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 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)

INSTITUTES Prescriptions Total

VPDC, Sangli 1805

TKDC, Kolhapur

910

GMC, Miraj 903

Total 3618

PRIVATE CLINICS

Specialists 1235

GDP 2740

Total 3975

TOTAL 7593

TEACHING INSTITUTES

DRUG 1 2 3 Total ( %)

Penicillins 222 120 419 761 (21%)

Pen + clavulanate

215 52 137 404 (11.16%)

Cephalosporin 52 16 37 105 (2.9%)

Quinolone 237 135 123 495 (13.68%)

Quino + metro/T 820 475 95 1390 (38.4%)

Macrolide 118 63 45 226 (6.24%)

Sulfa/cotrimoxazole

95 19 22 136 (3.7%)

Tetra 37 20 5 62 (1.71%)

Clindamycin 9 10 20 39 (1.07%)

PRIVATE CLINICS

DRUG SPE GDP TOTAL (%)

Penicillins 75 247 322 (8.10%)

Pen+ clavulanate

77 260 337 (8.47%)

Cephalosporin 95 67 162 (4.07%)

Quinolone 97 164 261 (6.56%)

Quino + metro/T

805 1661 2466 (62.3%)

Macrolide 34 230 264 (6.64%)

Sulfa/cotrim 16 62 78 (1.96%)

Tetra 8 44 52 (1.3%)

Clindamycin 28 5 33 (0.83%)

TRENDS – Institutes Vs Private DRUG INSTI PRI TOTAL (%)

Penicillins 761 322 1083 (14.4%)

Pen+clavulanate

404 337 741 (9.83%)

Cephalosporin 105 162 267 (3.54%)

Quinolone 495 261 756 (10%)

Quino+metro/T

1390 2466 3856 (51.2%)

Macrolide 226 264 490 (6.5%)

Sulfa/cotrim 136 78 214 (2.84%)

Tetra 62 52 114 (1.51%)

Clindamycin 39 33 72 (0.95%)

Trends

INSTITUTES

PRIVATE

TOTAL

Quinolone + metronidazole/T

38.41% 62.3% 51.18%

Penicillins 21% 8.10% 14.37%

Quinolone alone

13.68% 6.56% 10.03%

Penicillin + clavulanate

11.16% 8.47% 9.83%

Macrolides 6.24% 6.64% 6.5%

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 1. Most commonly prescribed

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

2. Amongst the quinolones, ciprofloxacin and ofloxacin were the quinolones chosen by 95% of the prescribers.

3. Quinolones – ciprofloxacin, ofloxacin were prescribed alone by 10% 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 of 1-3% of the prescriptions given for quinolones.

7. The antimicrobial agent was started AFTER THE PROCEDURE in about 61% cases.

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