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ORIGINAL ARTICLE
Year : 2017  |  Volume : 6  |  Issue : 3  |  Page : 149-153

Exploring the pattern of antibiotic prescription by dentists: A questionnaire-based study


Department of Oral Medicine and Radiology, Meghna Institute of Dental Sciences, Mallaram, Telangana, India

Date of Web Publication25-Sep-2017

Correspondence Address:
T Harsha Vardhan
Department of Oral Medicine and Radiology, Meghna Institute of Dental Sciences, Mallaram, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JDRNTRUHS.JDRNTRUHS_30_17

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  Abstract 

Introduction: Antibiotic overuse and misuse among dentists was found to be substantial. Exploration of scientific literature revealed very limited studies in India assessing the antibiotic prescription pattern among dentists. Antibiotics are one among the most commonly prescribed drugs by dentists for prophylactic and therapeutic management of oro-dental infections. Increasing inappropriate use of antibiotics has helped the bacteria to armor themselves and develop “Antibiotic Resistance.” Antibiotic resistance is an emerging global menace haunting all fields of the medical fraternity. All dentists should have to take moral responsibility to minimize and wisely use antibiotics.
Aim: To know the prescription pattern of antibiotics for various dental procedures by dental practitioners.
Objective: For treating in a better way to prevent antibiotic resistance.
Materials and Methods: A self-administered, 12-item close-ended questionnaire was used. Questionnaire consisted of questions pertaining to knowledge, attitude, and practice of dental health care professionals before prescribing antibiotics. Associations were found out via the Chi-square test with P value kept as P ≤ 0.05.
Results: With a response rate of 69.76%, medical representatives, patients' preference, fear of losing patients, and fear of spread of infections can potentially “influence” a dentist's capability to prescribe antibiotics.
Conclusion: The dental profession as a whole needs to acquire a deeper understanding of the global effects of superfluous antibiotic prescription. Antibiotics, when judiciously used, are precise life-saving drugs. Proper knowledge about the prescription of antibiotics is the need of the hour. As a nation, we must respond to this growing problem so that antibiotics misuse can be stopped.

Keywords: Antibiotic prescription, awareness, dentists


How to cite this article:
Vardhan T H, Lakhshmi N V, Haritha B. Exploring the pattern of antibiotic prescription by dentists: A questionnaire-based study. J NTR Univ Health Sci 2017;6:149-53

How to cite this URL:
Vardhan T H, Lakhshmi N V, Haritha B. Exploring the pattern of antibiotic prescription by dentists: A questionnaire-based study. J NTR Univ Health Sci [serial online] 2017 [cited 2017 Oct 23];6:149-53. Available from: http://www.jdrntruhs.org/text.asp?2017/6/3/149/215525


  Introduction Top


The mortality rate due to infectious diseases was high ages ago. Millions of lives were saved owing to the discovery of antibiotics. In fact, antibiotics can be called as “life-saving drugs.” However, antibiotic usage may be associated with unfavorable side effects ranging from gastrointestinal disturbances to fatal anaphylactic shock.[1] Unfortunately, in the present era inappropriate, indiscriminate, and irrational use of antibiotics has led to the development of antibiotic resistance. Even more alarming is the rate at which bacteria develop resistance; microorganisms exhibiting resistance to new drugs are often isolated soon after the drugs have been introduced.[2] This growing problem has contributed significantly to the morbidity and mortality due to infectious diseases, with death rates for communicable diseases rising again.[3],[4]

Moreover, antibiotics are societal drugs that affect microbial resistance not only in the person taking drug but also everyone else, as the resistant genes can easily pass via personal contacts, fomites, human, and animal refuse.[5]

World Health Organization has recognized this growing global problem and announced the theme for the year 2011 as “Antibiotic resistance: No action today, No cure tomorrow” and has stressed for an international action. Scientific literature evidence suggests that dentists are prescribing around 7–11% of common antibiotics (beta-lactams, macrolides, tetracycline, clindamycin, and metronidazole).[6] However, dental contribution to antibiotic resistance is unknown. Exploration of scientific literature revealed very limited studies in India assessing the antibiotic prescription pattern among dentists. This provided an impetus to conduct this survey to assess and understand the antibiotic prescribing practices among the dentists. The aim of the survey was to assess the antibiotic prescription pattern for common oral conditions, routine dental treatment, and awareness on antibiotic resistance among dentists in South India.


