The US Centers for Disease Control and Prevention (CDC) have a report that shows from 2011 to 2017 antibiotic prescriptions have decreased among primary care physicians, emergency medicine, dermatology, gynecology and the surgical specialties. In contrast dentists, physician’s assistants and nurse practitioners have increased over the same time. The ADA guidelines for prescribing antibiotics recommends AGAINST using them for most pulpal and periapical conditions and instead recommend definitive treatment. The ADA does recommend antibiotics for patients with systemic involvement (e.g. fever, malaise),
One of the risks of antibiotic prescriptions is that it disturbs gastrointestinal microbiomes. One study showed a single dose of Clindamycin given to mice resulted in an 87% loss of gut microbiome species, 4 weeks after the dose. Experts have warned that pathogens are growing resistant to antibiotics, predicting that by 2050 approximately 10 million people a year will die of antibiotic-resistant infections. Dentists are the highest prescribers of clindamycin despite the relationship between clindamycin and Clostridium difficile, a potentially life-threatening condition. Researchers at the University of Minnesota reported 15% of patients were diagnosed with C. Difficile infections and at least ½ of those patients had received clindamycin.
In 2015, the ADA updated its guidelines, advising antibiotics ARE NOT recommended prior to dental procedures to prevent prosthetic joint/implant infections. Complementary and alternative medicine (CAM) recommends an approach using probiotics, changes in diet and meditation. Doctors who use both CAM and conventional strategies have much lower antibiotic prescribing rates than doctors who rely solely on conventional strategies.
Missing from these reports is the risk of mild to moderate allergic and anaphylactic reactions to antibiotics. Clearly it’s time we become clearer on when antibiotics are appropriate, which antibiotics are most efficacious and what sig to use when prescribing them.
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