Dental Tribune United Kingdom Edition

19Infection ControlNov 26 - Dec 3, 2012United Kingdom Edition 19 a 78.6 per cent reduction in antibiotic prophylaxis prescription (Thornhill et al., 2011). Palmer and colleagues (2000) observed many inappropriate doses and frequencies of antimicrobial prescription, falling outside the guidance of the Den- tal Practitioners Formulary (DPF), when they evaluated the antibiotic prescription pat- tern by general dental prac- titioners from ten different health authorities in England (Palmer et al., 2000). As a gen- eral rule, the majority of den- to-alveolar abscesses respond well to incision and drainage without the need for antimi- crobial treatment apart from cases with evidence of spread of infection or systemic in- volvement such as lymphad- enopathy and/or raised body temperature. The prophy- lactic antimicrobial therapy before wisdom teeth extrac- tion and implant surgery is not currently recommended, provided that good surgical and aseptic techniques are maintained (Martin 2010). Indeed, the Health Protec- tion Agency in collaboration with the British Infection As- sociations are currently in the process of developing antimi- crobial guidelines for the em- pirical treatment of dental in- fections directed towards the general medical practitioner and derived from the Scottish Dental Clinical Effectiveness Programme (SDCEP Guide- lines, 2011). We believe that, imple- menting prescription audits and feedback is one of the most successful strategies for the antimicrobial steward- ship programme which can be easily implemented in the dental practice. Also the De- partment of health approach “start smart and focus” can be adopted in the dental practice. This concept advise to “start smart” by avoiding any anti- microbial prescription in the absence of clinical evidence of bacterial infection, use the available guidelines to initi- ate a prompt effective antimi- crobial treatment if justified, document any antimicrobial usage, obtain culture before the initiation of antimicrobial therapy, prescribe single dose only of antimicrobials for sur- gery prophylaxis if justified. The following step is to “fo- cus” which means to review the diagnosis and the con- tinuing need for antimicro- bial treatment after 48 hours of prescription, make clear plan of actions “antimicro- bial prescribing decision”, and document the decision (ARHAI, 2011). DT References: 1. Department of health advisory com- mittee on antimicrobial resistance and healthcare associated infection (arhai) 2011. Antimicrobial stewardships: “start smart and the focus”. (Http://www. Dh.Gov.Uk/prod_consum_dh/groups/ dh_digitalassets/documents/digitalasset/ dh_131181.Pdf). 2. Scottish dental clinical effectiveness programme 2011. Drug prescribing for dentistry, second edition. Http://www. Sdcep.Org.Uk/index.Aspx?O=2334. 3. Nathwani, d., Sneddon, j., Malcolm, w., Wiuff, c., Patton, a., Hurding, s., Eastaway, a., Seaton, r. A., Watson, e., Gillies, e., Davey, p. & Bennie, m. 2011. Scottish antimicrobial prescribing group (sapg): development and impact of the scottish national antimicrobial steward- ship programme. Int j antimicrob agents, 38, 16-26. 4. O’leary, e., Lockhart, d. E. & Smith, a. 2011. Coming to a practice near you? Community-acquired meticillin resistant staphylococcus aureus (ca-mrsa). Dent update, 38, 254-6, 259-60. 5. Palmer, n. O., Martin, m. V., Pealing, r. & Ireland, r. S. 2000. An analysis of anti- biotic prescriptions from general dental practitioners in england. J antimicrob chemother, 46, 1033-5. 6. Thornhill, m. H., Dayer, m. J., Forde, j. M., Corey, g. R., Chu, v. H., Couper, d. J. & Lockhart, p. B. 2011. Impact of the nice guideline recommending cessation of antibiotic prophylaxis for prevention of infective endocarditis: before and after study. Bmj, 342, d2392. ‘The prophylactic antimicrobial ther- apy before wisdom teeth extraction and implant surgery is not cur- rently recommend- ed, provided that good surgical and aseptic techniques are maintained’