Prescription Pattern of Antimicrobial Agents Among Dental Practitioners in a Tertiary Care Centre in North India

Abstract

Objective: The purpose of the study was to find out the pattern of antimicrobial prescription among dental practitioners in a tertiary care center in North India. Methods:A total of 100 prescriptions of the patients attending the various dental outpatient departments of Ziauddin Ahmad Dental College, Aligarh Muslim University were collected and tabulated between January 2016 and June 2016. An observational study was done on the obtained prescriptions on various aspects like dental pathology for which antimicrobial were prescribed, antimicrobial agents used for management of acute and chronic conditions along with their dose and duration. Compliance of the patients during therapy and adverse effects associated with the regimen was also taken into consideration, and the final data were expressed as counts and percentages.Results: Out of a total of 100 patients, 54 (54.0%) were males while females were numbered as 46 (42.0%) with maximum distribution of the patients between 31 and 40 years. On analysis, the most commonly presented dental condition for which antimicrobials were prescribed were acute/chronic periodontitis (48%), acute/chronic gingivitis (32%), caries (11%), post root canal treatment (4%), pericoronitis (3%), oral trauma (1%), and other condition (1%). For the management of above conditions, antimicrobials were the most extensively used agents which were prescribed for only 3-5 days which may not be sufficient, followed by analgesics and antimicrobial mouthwashes. Among the antimicrobials used, most frequently used agents were amoxicillin (50%) followed by ornidazole (21%), ofloxacin (20%), doxycycline (16%), cefixime (9%), and ciprofloxacin (3%) used either alone or in combination for the management of acute and chronic conditions. Only two patients were advised for culture and sensitivity tests before antimicrobial therapy because of noncompliance of patients. The majority (74%) of patients completed the prescribed regimen of antimicrobials while 7 patients reported adverse drug reactions (ADRs), among which most common were nausea and vomiting. Conclusions:In our study, we found that the periodontal diseases were the most frequently reported conditions followed by acute/chronic gingivitis for which antimicrobials were prescribed while amoxicillin and ornidazole were the most commonly used antimicrobials for the management of various acute and chronic dental conditions, but were prescribed without culture and sensitivity in most cases. 7% patients reported ADRs. To conclude appropriate measures are to be promoted for rational prescribing and ADR reporting.

Antibiotic Use and Misuse in Dentistry in India—A Systematic Review

“…Fourteen studies [ 38 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 ] assessed the prescribing rates for antibiotics by examining either prescription audits or dental outpatient hospital case records of patients. In 13 of these studies, the prescribers were dentists or dental specialists, while one study [ 38 ] examined the prescribing rate of informal healthcare providers for dental problems.…”

“…The study setting was reported clearly as involving both urban and rural populations in one study [ 47 ], as rural in 6 studies (three prescription audits [ 38 , 48 , 52 ] and three self-medication audits [ 60 , 61 , 63 ]), and as urban in 16 (nine prescription audits [ 45 , 49 , 50 , 51 , 53 , 54 , 55 , 56 , 57 ], six self-medication audits [ 58 , 59 , 64 , 65 , 66 , 88 ], and one survey [ 87 ]). In the remaining 27 studies, the study setting was unclear.…”

“…Of the 49 studies assessed using the AXIS tool, six studies were judged as having a low risk of bias [ 35 , 47 , 59 , 63 , 72 , 85 ], fifteen studies [ 34 , 38 , 48 , 53 , 57 , 58 , 60 , 62 , 64 , 70 , 78 , 83 ] were judged as having a moderate risk of bias and twenty-eight studies [ 33 , 45 , 46 , 47 , 49 , 50 , 51 , 52 , 54 , 55 , 56 , 61 , 67 , 68 , 69 , 71 , 73 , 74 , 75 , 76 , 77 , 79 , 80 , 81 , 82 , 84 , 89 , 90 ] were judged as having a high risk of bias. The qualitative study satisfied seven out of ten criteria of the JBI Critical appraisal tool.…”

Study to Assess the Drug Consumption and Rationality in the Prescription of Outpatients Undergoing Periodontal Treatment

“…The most common antibiotic for dental patients was found to be amoxicillin in some other Indian studies as well. Ravichandran et al 17 , Kaul et al 18 and Suhaib et al 19 Agossa et al 20 26 documented that the most commonly prescribed antibiotic was Amoxicillin. However, according to Aly et al 27 Deniz-Sungur et al 28 Javed et al 29 and Shrestha et al 30 , the most often prescribed antibiotic was amoxicillin & clavulanic acid combination.…”