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Coronavirus: When to prescribe antibiotics

Blog Author Susie Sanderson

Blog Date 07/05/2020

Susie Sanderson outlines when it's appropriate to prescribe antibiotics, and the harm overprescription could cause.

 

"It risks harming the patient and undoing the great work done by dentists on antimicrobial resistance"

We've seen a worrying rise in stories of antibiotics apparently being overprescribed for dental pain since the outbreak of COVID-19. Anecdotal evidence suggests that some patients with dental pain have been prescribed multiple courses of antibiotics to no benefit. This is alarming, as it risks harming the patient and undoing the great work done by dentists on antimicrobial resistance.

 

Dentists should not be under pressure to prescribe antibiotics unless indicated by the patient's condition.

 

Right now, dentists are in a very difficult situation. The advice is for us is to triage patients remotely with the three As: advice, analgesics and antibiotics where appropriate. Despite the many challenges we face, it's essential that dentists remain guardians against antimicrobial resistance.

 

Antibiotics should be prescribed in the following situations:

  • If it is considered that the patient has a bacterial infection which requires antibiotics. This would include the treatment of acute apical or periodontal abscess and acute pericoronitis, necrotising ulcerative gingivitis/periodontitis.
  • After discussion with the patient about the benefits and risks associated with the treatment options offered
  • With advice on what to do if symptoms continue to progress
  • With consideration of a follow-up call to the patient after a few days to check how their infection has responded to the antibiotics.

 

Antibiotics should not be prescribed:

  • To treat conditions that do not respond to antibiotics e.g. pulpitis
  • Because of a patient request
  • Routinely for all patients as part of a pathway to care.
"This pandemic has demonstrated the havoc a pathogen can unleash when we have no protection against it"

This pandemic has demonstrated the havoc a pathogen can unleash when we have no protection against it. Inappropriate use of antibiotics at this time, even if motivated by the best of intentions, increases the likelihood that resistant bacteria will evolve. I'm sure you'll agree, that with a global viral pandemic underway, the last thing we need is to add to these risks.

 

We joined up with Public Health England, the Royal College of Surgeons and the Faculty of General Dental Practice to send an open letter to support dentists in appropriate prescribing of antibiotics in urgent dental care.

 

It's never been harder to be a dentist working in the UK. We're all trying our utmost to provide for our patients and protect our businesses. Being careful not to prescribe antibiotics inappropriately and to continue to guard against antimicrobial resistance, despite the pressures we are under, is an essential part of this.

 

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Dr Susie Sanderson

BDA Health and Science Committee

Member of working group on antibiotics, Council of European Dentists

BDA Past President