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ePaper created 2016-11-22, 09:52:12 | version 1.38.0
antibiotics CE article | 09 roots 4 2016 andcontagiousstaphinfectionskillthousandsofpa- tients in the most sophisticated hospitals in Europe, North America and Asia, there is virtually no sign of this “killer superbug” in Norway. The reason? Norway stopped using so many antibiotics. “We don’t throw antibiotics at every person with a fever.Wetellthemtohangon,waitandsee,andwegive themaTylenoltofeelbetter,”saidDrJohnHaug,infec- tious disease specialist at Aker University Hospital.8 In Norway’ssimplesolution,thereisaglimmerofhope. The proper clinical use of antibacterial drugs In 1997, the ADA Council on Scientific Affairs issued a position statement on Antibiotic Use in Dentistry.9 The Council stated: “Microbial resistance to antibiotics is increasing at an alarming rate. The major cause of thispublichealthproblemistheuseofantibioticsinan inappropriatemanner,leadingtotheselectionofdom- inance of resistant microorganisms and/or the in- creased transfer of resistance genes from antibiotic- resistant to antibiotic-susceptible microorganisms.”9 The council’s position statement further identified that “Antibiotics are properly employed only for the management of active infectious disease or the pre- vention of metastatic infection, such as infective en- docarditis, in medically high-risk patients.”9 One method of education is to teach from errors ratherthanprinciples.PsychologistsfromtheUniver- sityofExeterhaveidentifiedan“earlywarningsignal” in the brain that helps us avoid repeating previous mistakes. Published in the Journal of Cognitive Neu- roscience,10 theirresearchidentifiesforthefirsttime, amechanisminthebrainthatreacts,injustone-tenth ofasecond,tothingsthathaveresultedinusmaking errorsinthepast.Evaluatingthefollowingeightmis- conceptionsor“myths”mayhelptoestablishgeneral guidelines to aid us in making clinical decisions re- gardingtheuseofantibiotictherapy,therebyleading to optimum use and therapeutic success.11 Myth No. 1: Antibiotics cure patients Except in patients with a compromised immune system,antibioticsarenotcurative,butinsteadfunc- tion to assist in the re-establishment of the proper balance between the host’s defenses (immune and inflammatory) and the invasive agent(s). Antibiotics do not cure patients; patients cure themselves. Myth No. 2: Antibiotics are substitutes for surgical intervention Veryseldomareantibioticsanappropriatesubstitute for removal of the source of the infection (extraction, endodontic treatment, incision and drainage, peri- odontalscalingandrootplanning).Occasionally,when the infection is too diffuse or disseminated to identify a nidus for incision, or the clinical situation does not allow for immediate curative treatment, the prudent dentist will choose to place the patient on appropriate antibacterial therapy until such time as curative treat- ment can be implemented. It is imperative to remove thecauseoftheinfectionpriorto,orconcomitantwith, antibiotictherapy,whenthecauseisreadilyidentifiable. Wheneverantibiotictherapyisused,theriskofbacterial selectionforantibioticresistanceispresent. Myth No. 3: The most important decision is which antibiotic to use Toavoidthedeleteriouseffectsofneedlessantibiot- icsonpatientsandtheenvironment,themostimport- ant initial decision is not which antibiotic to prescribe butwhethertouseoneatall.Ithasbeenestimatedthat up to 60 percent of human infections resolve by host defenses alone following removal of the cause of the infectionwithoutantibioticintervention. Fig.1:Asymptomatic apical periodontitis.(Photos/Provided by AmericanAssociation of Endodontists) Fig.2: Chronic apical abscess. Fig.2 Fig.1 42016