Antibiotics are now failing to work in a fifth of patients who suffer an infection after hospital surgery, according to the first major study investigating the crisis published in the Lancet.

One in eight patients undergoing common procedures such as appendix removal developed an infection while recovering. And 22 per cent of cases were found to be resistant to the antibiotics which should have protected them.

The study tracked more than 13,000 patients in 66 countries who were undergoing gastrointestinal surgery.

For the dental profession which has many surgical procedures associated with antibiotics, this finding of increasing resistance is worrying.

A new study reported that between 7% and 10% of all antibiotics used in outpatient care,  are prescribed by dentists.  Moreover, this study reported ” abundant evidence, particularly from the UK, that a high number of antibiotics were provided despite being incompatible with guidelines in dentistry. Most commonly, antibiotics were prescribed for irreversible pulpitis, chronic periodontitis, acute dental problems, removal of third molars or as prophylactic treatment against implant failure.

There is ongoing controversy whether antibiotics are necessary in most of these dental conditions and a lot of studies confirmed that dentists around the world prescribe antibiotics contrary to local guidelines. Indeed, while antibiotic prescribing by medical doctors has declined over the past 10 years, it has grown significantly in dentistry.

Let’s take a look at one infection in particular, and the role of dentistry in managing resistance therein.

Clostridium difficile infection, the most common cause of hospital-acquired diarrhea, is serious business. There were nearly half a million C difficile infections in the US in 2011 – the last year numbers were available – and 29,000 patients died within a month of diagnosis. The two most important risk factors for developing C. diff infection are antibiotic exposure and age > 65 years old.

We tend to equate antibiotic exposure with the prescription from our doctor. But a new study reported in Medscape Medical News says that “Antibiotics prescribed by dentists could be contributing to cases of potentially deadly C. diff.”

The Centers for Disease Control researchers looked at 1626 cases of C diff across Minnesota and found that 136 patients (15%) had been prescribed an antibiotic by a dentist in the prior 12 weeks. Moreover, just over a third (34%) of those prescribed antibiotics by a dentist had no mention of the dental antibiotics in their medical chart.

So dentistry is facing a new era when infections from its surgical procedures will be difficult to control or where regulations will be imposed on antibiotic prescribing.

This means dentists will need to reduce invasive care associated with antibiotics and/or expand the use of topical antiseptics on a pre-op and post-op basis.

Prevora is the most proven topical antiseptic for the oral cavity.

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