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Global Trends: Antibiotic Resistance and Dental Antibiotic Prescribing

Watch Leanne Teoh explain how and why patterns of antibiotic resistance vary between countries and over time.
Antibiotics are a unique class of drugs that affect not only the individual being treated, but entire communities secondary to the spread of resistant bacteria. Patterns of antibiotic resistance vary widely between countries and over time. Resistance to penicillin was first noticed in the 1940s, with even Fleming warning about it in his speech when accepting a Nobel Prize in 1945. Through natural selection, antibiotic use selects for resistant bacteria and can result in infections that do not respond to antibiotics. The first clinical failures of penicillin therapy for orofacial infections were described in 1980 where strains of the Bacteroides species producing the enzyme beta-lactamase were isolated from five cases of ineffective penicillin treatment.
More recently, studies of bacteria isolated from head and neck abscesses have found to have lower rates of penicillin resistance in Australia compared to other parts of the world. Rates of dental antibiotic prescribing in Australia are lower compared to other high income countries, such as the United Kingdom and the United States. Many factors are known to influence a dentist’s decision to prescribe antibiotics, and you’ll be finding out more about this later in the course. One of these factors is local guidelines. Guidelines relate to the clinical indication for antibiotics, as well as the antibiotic regimen– type, dose, and duration. Wide variation exists between countries in their national guidelines for the therapeutic and prophylactic use of antibiotics.
For example, in the United Kingdom, guidelines focus on the use of penicillins and metronidazole. Clindamycin use is rare, as guidelines identify it as a second line agent for use only when first line drugs have been unsuccessful. However, it’s a very different picture in the United States, where guidelines include Clindamycin for those allergic to penicillin, and prophylactic prescribing predominates. Different prescribing patterns result in different patterns of resistance. And of course, it’s not only dentistry that has an impact. Use in human and animal health care is relevant and can result in quite different antibiotic resistance patterns, even in places that are quite close together.
For this reason, guidelines that underpin dental antibiotic use need to be produced collaboratively by dentists, local infectious disease specialists, and pharmacists to ensure they consider local patterns of resistance when choosing an antibiotic with an appropriate spectrum to minimise the selective pressure for resistant bacteria whilst achieving an effective clinical outcome. Using patterns of resistance to monitor the impact of efforts to tackle the problem is, however, more difficult, as many factors outside of dentistry has an impact. In later parts of this course, you’ll hear about designing antibiotic stewardship programmes customised for your team or context.
For those of you working in primary care, we have just published a systematic review of metrics for antibiotic stewardship in contexts across primary health care, including dentistry, that you may find useful. To summarise, there is no one size fits all global solution for antibiotic resistance. Understanding your local context may not always be easy, but you are not alone. Other health care professionals are also looking at ways to optimise antibiotic use and will be able to help you consider local patterns of antibiotic resistance and to identify or formulate locally appropriate dental antibiotic guidelines. By working together, we can tackle antibiotic resistance.

In this video, Leanne Teoh discusses antibiotic resistance and prescribing for dentistry within a global context.

Patterns of resistance vary widely between places and over time. Whilst many factors affect a dentist’s decision to prescribe, one of them must be local guidelines for therapeutic and prophylactic use of dental antibiotics. Different regional prescribing patterns result in regional differences in patterns of resistance. Therefore, local patterns of resistance should be considered when guidelines for appropriate dental antibiotic use are produced. Using patterns of antibiotic resistance to monitor the impact of efforts to tackle the problem is, however, more difficult because too many factors outside of dentistry have an impact.

There is no one-size-fits-all global solution for antibiotic resistance but by working together, we can tackle antibiotic resistance.

The systematic review referenced in the video can be accessed in the downloads section below.

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Tackling Antibiotic Resistance: What Should Dental Teams Do?

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