Attitudes of dental practitioners towards antimicrobial therapy in Croatia and Bosnia and Herzegovina

Abstract

Introduction:The objective of this study was to assess perceptions and attitudes amongst dental practitioners in relation to antibiotic usage and antibiotic resistance. Methods: Self-administered questionnaire was given to dental practitioners employed in south Croatia, west Herzegovina and Sarajevo, Bosnia and Herzegovina (N = 115).Results: 81.7% of respondents agreed the usage of antimicrobials is frequently uncritical and unnecessary. 83.5% of dental practitioners reported that they have used guidelines in their practice; however, only 9 out of 115 stated valid guidelines. Onethird of the respondents agreed or were undecided that the usage of antimicrobials in every oral inflammatory process treatment is justified. Furthermore, 13% was undecided and 26% agreed that pregnant women and breastfeeding women should not use any antimicrobials. However, three quarters of respondents considered they had satisfactory knowledge on antimicrobials. Discussion:The respondents considered they had satisfactory knowledge on antimicrobials, which was in contrast to the knowledge shown, but also expressed the need for additional education. Therefore, adequate measures include the creation of the local guidelines, their implementation, and updating the practitioners' knowledge on antibiotic use and resistance through continuous educational courses.

Antibiotic Prescribing in Dental Medicine—Best Practices for Successful Implementation

“…Antimicrobials are inappropriately prescribed in many instances for conditions that are mainly inflammatory and not infectious, i.e., acute apical periodontitis, alveolar osteitis, or irreversible pulpitis, as cited from one study [ 35 ]. This is in line with data from Croatia and Bosnia and Herzegovina, where one third of those surveyed considered antimicrobials to be warranted in every oral inflammatory process [ 32 ]. This suggests the importance of stopping to think about the second D of rational antibiotic prescription: the question that should be asked is whether or not an antibiotic really is indicated for the patient’s dental condition.…”

“…This was also true in a study from Croatia and Bosnia and Herzegovina, where the surveyed dentists believed that excessive or unnecessary antibiotic use was less frequent in dental practice than in other branches of medicine [ 32 ]. Furthermore, in this study, most respondents recognized that unnecessary antibiotic use can be harmful (88.7%), but only half of them (56.5%) also recognized that appropriate antibiotic use can also contribute to AMR [ 32 ].…”

“…On a wider level, doctors, dentists, and veterinarians surveyed in Australia tended to externalize the responsibility of AMR and believed that the other professional categories played more important roles than their own in driving AMR [48]. This was also true in a study from Croatia and Bosnia and Herzegovina, where the surveyed dentists believed that excessive or unnecessary antibiotic use was less frequent in dental practice than in other branches of medicine [32]. Furthermore, in this study, most respondents recognized that unnecessary antibiotic use can be harmful (88.7%), but only half of them (56.5%) also recognized that appropriate antibiotic use can also contribute to AMR [32].…”

“…It is encouraging to see that, in many settings, most dentists are open to receiving information regarding proper antimicrobial use [ 25 , 32 , 38 , 45 , 47 ] and AMR [ 25 , 38 , 47 ], and some go as far as mentioning that this “should be as important as getting your 60 h of CPD every two or three years” [ 47 ] and that if clinically relevant updates to non-dental guidelines are released, the information should also be sent to dentists [ 25 ]. Otherwise, antibiotic training is considered by dentists to be slightly out of the scope of dentistry, which makes it quite unlikely that they would find out about changes in other fields of practice [ 25 , 47 ], even though these changes can also have repercussions on their own practice.…”

Knowledge, attitudes and behaviors on antimicrobial resistance among general public across 14 member states in the WHO European region: results from a cross-sectional survey

“…There are several quantitative and qualitative studies conducted to investigate public knowledge, attitudes, and behaviors (KAB) on antibiotic use and AMR, mainly among EU/EEA Member States in the Region and sporadically among some other Member States in the Region (16)(17)(18)(19)(20)(21)(22)(23). Since 2009, the European Commission (EC) has administered a periodic survey among the general public in EU/EEA Member States to monitor the levels of usage of, and knowledge about, antibiotics and most recently conducted the survey in 2022 (24).…”