Oral antibiotic prescription patterns for dental conditions at two public sector hospitals in Pietermaritzburg, KwaZulu-Natal
DOI:
https://doi.org/10.17159/2519-0105/2022/v77no2a5Keywords:
discrepancies, AntimicrobialAbstract
Antibiotic resistance is a growing public health concern. Yet, there is a paucity of published data in KwaZulu-Natal on antibiotic prescription trends and patterns related to dental use. The objectives of this study were to identify the range of dental conditions for which oral antibiotics are prescribed at two public health settings (Institution A and B) in the Pietermaritzburg Complex, KwaZulu-Natal and to explore practitioner understanding of the indications for antibiotic prescription for dental conditions. The study used a two-phased approach and collected a combination of qualitative and quantitative data. Phase 1 comprised a retrospective clinical chart review (n=720), while phase 2 comprised a focus-group discussion with purposively selected health care practitioners at each
institution. The results of the retrospective clinical chart review indicated that dental abscesses were the most common dental
infections requiring oral antibiotic therapy (n= 479; 66%), followed by acute alveolar osteitis (dry socket) (n=110; 15%),
dental impactions (n=78; 11%) and dental extractions (n=62; 9%). At Institution A, antibiotic therapy was prescribed for conditions such as trismus (n=13; 6%), soft palate swelling of unspecified origin (n=9; 4%), fibrous epulis (n=6; 3%) and acute herpes simplex (n=2; 1%). Interestingly, antibiotics were not prescribed at Institution B for the same dental conditions. Antibiotic therapy was also prescribed for eruption pain (n=4; 1%) and for cases when patients did not bring their inhaler for asthma treatment (pump) (n=3; 1%). The findings from the focus-group discussions suggested that there is a need to improve practitioner understanding of the indications for
antibiotic prescriptions for dental conditions. This study showed some differences in antibiotic therapy prescription patterns at the two public health institutions, especially for dental conditions that did not require such management. This suggests a need for consensus building among health professionals and the provision of more dedicated guidance for antibiotic prescription in the management of dental conditions.
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References
Farley, E., Stewart, A., Davies, M.A., Govind, M., Van den Bergh, D. and Boyles, T.H. (2018). Antibiotic use and resistance: Knowledge, attitudes and perceptions among primary care prescribers in South Africa. SAMJ: South African Medical Journal, 108(9), pp.763-771. DOI: https://doi.org/10.7196/SAMJ.2018.v108i9.12933
O'Neill, J. (2019). Tackling drug-resistant infections globally: final report and recommendations: the review on antimicrobial resistance; 2016 [Available from: https://amr-review. org. Publications. html.
Lalloo, R., Solanki, G., Ramphoma, K. and Myburgh, N.G. (2016). Antibiotic‐prescribing patterns of South African dental practitioners following tooth extractions. Journal of Investigative and Clinical Dentistry, 8(4), p.e12247
Schellack, N., Benjamin, D., Brink, A., Duse, A., Faure, K., Goff, D., Mendelson, M., Meyer, J., Miot, J., Perovic, O. and Pople, T. (2017). A situational analysis of current antimicrobial governance, regulation, and utilization in South Africa. International journal of infectious diseases, DOI: https://doi.org/10.1016/j.ijid.2017.09.002
, pp.100-106.
Mainjot, A., D’hoore, W., Vanheusden, A. and Van Nieuwenhuysen, J.P.(2009). Antibiotic prescribing in dental practice in Belgium. International endodontic journal, 42(12), pp.1112-1117. DOI: https://doi.org/10.1111/j.1365-2591.2009.01642.x
Mthethwa, S.R. and Matjila, S.A. (2018). Antibiotic prescribing practices of dentists at Medunsa Oral Health Centre. South African Dental Journal, 73(8), pp.520-526. DOI: https://doi.org/10.17159/2519-0105/2018/v73no8a6
Matthews, D.C., Sutherland, S. and Basrani, B. (2003). Emergency management of acute apical abscesses in the permanent dentition: a systematic review of the literature. Journal of the Canadian Dental Association, 69(10), pp.660. In Database of Abstracts of Reviews
of Effects (DARE): Quality-assessed Reviews [Internet]. Centre for Reviews and Dissemination (UK).
Lalloo, R., Solanki, G., Ramphoma, K. and Myburgh, N.G. (2016). Antibiotic‐prescribing patterns of South African dental practitioners following tooth extractions. Journal of Investigative and Clinical Dentistry, 8(4), p.e12247 DOI: https://doi.org/10.1111/jicd.12247
National Department of Health of South Africa (2017). Guidelines on the Implementation of the Antimicrobial Strategy in South Africa: One Health Approach and Governance. Ministerial Advisory Committee on Antimicrobial Resistance, National Department of Health Affordable Medicines Directorate, Department of health, RSA, June 2017.
Standard Treatment Guidelines and the Essential Medicines List (2020). Available at: http://www.kznhealth.gov.za/pharmacy/PHC-STG-2020.pdf
Perumal-Pillay, V.A. and Suleman, F. (2017). Selection of essential medicines for South Africa-an analysis of indepth interviews with national essential medicines list committee members. BMC health services research, 17(1), p.17. DOI: https://doi.org/10.1186/s12913-016-1946-9
Huang, W.H. and Owen, C.P. (2012). Antibiotic prophylaxis for dental procedures: is it necessary? Clinical review. South African Dental Journal, 67(7), pp.413-419.