  Materials and Methods Top


During the period from October, 2015 to March, 2016, all the dentists working in various dental colleges were invited to participate in the study. Participation was voluntary and confidentiality of the data was assured to the participants. Prior to the conduction of the study, ethical clearance was obtained from the parent institution. Any dentist with a minimum qualification of a BDS degree was included in the study. Data collection was carried out through a self-administered, 12-item close-ended questionnaire, distributed personally to various dental colleges in South India after obtaining proper permission from the concerned institutions.

The questionnaire consisted of two parts: The first part consisted of demographic variables of the respondents, and the second part consisted of questions pertaining to knowledge, attitude, and practice of dental health care professionals before prescribing antibiotics. The completed questionnaire was received in stipulated time. Of the 700 questionnaires distributed, we received 520 forms, in that 70 forms were discarded because of incomplete or multiple answers given by participants. Total 450 questionnaires were sent for statistics.

Descriptive statistics was used to calculate frequencies, and the Chi-square test was applied to explore any association between demographics and behavioral variables. Statistical significance was kept as P < 0.05. Data analysis was performed using Statistical Package for the Social Sciences, version 21 (IBM software).[7]


  Results Top


Out of 700 questionnaires distributed, 520 volunteered to be the part of the study, where 450 correctly filled forms were taken, thus making a response rate as 64.28%, which was satisfactory. Our sample of the dentists comprised 315 males and 135 females. The demographic variables, which were the first part of the questionnaire, are described in [Table 1].
Table 1: Demographic and Professional Characteristics of Participating Dentists in the Study

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The respondents had minimum BDS qualification to be included in the study. Respondents comprised 135 graduates and 315 postgraduates (PGs). Data processing was done based on the academic qualification (BDS/MDS). [Table 2] shows the questions and the overall response of the clinicians, and there were five questions that were found to be statistically significant. [Table 3] describes the different response rate of dentists according to qualification and there were four questions that were found to be statistically significant.
Table 2: Response Rate of Clinicians

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Table 3: Different Response Rate of Dentists According to Qualification

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  Discussion Top


Our study showed very important and significant finding when considering antibiotic prescription habits among dentists of South India. In our study, we collected data through 15 close-ended questions that discussed factors that influenced the dentist's decision on prescription of antibiotics. It was seen that 93.33% (n = 420) of dentists agreed that overdose of prescription of antibiotics can lead to resistance and 91.32% of dentists (n = 411) regularly keep themselves updated by reading any latest scientific material prior to the use of antibiotics in dentistry [Table 2]. This statement is in accordance to Karibasappa and Sujatha, who in their study found out that approximately 90% of the dentists were aware of the term “Antibiotic Resistance” and knew that injudicious prescription pattern among health professionals and self-medication with antibiotics inappropriately were contributing to the emergence of antibiotic resistance around the world.[8] It was observed that 73.32% (n = 330) of the participants agreed that they prescribe antibiotics depending upon patient preference, 76.66% (n = 345) of the participants agreed that their prescriptions were influenced by advertisements/medical representatives, and 78.66% (n = 354) of participants agreed to the fact that they prescribe antibiotics depending upon cost, which was similar to other studies done by Faure et al. and Straand et al.[9],[10],[11],[12]

When the dentists were asked whether their prescriptions were influenced by advertisements (free samples/medical representatives) [Table 2] and [Table 3], we observed a statistical significance between graduates and PGs. It is in agreement with various studies carried out across the globe that it was influenced by a medical representative and is one of the “external” factors that influenced the antibiotic prescription ability of the doctor.[13],[14],[15],[16],[17],[18] However, in contradiction to our findings, Chimonas et al. (2007) in their study reported that physicians “denied” being influenced by medical representatives.[19] It was observed that only 38% (n = 171) [Table 2] agreed that they prescribe antibiotics due to a fear of loss of patients.

