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

Oral cavity organisms

400 more than species

Aerobic as well as anaerobic

10 – 100 Anerobic times more

, , Spirochetes Candida viral

To deal with - Dental Caries , , Dentoalveolar abscess pulp infection

periapical abscess Gingivitis – , Periodontitis pericoronitis

, , periodontal abscess osteomyelitis-peri implantitis

Deep fascial infection

Indications for Chemotherapeutic Agents

Orodental Infections To prevent other infections – bacterial

endocarditis To prevent postoperative infection Improve healing

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

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)

7593TOTAL

3975Total

2740GDP

1235Spec ialis ts

PRIVATECLINICS

3618 Total

903, GMC Miraj

910, TKDC Kolhapur

1805, VPDC Sangli

Total Pres criptions INSTITUTES

TEACHING INSTITUTES

39 (1.07%)

62 (1.71%)

136 (3.7%)

226 (6.24%)

1390 (38.4%)

495 (13.68%)

105 (2.9%)

404 (11.16%)

761 (21%)

Total ( %)

20

5

22

45

95

123

37

137

419

3

109Clindamycin

2037Tetra

1995Sulfa/cotrimoxazole

63118Macrolide

475820Quino + metro/T

135237Quinolone

1652Cephalosporin

52215Pen + clavulanate

120222 Penicillins

21 DRUG

PRIVATE CLINICS

33 (0.83%)528Clindamycin 52 (1.3%)448Tetra 78 (1.96%)6216Sulfa/cotrim264 (6.64%)23034Macrolide2466 (62.3%)1661805Quino + metro/T261 (6.56%)16497Quinolone162 (4.07%)6795Cephalosporin337 (8.47%)26077Pen+ clavulanate322 (8.10%)24775 PenicillinsTOTAL (%)GDPSPE DRUG

TRENDS – Institutes Vs Private

72 (0.95%)3339Clindamycin 114 (1.51%)5262Tetra 214 (2.84%)78136Sulfa/cotrim490 (6.5%)264226Macrolide3856 (51.2%)24661390Quino+metro/T756 (10%)261495Quinolone267 (3.54%)162105Cephalosporin741 (9.83%)337404Pen+clavulanate1083 (14.4%)322761 PenicillinsTOTAL (%)PRIINSTI DRUG

Trends

6 .5%6.64%6.24% Macrolides

9 .8 3%8.47%11.16% + Penicillinclavulanate

1 0 .0 3%6.56%13.68% Quinolone alone

1 4 .3 7%8.10%21% Penicillins

5 1 .1 8%62.3%38.41% + Quinolone/metronidazole T

TOTALPRIVATEINSTITUTES

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%

Timing of treatment/prophylaxis

Inadequate duration: 19.4%Ciprofloxacin single dose,

Amoxicillin 2 days, Ampicillin 2 days

Antibiotic started after the procedure: 61.3%

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

SPECTRUM

MACROLIDE

CLINDA CEPHA

AMPI/AMOXY

PEN G/PEN V

ORODENTALINFECTIONS

Prophylaxis (Prevention)

1. Bacterial Endocarditis.

2. Prosthetic Joint Infections.

3. Immuno-Compromised Hosts.

4. Procedures and others.

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

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

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

PREFER CIDAL AGENT, SUSCEPTIBILITY

NARROWEST SPECTRUM

CORRECT DOSING AND ADEQUATE DURATION OF TREATMENT

Inferences Most commonly prescribed antimicrobials

were quinolones in combination with (51% ).metronidazole and tinidazole

Amongst , the quinolones c iprofloxacin andofloxacin were the quinolones chosen by95% .of the prescribers

Quinolones – , ciprofloxacin ofloxacin were prescribed 10%alone by .prescribers

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 of1-3% of the prescriptions given for

.quinolones 7. The antimicrobial agent was started

AFTER THEPROCEDURE in about 61% .cases

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