We’re all familiar with the idea that we have to use antibiotics wisely. You’ve probably seen a poster at your local health centre warning about their loss of effectiveness, and with good reason – bacterial resistance to these drugs is currently one of the biggest threats to global health.
As patients, many of us have contributed, in one way or another, to this phenomenon, whether by skipping antibiotic doses, failing to complete a course of treatment, or simply taking pills leftover from a previous prescription. But a significant part of the responsibility lies with the healthcare sector, as antibiotics are often prescribed unnecessarily or inappropriately.
The solution seems clear. If professionals only prescribe these drugs when necessary and patients follow their advice, this part of the problem would be solved. But it’s not that simple, at least not for dentists.
What would you think if your dentist prescribed you antibiotics, and the active ingredient listed was “it depends”? Well, that is what they would have to prescribe in some cases, if their only source of information was the clinical practice guidelines they have access to.
Patchy guidelines
Clinical practice guidelines are sets of recommendations developed by experts and organisations such as health ministries, professional dental associations and the World Health Organization to aid decision-making. They are based on a systematic review of the available scientific evidence.
However, our recent study, which analysed existing international antibiotic prescribing guidelines, found that not all of them are of the same quality or equally reliable. Some countries don’t even have them at all.
Firstly, we found that not all dentists have a reference document, as only nine countries have guidelines on prescribing antibiotics for oral conditions. Furthermore, only 10 of the 17 analysed can be classified as “recommended for use” based on their quality. Two sets of guidelines are even classified as “not recommended”.
Dentists in Belgium, Spain, Scotland and the United Kingdom are the luckiest, as they have access to the highest quality guidelines.
In Spain, for instance, the document that met the requirements to be considered a clinical practice guideline was the Aljarafe Area Antimicrobial Therapy Guidelines. This is created by the Andalusian Regional Ministry of Health and updated by the Ministry of Health’s National Plan for Antibiotic Resistance.
Other organisations that have recommended guidelines are the Chilean Ministry of Health, the Royal College of Surgeons of England, the World Health Organization, the Belgian Health Care Knowledge Centre, the American Dental Association, and the Scottish Dental Clinical Effectiveness Programme.
What antibiotics do dentists prescribe?
Our findings were not all negative. In general, the available guidelines agree that dentists should prescribe amoxicillin (a derivative of Fleming’s famous penicillin). According to studies, this is one of the active ingredients most commonly prescribed by dentists, which is a positive.
There is also considerable agreement among the guidelines regarding the duration of this treatment, although some do not directly refer to the time frame.
However, there is less agreement when it comes to the active ingredients recommended for treating specific diseases.
Things become even more complicated when the patient is allergic to amoxicillin – a relatively common allergy that affects up to 25% of the population. In this case, the recommendations become very disparate. 29% of the guidelines recommended metronidazole, 24% azithromycin, 24% clindamycin, 18% cephalosporins and 6% doxycycline. These differences are not justified.
Better guidance
These documents have considerable room for improvement in certain specific areas: the rigour of the evidence, the way in which information is presented, and the applicability of recommendations on prescribing antibiotics.
Improving all of these aspects could make it easier to follow guidelines and help dentists to make the best decisions. Dentists would also be less likely to obtain information from other sources that could be more biased, such as the pharmaceutical industry, which will always have commercial interests behind it.
The ultimate goal is clear: we need to reduce the unnecessary consumption of antibiotics, and we cannot stand idly by. Antibiotic resistance is no longer a threat, but a reality – in Europe, around 100 people die every day from antimicrobial resistance. It is urgent that we act in unison, and we need healthcare professionals to have reliable and practical sources that allow them to be confident that they are making the best decision for their patients.
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This article was originally published on The Conversation. Read the original article.
