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The increasing emergence of antibiotic resistance is a major international public health problem. As a consequence, it is essential that steps are taken to conserve the effectiveness of existing antimicrobial agents. Consumption of antibiotics is the prime contributor to the development of resistance. General dental practitioners write almost 1 out of 10 prescriptions for antibiotics in primary care within the UK and therefore the prudent prescribing of antibiotics in dentistry has never been more vital. This paper outlines the impact of antimicrobial resistance on modern healthcare, describes the current use of antibiotics in general dental practice, and recommends pragmatic ways in which dental practitioners can evaluate and optimize their prescribing.
CPD/Clinical Relevance: Dental professionals have a responsibility to both their patients and the wider community to prescribe antibiotics appropriately.
Article
The ability to treat infectious diseases safely and effectively has medically, socially and economically revolutionized the 20th Century. Life expectancy in 1927, the year before penicillin was discovered, was 57 years for men and 61 years for women.1 The life expectancy of individuals born in 2012 has increased by over 20 years, to 79 years for men and 83 years for women.2 One of the principal reasons that people are living longer is a dramatic improvement in healthcare, specifically the ability to control infectious diseases using antimicrobial agents. However, there is now worldwide concern that the increasing emergence of antibiotic resistance may render these ‘wonder-drugs’ ineffective, transporting healthcare back to the pre-antibiotic era.
Antimicrobial resistance is the ability of micro-organisms, such as bacteria, fungi and viruses, to resist the action of an antimicrobial agent.3 Resistance is not a new phenomenon; soon after his discovery of penicillin Alexander Fleming delivered a stark warning about the potential consequences of abusing antibiotics. In his 1945 Nobel Lecture, Fleming spoke about the ability of microbes to develop or acquire resistance to penicillin, and how resistant bacterial strains could be spread between individuals with potentially fatal outcomes.4 During the subsequent four decades, the problem of antimicrobial resistance did not go away, but was largely masked or ignored due to the spectrum of new antimicrobial agents becoming available clinically. However, the situation changed during the 1980s when the incidence of bacterial resistance was still increasing but the previously plentiful supply of new antimicrobial drugs was reducing. Since the 1980s, the number of new antibiotics approved for use has fallen dramatically (Figure 1), yet the proportion of bacterial isolates demonstrating resistance to frequently used antibiotics has increased (Figure 2).
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