About 80 percent of antibiotics prescribed before dental procedures to prevent infection are unnecessary, according to a study published in JAMA Network Open. Overuse of antibiotics contributes to bacterial resistance.
The findings suggest dentists, who write one of every ten antibiotic prescriptions, should be part of the discussion on antibiotic stewardship.
Antibiotic Premedication
Antibiotics are medicines that kill or stop the growth of bacteria. They are used to treat many infections, including some dental problems. Taking antibiotics as prescribed helps ensure the medicine works and that you get the right amount of it. Healthcare providers write more than 211 million prescriptions for oral antibiotics to outpatients (people not staying in the hospital) each year. Those antibiotics include medicines like penicillins, cephalosporins, and macrolides.
But some prescriptions are unnecessary, and inappropriate prescribing contributes to antibiotic resistance. For example, an ear infection or sinus infection may be caused by a virus instead of bacteria. A recent study in the journal JAMA found that 6 million antibiotics were written for a sinus infection or ear infection, and that half of those prescriptions were deemed unnecessary because the illness wasn’t caused by bacteria.
To help improve the way doctors prescribe antibiotics, they classify them into groups called classes, and each class has individual medicines that healthcare providers choose to treat particular infections. They also consider factors like how the medicine will work in your body, and how it will interact with other medications you take — for example, some antibiotics can make birth control pills less effective.
Doctors can also use broad-spectrum antibiotics, which target lots of different bacteria at once. In some cases, healthcare providers can even use antibiotics to prevent infections that happen after certain surgeries or procedures, such as some dental procedures.
Preventing Bacterial Infections
Some infections are caused by bacteria, which are microscopic organisms (like viruses and fungi) that live in the body and cause illness. Antibiotics are medicines that fight infection by killing or stopping the growth of bacteria. They may be made from natural products or synthetic (made in a lab).
Harmful bacteria can enter your body through air, water or food, or they can come from an infected person or animal, such as through coughing or close contact. Some infections are contagious and can spread from person to person, including strep throat, pertussis (whooping cough), tuberculosis, meningitis and bacterial sexually transmitted infections.
Healthcare providers diagnose bacterial infections by listening to your symptoms, doing an exam and taking samples to test for bacteria. They may also order X-rays, ultrasound or CT scans to look at your organs and tissues, such as the lungs and brain. In severe cases, healthcare providers can inject or give antibiotics through a tube in your vein (intravenously, or IV).
Health care professionals recommend taking antibiotics exactly as prescribed to decrease the development of resistant bacteria. This means finishing the full course of medication even if you feel better before the prescription expires and not sharing antibiotic medicines with others.
Preventing Infective Endocarditis
The aim of antibiotics is to kill undesired bacteria, but there are times when certain bacteria survive the treatment and become resistant. This means the next time an infection comes along, the antibiotic won’t be as effective as it would have been. This is a big reason why doctors are careful to only prescribe antibiotics when it’s necessary.
Infective endocarditis is an inflammation of the heart’s inner lining. It occurs when bacteria infect a damaged heart valve or the lining of the heart chambers. It can lead to serious complications, including death and heart failure.
Doctors often recommend antibiotic prophylaxis for patients who are at high risk of IE. This includes people with a history of heart valve disease, or who have had a heart transplant or surgery for congenital heart defects. The 2021 American Heart Association guidelines have narrowed the indications for IE prophylaxis, and dentists are now only recommended to give it to patients with certain cardiac conditions.
Despite this, researchers found that most of the time dentists are prescribing antibiotics for premedication, they’re doing it unnecessarily. It’s not clear whether this practice actually prevents IE, but the findings suggest that dentists should be involved in antimicrobial resistance efforts. They may be influenced by colleagues who are less familiar with the latest guidelines or a desire to avoid being held responsible for a patient’s IE, according to the study published in JAMA Network Open.
Preventing Prosthetic Joint Infections
When antibiotics are used, they kill the unwanted bacteria and leave the good bacteria unharmed. Unfortunately, this can also lead to resistant bacteria. When those resistant bacteria survive, they can grow and multiply and become more plentiful, resulting in the medication not working as effectively the next time it is needed. This is why doctors are cautious about prescribing antibiotics unless they are absolutely necessary.
Many studies have focused on physicians and other primary care providers for their prescribing habits in order to curb the growth of antibiotic resistance. However, little is known about dentists’ prescribing practices. This is particularly true with regard to the use of antibiotic prophylaxis.
Dentists typically prescribe antibiotics for patients undergoing certain dental procedures, such as oral surgery. The aim is to prevent the spread of oral bacteria to other parts of the body, which could trigger certain diseases. This is especially important for patients with a weakened immune system.
In the past, it was common practice for dentists to recommend antibiotics for immunocompromised patients prior to invasive dental procedures to protect them from infections such as endocarditis. Nowadays, however, dentists do not routinely prescribe these medications for this reason. Instead, they decolonize patients with MRSA (Methicillin-resistant Staphylococcus aureus) colonization with mupirocin ointment before dental treatment to reduce the risk of infection of orthopedic implant prostheses.
