CLINDA CEPHA

AMPI/AMOXY

PEN G/PEN V

ORODENTAL

INFECTIONS


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Prophylaxis (Prevention)

1. Bacterial

Endocarditis.2. Prosthetic Joint

Infections.

3. Immuno-Compromised

Hosts.

4. Procedures and others.


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SBE PROPHYLAXIS

RECOMMENDED

Extractions, Periodontal procedures Prophylactic cleaning

Implant placement, Re-implantation EndodonticInstrumentation/Surgery beyond

root apex, Placem

ent or rem

oval oforthodontic bands Intraligamentary LA


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SBEPROPHYLAXIS - 1

(1 hr before procedure) STANDARDREGIMEN

Amoxicillin2 g

PENICILLINALLERGY

Clindamycin 600 mg

Cephalexin/

Cefadroxil

2gm

Clarithromycin/Azithromycin 500mg


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SBEPROPHYLAXIS - 2

30 mins beforeprocedure)

Failure totake P/O

Ampicillin2 gmIM/IV

Penicillinallergy & Failure totake P/O

Clindamycin 600 mg IV

Cefazolin 1 gmIM/IV


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PREFER

CIDALAGENT,SUSCEPTIBILITY

NARROWESTSPECTRUM

CORRECTDOSINGANDADEQUATEDURATION OFTREATMENT


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Inferences1. Most commonly prescribed

antimicrobials were quinolones in

combination with metronidazole and

tinidazole (51% ).2. Amongst the quinolones, ciprofloxacin

and ofloxacin were the quinolones

chosen by 95% of the prescribers.

3. Quinolones ciprofloxacin, ofloxacin

were prescribed alone by 10%

prescribers.


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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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5c507c75-trends of antimicrobial usage in dental practice

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