Principles of Rational Antibiotic Therapy In Dental Practice

1. Subject:-Evidence Based Medicine
Submitted by:-Khan Mussaddique Hussain
Submitted to:-Izekenova Aigulsum
Kazakh National Medical
University,
Asfendiyarov.
2017-2018
Topic:-
Principles of Rational Antibiotic Therapy
In Dental Practice
From
The Position of
Evidence-Based medicine

2. Index
– Introduction
– EBD(Evidence based dentistry)
– Rational Antibiotics
– Misuse of Antibiotics
– Principle of Antibiotics usage
– Conclusion
– My opinion
– Reference

3. INTRODUCTION
The concept of evidence-based medicine was introduced in the 19th century and referred to as the
conscientious, explicit, and judicious use of current best evidence in making best decision about the care
of individual patients.
[1] The same principle has been utilized in dentistry worldwide with some of the top dental organizations
such as the American Dental Association (ADA) and the American Academy of Pediatric Dentistry at
the forefront of this development. The ADA defines the term “evidence-based dentistry (EBD),” as an
approach to oral health care that requires the judicious integration of systematic assessments of
clinically relevant scientific evidence, relating the patient's oral and medical condition and history, with
the dentist's clinical expertise and the patient's treatment needs and preferences.
[2] As it is clearly evident, the ADA identifies three main areas in evidence-based dental care: Relevant
scientific evidence, patient needs and preference, and dentists’ clinical expertise. Since the patient
needs/preferences and clinical expertise are subjective and can vary among various providers and
population, relevant scientific evidence is of critical importance. There is perhaps no perfect recipe for
optimal clinical practices, but keeping it evidence-based is probably the clinician's best bet.

4. Evidence-based dentistry (EBD) is an approach to oral
health care that requires the judicious integration of
systematic assessments of clinically relevant scientific
evidence, relating to the patient's oral and medical
condition and history, with the dentist's clinical
expertise and the patient's treatment needs and
preferences.

5. Do We Know about Antibiotics.
Yes we do. But, What’s New in
Rational Antibiotics?
Rational AntiBiotics Therapy depends on the identity of the causative organisms, the
location of the infection, and the condition of the host.
Selection of antimicrobial therapy is often started before identification of the causative
organism is complete.
Certain cultural and staining procedures must be instigated prior to therapy in order to
isolate the causative organism.
Knowledge of the host's physiologic state is necessary to minimize toxicities and/or
failures of therapy.
Knowledge of synergistic and antagonistic actions of some antibiotics agents is
necessary for optimal results.

6. WHY Rational Antibiotic Therapy?
– Better care of Patients
– Combacting antimicrobial resistance
– Prevent misuse of antibiotics
– Reduce cost of treatment
– While the issue of antibiotic misuse and resistance is a large
one, antibiotics are life-saving therapy. Several general
principles can help you make decisions about initiating,
selecting, and discontinuing antibiotic therapy.

7. Misuse of antibiotics
– Lack of awareness & evidence base practive
– Fear of secondary infection.
– Falsse sense of security
– Fear of losing patients
– Parental anxiety & pressure

8. Dentists commonly prescribe antibiotics for controlling and
treating dental infections. But there is a widespread abuse of
antibiotics in medical and dental field. The inappropriate use
of antibiotics results in increased treatment costs, increased
risk of adverse events related to the antibiotic used and most
importantly development and propagation of antimicrobial
resistance. The definitive indications for use of antibiotics in
dentistry are limited and specific. This review discusses the
various principles and rationale behind antibiotic therapy in
different fields of dentistry with stress on rational antibiotic
use in dentistry.

9. Principles of antibiotic usage
– In recent times, antimicrobial stewardship has been given lots of importance at
the patient level and at the community level. Antimicrobial stewardship is
defined as “the optimal selection, dosage, and duration of antimicrobial treatment
that results in the best clinical outcome for the treatment or prevention of
infection, with minimal toxicity to the patient and minimal impact on subsequent
resistance.” Joseph and Rodvold summarised the 4 D's of antimicrobial therapy
which is given in Table 1. An important consideration in starting antimicrobial
therapy is to assess if the infection is localized and if the patient has an adequate
immune response to control the bacteria if supported surgically. These
considerations are summarised in Table 2.
Table 2.

11. Here are some usefull Drugs in
Dental treatment.(Table 3)

12. Some points in Relation to
dentistry and EBM
– Clinical dentistry is becoming increasingly complex and our patients more
knowledgeable. Evidence-based care is now regarded as the "gold standard" in health care delivery
worldwide.
– The basis of evidence based dentistry is the published reports of research projects. They are, brought
together and analyzed systematically in meta analysis, the source for evidence based decisions.
– Activities in the field of evidence-based dentistry has increased tremendously in the 21(st) century,
more and more practitioners are joining the train, more education on the subject is being provided to
elucidate the knotty areas and there is increasing advocacy for the emergence of the field into a
specialty discipline.
– Evidence-Based Dentistry (EBD), if endorsed by the dental profession, including the research
community, may well- influence the extent to which society values dental research.
– Hence, dental researchers should understand the precepts of EBD, and should also recognize the
challenges it presents to the research community to strengthen the available evidence and improve
the processes of summarizing the evidence and translating it into practice This paper examines the
concept of evidence-based dentistry (EBD), including some of the barriers and will discuss about
clinical practice guidelines.

13. Conclusion:
– Even though the EBD has been the “buzz word” for quite some time now,
the acceptance into dental practices has been a relatively slow process.
However, to offer the acceptable clinical care and meet the increasing
awareness of the patient population, it is in the best interest of the
practitioners to adopt EBD sooner rather than later. The importance of
providing a balanced mix of science, clinical expertise, and patient needs
to optimize patient care in a practice cannot be underestimated.

14. My opinion
– Unfortunately, the prescribing practices of dentists are inadequate and
this is manifested by over-prescribing. Recommendation to improve
antibiotic prescribing practices are presented in an attempt to curb the
increasing incidence of antibiotic resistance and other side effects of
antibiotic abuse.

15. Reference
– http://jaoa.org/article.aspx?articleid=2097232
– Https://www.ncbi.nlm.nih.gov/pubmed/24701551
– http://infectionnet.org/notes/antibiotic-therapy-principles/
– https://www.researchgate.net/publication/266968828_A_review_of_use_of_a
ntibiotics_in_dentistry_and_recommendations_for_rational_antibiotic_usage_
by_dentists
– https://en.wikipedia.org/wiki/Evidence-based_dentistry