5c507c75-trends of antimicrobial usage in dental practice
TRANSCRIPT
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Trends of usage of antimicrobial
agents in dental practice on the
basis of prescription analysis
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Oral cavity organisms
more than 400 species
Aerobic as well as anaerobic
Anerobic 10 100 times more
Spirochetes, Candida, viral
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To deal with -
Dental Caries Dentoalveolar abscess, pulp infection,
periapical abscess
Gingivitis
Periodontitis pericoronitis,
periodontal abscess, osteomyelitis,
peri-implantitis
Deep fascial infection
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Indications for
Chemotherapeutic Agents
OrodentalInfections
To prevent other infections bacterial
endocarditis
To prevent postoperative infection Improve healing
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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 todetermine -
The rationale - indications, adequacy
of dosage, and duration of treatment The adequacy for prophylaxis
The attention given to -
contraindications and precautions
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Period of study: 01/01/0506/30/05:
6 months
Material: OPD antimicrobial Prescriptions
Data collected from
TEACHING INSTITUTES: 03
PRIVATE CLINICS: 30 SPECIALISTS: 10
GDP: 20 (General Dental Practitioners)
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INSTITUTES Prescriptions Total
VPDC, Sangli 1805
TKDC, Kolhapur 910
GMC, Miraj 903
Total 3618
PRIVATE
CLINICS
Specialists 1235
GDP 2740
Total 3975
TOTAL 7593
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TEACHINGINSTITUTES
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%)
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PRIVATECLINICS
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%)
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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%)
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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%
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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%
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Timing of
treatment/prophylaxis Inadequate duration: 19.4%
Ciprofloxacin single dose,Amoxicillin 2 days, Ampicillin 2days
Antibiotic started after theprocedure: 61.3%
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ORO DENTALINFECTIONS Periapical/Periodontal Abscess
Acute
Suppurative pulpitis/
Toxiccellulitis.
Salivary Gland Sepsis/Sinusitis
PostSurgical/PostTraumatic.
Oro-antral/Oro-nasal Fistula.
Ludwigs angina/Purulent osteitis
Pericoronitis/Mucositis/Pemphigus
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SPECTRUM
MACROLIDE
CLINDA CEPHA
AMPI/AMOXY
PEN G/PEN V
ORODENTAL
INFECTIONS
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Prophylaxis (Prevention)
1. Bacterial
Endocarditis.2. Prosthetic Joint
Infections.
3. Immuno-Compromised
Hosts.
4. Procedures and others.
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SBE PROPHYLAXIS
RECOMMENDED
Extractions, Periodontal procedures Prophylactic cleaning
Implant placement, Re-implantation EndodonticInstrumentation/Surgery beyond
root apex, Placem
ent or rem
oval oforthodontic bands Intraligamentary LA
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SBEPROPHYLAXIS - 1
(1 hr before procedure) STANDARDREGIMEN
Amoxicillin2 g
PENICILLINALLERGY
Clindamycin 600 mg
Cephalexin/
Cefadroxil
2gm
Clarithromycin/Azithromycin 500mg
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SBEPROPHYLAXIS - 2
30 mins beforeprocedure)
Failure totake P/O
Ampicillin2 gmIM/IV
Penicillinallergy & Failure totake P/O
Clindamycin 600 mg IV
Cefazolin 1 gmIM/IV
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PREFER
CIDALAGENT,SUSCEPTIBILITY
NARROWESTSPECTRUM
CORRECTDOSINGANDADEQUATEDURATION OFTREATMENT
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Inferences1. 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.
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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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