It is possible that the above said significant difference between graduates and PGs could be due to the fact that most PGs have a private practice of their own and fear legal action if the patient health deteriorates and/or could lead to a loss of patients if antibiotics are not prescribed.[20] Along with it, 57.32% of the dentists (n = 258) agreed to the question that they prescribe antibiotics because patient wants the drug [Table 3].

This basically arrives from a belief of the patient that their ailment was caused due to bacterial infection, and this provides a stimulus for them to ask their doctor to prescribe an antibiotic.[21],[22] It was seen that 78% (n = 351) of dentists has fear of the spread of infection if they do not prescribe antibiotics. This may be because they prescribe a broad spectrum antibiotic to protect their patients from any infection that could lead to deterioration of their health and that could lead to a loss of their patients.[20]

Dentists, irrespective of clinical practice, i.e. 86.66% (n = 390) of dentists, take a thorough case history and tried to get a sensitivity test prior to antibiotic prescription [Table 2]. However, it was found out that 73% (n = 330) of the dentists write the drug brand/market name or content name, whereas only 27% (n = 120) were writing both in the prescription [Table 2], and this might cost a financial burden to the patient, especially those from low socioeconomic groups. This is in agreement with Haas et al. (2005), who used data from the 1997–2000 Medical Expenditure Panel Survey's Household Component (Boston, MA) and found out that substitution of a generic drug in place of a brand name of a drug whenever available would have saved approximately $46 per year for adults younger than 65 years of age and approximately $78 per year for older adults.[23] This could have led to better savings and affordability to people, especially those belonging to low socioeconomic group, which would help us provide a better service to the community.

Our study, however, was prone to certain limitations, which are:

  • Presence of a social desirability bias by the dentists while answering the questionnaire;
  • Sometimes as graduates are not exposed to clinical practice, there could be a slight difference in their antibiotic prescription habits when compared to the PGs;
  • Underreporting/overreporting of the answers by the respondents is quite a common feature in questionnaire surveys.



  Conclusion Top


From the above results, it is clear that “antibiotic abuse” is widely prevalent in the region of Telangana, Andhra Pradesh and suitable measures should be undertaken to prevent the misuse of antibiotics. It is even dreadful to think what misery humankind should suffer if antibiotic-resistant organisms start spreading from one human to another. Its high time that legislation and stringent guidelines be brought into immediate effect to prevent any further antibiotic misuse by physicians and dentists alike. We also suggest the necessity to perform further systematic and extensive research to gain a better understanding regarding the prevailing situation in India about antibiotics, their use, and misuse.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Dar-Odeh NS, Abu-Hammad OA, Al-Omiri MK, Khraist AS, Shehabi AA. Antibiotic prescribing practices by dentist: A review. Ther Clin Risk Manag 2010;6:301-6.  Back to cited text no. 1
    
2.
Stratton CW. Dead bugs don't mutate: Susceptibility issues in the emergence of bacterial resistance. Emerg Infect Dis 2003;9:10-6.  Back to cited text no. 2
    
3.
Khan K, Muennig P, Behta M, Zivin JG. Global drug resistance patterns and the management of latent tuberculosis infection in immigrants to the United States. N Engl J Med 2002;347:1850-9.  Back to cited text no. 3
    
4.
Musoke RN, Revathi G. Emergence of multidrug-resistant gram negative organisms in a neonatal unit and the therapeutic implications. J Trop Pediatr 2000;46:86-91.  Back to cited text no. 4
    
5.
Levy SB. The antibiotic paradox: How the misuse of antibiotics destroys their curative powers. 2nd ed. Cambridge, MA: Perseus; 2002.  Back to cited text no. 5
    
6.
Cleveland JI, Kohn WC. Antimicrobial resistance and dental care: A CDC Perspective. Dent Abstr 1998;108-10.  Back to cited text no. 6
    