Ntšekhe, M., Hoohlo-Khotle, N., Tlali, M. and Tjipura, D. (2011). Antibiotic prescribing patterns at six hospitals in Lesotho. Submitted to the US Agency for International Development by the Strengthening Pharmaceutical Systems (SPS) Program. http://apps.who.int/
medicinedocs/
documents/s21028en/s21028en.pdf) Accessed on 16 June2020.
Thomas, J. and Harden, A. (2008). Methods for the thematic synthesis of qualitative research in systematic reviews. BMC medical research methodology, 8(1), pp.45. DOI: https://doi.org/10.1186/1471-2288-8-45
Bazeley, P. (2009). Analysing qualitative data: More than ‘identifying themes’. Malaysian Journal of Qualitative Research, 2(2), pp.6-22.
Dookie, S., Singh, S. and Myburgh, N.G. (2017). Analysis of district oral health services in KwaZulu-Natal. African Population Studies, 31(2), pp.3683-3693 DOI: https://doi.org/10.11564/31-2-1041
Braun, V. and Clarke, V. (2006). Using thematic analysis in psychology. Qualitative research in psychology, 3(2), 90 > RESEARCH www.sada.co.za / SADJ Vol. 77 No. 2pp.77-101. DOI: https://doi.org/10.1191/1478088706qp063oa
Creswell, J.W. and Creswell, J.D. (2017). Research design: Qualitative, quantitative, and mixed methods approaches. 4th edition, Sage publications.
Mandal, P. (2018). Qualitative research: Criteria of evaluation. International journal of academic research and development, 3(2), pp.591-596.
Bertani, A., Di Paola, G., Russo, E. and Tuzzolino, F. (2018). How to describe bivariate data. Journal of thoracic disease, 10(2), p.1133-1137. DOI: https://doi.org/10.21037/jtd.2018.01.134
Long, S.S. (2016). Optimizing antimicrobial therapy in children. Journal of Infection, 72, pp.S91-S97. DOI: https://doi.org/10.1016/j.jinf.2016.04.028
Olsen, I. and van Winkelhoff, A.J. (2014). Acute focal infections of dental origin. Periodontology 2000, 65(1), pp.178-189. DOI: https://doi.org/10.1111/prd.12018
Dar-Odeh, N.S., Abu-Hammad, O.A., Al-Omiri, M.K., Khraisat, A.S. and Shehabi, A.A. (2010). Antibiotic prescribing practices by dentists: a review. Therapeutics and clinical risk management, 6, p.301-306. DOI: https://doi.org/10.2147/TCRM.S9736
Kuriyama, T., Absi, E.G., Williams, D.W. and Lewis, M.A.O. (2005). An outcome audit of the treatment of acute dentoalveolar infection: impact of penicillin resistance. British dental journal, 198(12), pp.759-763. DOI: https://doi.org/10.1038/sj.bdj.4812415
Lodi, G., Figini, L., Sardella, A., Carrassi, A., Del Fabbro, M. and Furness, S. (2012). Antibiotics to prevent complications following tooth extractions (Review). Cochrane Database Syst Rev. DOI: https://doi.org/10.1002/14651858.CD003811.pub2
Sidana, S., Mistry, Y., Gandevivala, A. and Motwani, N. (2017). Evaluation of the need for antibiotic prophylaxis during routine intra-alveolar dental extractions in healthy patients: a randomized double-blind controlled trial. Journal of Evidence Based Dental Practice, 17(3), pp.184-189. DOI: https://doi.org/10.1016/j.jebdp.2017.04.007
Pallasch, T.J. (2003). Antibiotic resistance. Dental Clinics, 47(4), pp.623-639. DOI: https://doi.org/10.1016/S0011-8532(03)00039-9
Gould, F.K., Elliott, T.S.J., Foweraker, J., Fulford, M., Perry, J.D., Roberts, G.J., Sandoe, J.A.T. and Watkin, R.W. (2006). Guidelines for the prevention of endocarditis: report of the Working Party of the British Society for Antimicrobial Chemotherapy. Journal of antimicrobial chemotherapy, 57(6), pp.1035-1042. DOI: https://doi.org/10.1093/jac/dkl121
Wilson, W., Taubert, K.A., Gewitz, M., et. al. (2007). Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and
Outcomes Research Interdisciplinary Working Group. Circulation, 116(15), pp. 1736-1754.
Jankelow, D., Cupido, B., Zuhlke, L., Sliwa, K., Ntsekhe, M., Manga, P., Doubell, A., Lawrenson, J. and Essop, M.R. (2017). Prevention of infective endocarditis associated with dental interventions: South African Heart Association position statement, endorsed by the DOI: https://doi.org/10.24170/14-3-2716
South African Dental Association. SA Heart Journal, 14(3), pp.170-174.
Chambers, J.B., Shanson, D., Hall, R., Pepper, J., Venn, G. and McGurk, M. (2011). Antibiotic prophylaxis of endocarditis: the rest of the world and NICE. Journal of the Royal Society of Medicine, 104(4) pp.138-40. DOI: https://doi.org/10.1258/jrsm.2011.100356
Sanderson S. (2019). A Piece on the need for global guidance on antibiotic stewardship in dentistry.AMR Control, FDI 120, 27July.
Lewis, M.A.O. (2008). Why we must reduce dental prescription of antibiotics: European Union Antibiotic Awareness Day. British dental journal, 205(10), pp.537-538. DOI: https://doi.org/10.1038/sj.bdj.2008.984
Perić, M., Perković, I., Romić, M., Simeon, P., Matijević, J., Prpić Mehičić, G. and Jukić Krmek, S. (2015). The pattern of antibiotic prescribing by dental practitioners in Zagreb, Croatia. Central European journal of public health, 23(2), pp.107-113. DOI: https://doi.org/10.21101/cejph.a3981
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