Dr Nikolaus Palmer PhD FDSRCSEng FFGDP(UK) says antimicrobial resistance is a greater threat than the coronavirus pandemic, and describes how new guidance can help dentists avoid exacerbating the problem through their prescribing.
Since March 2020 the dental profession has focussed on protecting and preventing the transmission of COVID-19 to their team, patients and the wider population due to its associated mortality (globally estimated at present as > 1.5 million) and morbidity.
Unfortunately antimicrobial resistance (AMR) has been, and will be, a greater long-term worldwide problem, and a more major threat to public health, than COVID-19. It has been estimated that 700,000 people die of antibiotic resistant infections every year, and that by 2050 the global cost will be 10 million lives and £66tn a year.
AMR has increased as a result of widespread use of antimicrobials over many years, including the inappropriate prescribing of antibiotics by the healthcare professions. This remains a major concern, especially now as fewer and fewer new antibiotics are being developed. It is recognised that as antibiotics become less effective, the incredible health care gains they bring - through for example organ and stem cell transplants, major surgery and chemotherapy - will be lost, leaving these patients with a higher risk of mortality.
It is estimated that dentists prescribe almost 10% of all the oral antimicrobials prescribed in England, and there is a clear link between the consumption of antimicrobials in both primary and secondary care and the increasing rates of resistance. Published data shows reduced antibiotic prescribing in NHS primary dental care prior to the COVID-19 pandemic. However there remains clear evidence of the inappropriate use of antibiotics in dentistry, which contributes to the problem of increasing AMR. It is imperative therefore that we as dentists play our part and ensure appropriate prescribing of antibiotics when managing treatment of patients.
Antimicrobial Prescribing in Dentistry: Good Practice Guidelines is a collaboration between the Faculty of General Dental Practice UK (FGDP) and the Faculty of Dental Surgery of the Royal College of Surgeons of England. It updates and builds on the FGDP’s previous guidance, Antimicrobial prescribing for general dental practitioners, and was written in response to the increasing development of AMR worldwide and a call to provide initiatives to reduce and optimise dental antimicrobial prescribing.
The new guideline now includes management of oral and dental infections by all dental healthcare prescribers, not only in primary dental care but also in secondary dental care including trainees and specialists (including oral and maxillofacial surgery) and those involved in dental education and research. The recommendations provided are now appropriate for all dental patients, including adults, children, the elderly and those with special needs treated in the primary and secondary care setting.
Importantly the guidelines are not intended to be limiting or restrictive but to be useful in the decision making process, an aid to effective treatment planning and patient care and to promote judicious antimicrobial prescribing.
The GRADE system for the key recommendations provides an indication of the strength of the recommendation and the level of quality of the evidence. These are highlighted throughout the text and comprehensively referenced.
Clinical advice on assessment and definitive clinical treatment modalities for dental infections are also highlighted. These are based on recognised good clinical practice. Where antimicrobials are indicated, recommended regimens are provided for each condition based mainly on the British National Formulary (BNF).
Also included in the guidelines are a list of resources for prescribers of antimicrobials to help embed the recommendations in this guideline into clinical practice, and also to promote judicious use and monitoring of antimicrobial prescribing.
It is hoped that dentists will find Antimicrobial Prescribing in Dentistry: Good Practice Guidelines useful in everyday dental practice, and that when used alongside other AMS resources, it will not only reduce the impact of AMR but also improve patient care.
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