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Antimicrobial resistance and COVID-19

Blog Author Dr Susie Sanderson

Blog Date 17/11/2020

During World Antibiotic Awareness Week, Susie Sanderson tells us what impact COVID-19 has had on the fight against antimicrobial resistance in dentistry.

 

World Antimicrobial Awareness Week

Prescriptions for antibiotics spiked during the first phase of the pandemic. This World Antibiotics Awareness Week, I'm calling on dentists to be supported to reduce the number of antibiotics prescribed, so that we can return to the progress that was underway before the outbreak of COVID-19.

 

Dentists have an essential role to play in the fight against antimicrobial resistance. With the first phase of the pandemic behind us, we must now strive to prioritise antimicrobial resistance and reduce prescriptions to pre-pandemic levels.

 

The COVID spike in antibiotic prescriptions

The outbreak of COVID-19 and the resultant restrictions on dental services across the UK created new and difficult challenges for dentists. The first lockdown and the closure of dental surgeries caused major disruption to patient care. It took time for guidance to be issued and we were all under significant pressure, trying to do what was best for our patients in stressful and uncertain circumstances.

 

It was predicted that we'd see a major increase in the amount of antibiotics being prescribed during this period, and now we have figures which confirm it. In Northern Ireland, for example, there was a 64% increase in prescriptions for antimicrobials between February and its peak June in this year1. Even allowing for the fact that February was a particularly low month, this jump is significant.

 

Graph showing 21 month overview of the number of antimicrobial drug prescriptions in Northern Ireland

   A 21 month overview of the number of antimicrobial drug prescriptions in Northern Ireland.

 

"25% more prescriptions for antibiotics were issued between April and July 2020 than in the same period last year."

In England, meanwhile, antibiotic use in May of this year was 18.4% higher than in May 2019 (267,719 and 226,188 prescriptions respectively2). Antibiotic prescribing in England peaked in June. 25% more prescriptions for antibiotics were issued between April and July 2020 than in the same period last year. It’s also worth noting that some regions experienced greater increases and for longer periods than others. The increase was highest in London, which saw a 60% increase. The South West saw the lowest increase at just 10%. East of England meanwhile had the highest rate of dental antibiotic prescriptions every month between April and July this year3.


There are many understandable reasons why this increase may have occurred. Dentists may have felt pressured by some patients for antibiotics, or they may have had difficulties diagnosing a patient’s condition remotely and so adopted a better-safe-than-sorry approach. 


Both dentists and patients may have also been seeking to avoid an unnecessary extraction in the hope that AGPs might soon return to general dental practices, and dentists may have felt pressured by some UDCs which required patients to have tried antibiotics before accepting a referral for face-to-face care.

 

We must resume our pre-pandemic progress

With the first wave of the pandemic behind us, higher stocks of PPE in our surgeries and more comprehensive guidance in place, I believe it is time for dentists to prioritise antimicrobial resistance once again. Let’s get back to business as usual in terms of antibiotics, even if the reality of our lives and in our dental surgeries continues to be far from normal.

"Before the pandemic, we were making excellent progress in the fight against antimicrobial resistance"


Before the pandemic, we were making excellent progress in the fight against antimicrobial resistance and had made great headway in helping our patients understand that antibiotics don’t cure toothache. In Northern Ireland, for example, dentists recently decreased the amount of antimicrobial drugs prescribed by 4.8% in just one year4. While in Scotland, there have also been annual reductions in antibiotic items prescribed by dentists, and a 22.4% drop between 2014 and 20185.

 

In England, the figures published by the English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR), show dental practices dispensed around a quarter fewer prescriptions for antibioticsin 2017, compared to 2013. Against the background of this positive trend, the government launched a 5-year action plan and a 20-year vision for tackling antibiotic resistance.It’s time to get back to that.

 

Our efforts are essential

Dentists are essential to the fight against antimicrobial resistance. But the pandemic spike in antibiotic prescriptions threatens the phenomenal progress we’ve made in recent years. This must be reversed. That’s why it’s now more important than ever for dentists to be supported to continue the fight against antimicrobial resistance.


"We’ve asked government to commit to properly funded urgent care slots to reduce the need for antibiotics prescriptions."

We’ve asked government to commit to properly funded urgent care slots to reduce the need for antibiotics prescriptions. We’ve also set out our case for capital funding for practices to deliver the ventilation systems that can reduce fallow time and expand access. E-prescribing would help us to monitor dental antibiotic prescribing. Concrete steps like this are needed to support the fight against antimicrobial resistance.


We're all trying our best to provide for our patients and protect our businesses. This World Antibiotics Awareness Week, I believe we must redouble our efforts to prescribe antibiotics only when appropriate. We need to get back to the progress we were making before the outbreak, because this pandemic has demonstrated the damage a pathogen can do when we have no protection against it.


 


Dr Susie Sanderson
BDA Health and Science Committee
Member of the FDI Working Group on Antibiotic Stewardship
Member of working group on antibiotics,Council of European Dentists
BDA Past President

 

References

  1. Numbers of items prescribed increased from just 11,017 in February to 18,064 in June, data provided to BDA Northern Ireland.
  2. Wordley, V., Shah, S. & Thompson, W. Increased antibiotics use, British Dental Journal, 229, 266 (2020). https://doi.org/10.1038/s41415-020-2128-z 
  3. Shah, S., Wordley, V. & Thompson, W. How did COVID-19 impact on dental antibiotic prescribing across England? British Dental Journal, 229, 601–604 (2020). https://doi.org/10.1038/s41415-020-2336-6
  4. Figures provided to BDA Northern Ireland show total antimicrobial drugs prescribed by dentists in Northern Ireland: 148,989 in 2017-18, and 141,714 in 2018-19. That’s a 7,275 (4.8%) drop in prescriptions of antimicrobial items in one year.
  5. Scottish One Health Antimicrobial Use and Antimicrobial Resistance report, version updated 12 November 2020, https://www.hps.scot.nhs.uk/web-resources-container/scottish-one-health-antimicrobial-use-and-antimicrobial-resistance-in-2018/