7.
IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.  Back to cited text no. 7
    
8.
Karibasappa GN, Sujatha A. Antibiotic resistance – A concern for dentists? J Dent Med Sci 2014;13:112-8.  Back to cited text no. 8
    
9.
Faure H, Mahy S, Soudry A, Duong M, Chavanet P, Piroth L. Factors influencing the prescription or non-prescription of antibiotics by general practitioners. Med Mal Infect 2009;39:714-21.  Back to cited text no. 9
    
10.
Straand J, Rokstad KS, Sandvik H. Prescribing systemic antibiotics in general practice. A report from the Møre & Romsdal Prescription Study. Scand J Prim Health Care 1998;16:121-7.  Back to cited text no. 10
    
11.
Otters HB, vander Wouden JC, Schellevis FG, van Suulekonflmit LW, Koes BW. Trends in prescribing antibiotics for children in Dutch general practices. J Antirmicrob Chemother 2004;53:361-6.  Back to cited text no. 11
    
12.
Abukaraky AE, Afifeh KA, Khatib AA, Khdairi NO, Habarneh HM, Ahmad WK, et al. Antibiotics prescribing practices in oral implantology among Jordanian dentists. A cross sectional, observational study. BMC Res Notes 2011;4:266.  Back to cited text no. 12
    
13.
Kotwani A, Wattal C, Katewa S, Joshi PC, Holloway K. Factors influencing primary care physicians to prescribe antibiotics in Delhi India. Fam Pract 2010;27:684-90.  Back to cited text no. 13
    
14.
Vazquez-Lago JM, Lopez-Vazquez P, López-Durán A, Taracido-Trunk M, Figueiras A. Attitudes of primary care physicians to the prescribing of antibiotics and antimicrobial resistance: A qualitative study from Spain. Fam Pract 2012;29:352-60.  Back to cited text no. 14
    
15.
Cleary JD. Impact of pharmaceutical sales representatives on physician antibiotic prescribing. J Pharm Technol 1992;8:27-9.  Back to cited text no. 15
    
16.
Wazana A. Physicians and the pharmaceutical industry: Is a gift ever just a gift? JAMA 2000;283:373-80.  Back to cited text no. 16
    
17.
Vancelik S, Beyhun NE, Acemoglu H, Calikoglu O. Impact of pharmaceutical promotion on prescribing decisions of general practitioners in Eastern Turkey. BMC Public Health 2007;7:122.  Back to cited text no. 17
    
18.
McGettigan P, Golden J, Fryer J, Chan R, Feely J. Prescribers prefer people: The sources of information used by doctors for prescribing suggest that the medium is more important than the message. Br J Clin Pharmacol 2001;51:184-9.  Back to cited text no. 18
    
19.
Chimonas S, Brennan TA, Rothman DJ. Physicians and drug representatives: Exploring the dynamics of the relationship. J Gen Intern Med 2007;22:184-90.  Back to cited text no. 19
    
20.
Butler CC, Rollnick S, Pill R, Maggs-Rapport F, Stott N. Understanding the culture of prescribing: Qualitative study of general practitioners' and patients' perceptions of antibiotics for sore throats. BMJ 1998;317:637-42.  Back to cited text no. 20
    
21.
Pechère JC. Patients' interviews and misuse of antibiotics. Clin Infect Dis 2001;33:S170-3  Back to cited text no. 21
    
22.
Haltiwanger KA, Hayden GF, Weber T, Evans BA, Possner AB. Antibiotic-seeking behavior in college students: What do they really expect? J Am Coll Health 2001;50:9-13.  Back to cited text no. 22
    
23.
Haas JS, Phillips KA, Gerstenberger EP, Seger AC. Potential savings from substituting generic drugs for brand-name drugs: Medical expenditure panel survey, 1997-2000. Ann Intern Med 2005;142:891-7.  Back to cited text no. 23
    



 
 
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  [Table 1], [Table 2], [Table 3]



 

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