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Trends of usage of antimicrobial agents in dental practice on the basis of prescription analysis

Trends of usage of antimicrobial agents in dental practice on the basis of prescription analysis. Oral cavity organisms . more than 400 species Aerobic as well as anaerobic Anerobic 10 – 100 times more Spirochetes, Candida, viral. To deal with -. Dental Caries

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Trends of usage of antimicrobial agents in dental practice on the basis of prescription analysis

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  1. Trends of usage of antimicrobial agents in dental practice on the basis of prescription analysis

  2. Oral cavity organisms • more than 400 species • Aerobic as well as anaerobic • Anerobic 10 – 100 times more • Spirochetes, Candida, viral

  3. To deal with - • Dental Caries • Dentoalveolar abscess, pulp infection, periapical abscess • Gingivitis • Periodontitis – pericoronitis, periodontal abscess, osteomyelitis, peri-implantitis • Deep fascial infection

  4. Indications for Chemotherapeutic Agents • Orodental Infections • To prevent other infections – bacterial endocarditis • To prevent postoperative infection • Improve healing

  5. 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 to determine - • The rationale - indications, adequacy of dosage, and duration of treatment • The adequacy for prophylaxis • The attention given to - contraindications and precautions

  6. Period of study: 01/01/05–06/30/05: 6 months Material: OPD antimicrobial Prescriptions • Data collected from – • TEACHING INSTITUTES: 03 • PRIVATE CLINICS: 30 ¤ SPECIALISTS: 10 ¤ GDP: 20 (General Dental Practitioners)

  7. TEACHING INSTITUTES

  8. PRIVATE CLINICS

  9. TRENDS – Institutes Vs Private

  10. Trends

  11. Other remarkable 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%

  12. Timing of treatment/prophylaxis • Inadequate duration: 19.4% Ciprofloxacin single dose, Amoxicillin 2 days, Ampicillin 2 days • Antibiotic started after the procedure: 61.3%

  13. ORO DENTAL INFECTIONS • Periapical/Periodontal Abscess • Acute Suppurative pulpitis/Toxic cellulitis. • Salivary Gland Sepsis/Sinusitis • Post Surgical/Post Traumatic. • Oro-antral/Oro-nasal Fistula. • Ludwig’s angina/Purulent osteitis • Pericoronitis/Mucositis/Pemphigus

  14. SPECTRUM

  15. Prophylaxis (Prevention) • Bacterial Endocarditis. • Prosthetic Joint Infections. • Immuno-Compromised Hosts. • Procedures and others.

  16. SBE PROPHYLAXIS RECOMMENDED • Extractions, Periodontal procedures • Prophylactic cleaning • Implant placement, Re-implantation • Endodontic Instrumentation/Surgery beyond root apex, Placement or removal of orthodontic bands • Intraligamentary LA

  17. SBE PROPHYLAXIS - 1 (1 hr before procedure) • STANDARD REGIMEN Amoxicillin 2 g • PENICILLIN ALLERGY Clindamycin 600 mg Cephalexin/Cefadroxil 2 gm Clarithromycin/Azithromycin 500 mg

  18. SBE PROPHYLAXIS - 2 30 mins before procedure) • Failure to take P/O Ampicillin 2 gm IM/IV • Penicillin allergy & Failure to take P/O Clindamycin 600 mg IV Cefazolin 1 gm IM/IV

  19. PREFER • CIDAL AGENT, SUSCEPTIBILITY • NARROWEST SPECTRUM • CORRECT DOSING AND ADEQUATE DURATION OF TREATMENT

  20. Inferences • Most commonly prescribed antimicrobials were quinolones in combination with metronidazole and tinidazole (51% ). • Amongst the quinolones, ciprofloxacin and ofloxacin were the quinolones chosen by 95% of the prescribers. • Quinolones – ciprofloxacin, ofloxacin were prescribed alone by 10% prescribers.

  21. 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.

  22. BIBLIOGRAPHY 1. Sudha P et al: Journal of Indian society of Pedodontics and preventive dentistry 23-2 (2005) 74-79 2. Studervant et al: JIDA 64 (1993) 389-392 3. Damle et al: Community dental oral epidemiol:22 (1994) 62-63 4. Dajani et al: Prevention of bact endocarditis recommendations by AHA: JAMA: 277-1997-1794-1801 5. Oral health and morbidity - implications of oral infections on the elderly - Jukka H. Meurman, Piia Hämäläinen GerodontologyVol. 23 Issue 1 Page 3 March 2006

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