Clinical Trial Details
— Status: Not yet recruiting
Administrative data
NCT number |
NCT04795518 |
Other study ID # |
antibiotic misues |
Secondary ID |
|
Status |
Not yet recruiting |
Phase |
|
First received |
|
Last updated |
|
Start date |
June 1, 2021 |
Est. completion date |
June 1, 2022 |
Study information
Verified date |
March 2021 |
Source |
Cairo University |
Contact |
ahmed M EL-Gendy, BDS |
Phone |
00201092524899 |
Email |
ahmed_abdo[@]dentistry.cu.edu.eg |
Is FDA regulated |
No |
Health authority |
|
Study type |
Observational
|
Clinical Trial Summary
The aim of this study is to determine the pattern of antibiotic prescription for children
among a group of pediatric dentists
Description:
Antibiotic prescriptions for children is a cause for concern in both developed and developing
countries, especially for its excessive use in non-established infections or in infections
with viral etiology (Friedman et al., 2011). Although antibiotics play a crucial role in
reducing child morbidity and mortality (De Jong et al., 2009), its irrational use directly
increases antibiotic resistance by promoting the emergence of resistant bacteria leading to
increased rates of treatment failures and more severe illness episodes with higher costs and
mortality rates (Adisa et al., 2018).
Rational prescribing implies using the right drug for the right patient at the right time in
the right dose and manner of administration at affordable cost with the right information.
Thus, rational antibiotic prescription has to be tailor-made for individual patients taking
into account the diagnosis, age, sex, weight, microorganism susceptibility, vital organ
functions, drug and food interactions, as well as socioeconomic background of a patient
(Aronson, 2014).
Within the dental community, awareness of clinical indications of antibiotic prescriptions to
the child dental patient is lacking. It was found that a substantial proportion of children
who received dental treatment for pain or localized swelling under general anaesthesia had
also received antibiotics, with wide variation in antibiotic regimens (Dar-Odeh et al.,
2018). Further, among members of the American Academy of Pediatric Dentistry, there was a
trend toward overuse of antibiotics for non-indicated clinical conditions, like pain relief,
irreversible pulpitis, and localized dentoalveolar abscess (Sivaraman et al., 2013).
Conditions requiring antibiotic treatment in dentistry is limited and there should be (i) a
therapeutic goal to help treatment of acute/chronic infections (where drainage or debridement
is impossible) or (ii) a prophylactic goal to prevent metastatic infections (e.g., bacterial
endocarditis) or local or systemic spread of the infection (Dar-Odeh et al., 2010).
The non-clinical factors initiated antibiotic prescribing for some clinicians, such as
unavailability of close appointments and seeking parental satisfaction (Sivaraman et al.,
2013). A similar trend was observed in developing countries, where a substantial proportion
of dentists prescribe for non-indicated clinical conditions, such as dry socket, localized
periapical infection, marginal gingivitis, periodontitis, and pulpitis (Kouidhi et al.,
2011). This insufficient knowledge of the appropriate clinical indications is paralleled by a
lack of awareness of important interventions that promote the optimal use of antibiotics,
such as antibiotic stewardship programs. Other forms of abuse in prescribing antibiotics
include prescribing broad-spectrum antibiotics for infections that can be treated by
narrow-spectrum antibiotics, prescribing antibiotics for long periods, and adopting
inappropriate dosing regimens (Sivaraman et al., 2013).
Patients who consult their GP due to tooth-related problems are unlikely to receive a
surgical intervention and have a greater likelihood of being prescribed a systemic antibiotic
compared to individuals who consult a dentist with similar symptoms (Cope et al.,
2015)complications from an odontogenic infection, (Seppänen et al., 2011) the management of
dental problems in general practice could result in increased patient morbidity. Furthermore,
the indiscriminate use of antibiotics may contribute to the emergence of antibiotic-resistant
bacterial strains (Cope et al., 2015).
Antibiotic resistance (AR) is a condition when bacteria change against antibiotics which are
developed to cure the illnesses they cause. It is a global crisis and posed as one of the
greatest threats to population health. This problem is driven by many factors such as low
quality of antibiotics and improper (under- or over-) use of antibiotics (including
self-medication) (Alumran et al., 2013). Self-medication, which refers to the use of any
medical products without a prescription or following unprofessional recommendations in
treating any illnesses (Togoobaatar et al., 2010), is particularly leading to the AR.
Self-medication practice possibly raises incorrect drug selection, drug resistance,
uncontrolled adverse effects or drug reactions, misdiagnosis, and delay in medical care
(El-Hawy et al., 2017).
It has been observed that contribute to the problem of antibiotic resistance by dentists can
be substantial as dentists prescribe 10% of all common antibiotics. Yingling et al concluded
from the findings of his study among members of the American Association of Endodontists
(AAE) that they were prescribing antibiotics inappropriately. On the contrary (Yingling et
al., 2002), the National Center for Disease Control and Prevention found that almost
one-third of all outpatient antibiotic prescriptions are unnecessary (Swift and Gulden,
2002). The world has entered an era where some bacterial species are resistant to the full
range of antibiotics presently available, with the methicillin-resistant Staphylococcus
aureus and vancomycin-resistant Staphylococcus aureus being the most widely known example of
extensive resistance (Lewis, 2008).
It is estimated that, in 2050, there will be more than 10 million deaths and 100 trillion USD
lost due to AR if no substantial actions have been made to eliminate this emerging threat. As
inappropriate antibiotic use is the primary cause of AR, responses to this phenomenon
prioritize promoting public awareness about AR (El-Hawy et al., 2017).
Irrational prescribing can be due to errors such as required amount of drug or as errors in
writing, abbreviations, pharmaceutical form, drug dosage, administration method, or duration
of treatment. These errors can lead to ineffective treatment and dangerous, long-lasting
illness, or worse: harm to the patient and an increase of the cost of treatment (Grant et
al., 2013).
Dentists, like other health care practitioners should have sufficient knowledge about drugs.
Observing the prescription principles according to international law for dentists is
required. Although dental prescription generally contain pharmaceutics items are limited to
providing short-term drug therapy or specific drugs prescribed for dental surgeries but the
evidence suggests that in many countries, dentists often do not enjoy a good medical
knowledge for this reason, some mistakes in writing prescription occurred (Guzmán-Álvarez et
al., 2012).
Goud et al. reported that general dentists prescribed more than required antibiotics for root
canal therapy (Goud et al., 2012). Mendonca et al. found that in one-fourth of prescriptions
written by dentists, medication names were illegible (Mendonça et al., 2010). Ogunbodede et
al findings indicate the presence of different types of error in dentist's prescription in
term of dosing, frequency and duration of drug use (Ogunbodede et al., 2005).