Antibiotic Misuse in Endodontics by Sudanese Dentists

Abstract

Background: Evidence from many studies suggests that antibiotics are being prescribed inappropriately within general dental practice. In Sudan we have a general concern that the use of antibiotic in many instances unjustifiable in the medical field. Design: prospective clinical and cross sectional studies. Setting: Khartoum Dental Hospitals and Health Centers. Objectives: Investigate the prescribing habits of antibiotics by general dentists in Khartoum, Sudan. Methods: The study consists of two questionnaires: The first one investigated the therapeutic prescribing of antibiotics to patients attending for emergency dental treatment. Information was collected via a questionnaire concerning the patient’s reason for attendance and treatment undertaken at emergency dental clinics in Khartoum state. The second questionnaire: Investigated the knowledge of antibiotic prescription by GDP’s in Khartoum State. Questionnaires were distributed to General Practioners contracted to provide treatment in Khartoum health centers and hospitals. viii Results: First questionnaire: Over a 12-week period 1,062 questionnaires were collected in which 1,030 were useable. The majority of the attendees had pain, 83.2% of these patients had pulpitis and 32% had been issued a prescription for antibiotics, without any active surgical intervention. The principal antibiotic prescribed for both adult and child patients was combination of amoxicillin and metronidazole. Second questionnaire: Results Responses to the questionnaire were received from 322 (80.5%) practitioners. More than 85% of practitioners recognised the need for prescribing antibiotics where there was evidence of spreading infection. Some practitioners (28%) prescribed antibiotics for acute pulpitis and (18 %) for chronic one. Antibiotics were prescribed by practitioners before drainage of acute abscesses (33%) and by (90%) after drainage. Practitioners were generally not influenced by patient’s expectations of receiving antibiotics (88%), but would prescribe when under pressure of time (21.9%), if they were unable to make a definitive diagnosis (33.8%), or if treatment had to be delayed (71.52%). Amoxicillin was the most frequently prescribed antibiotic used for most clinical conditions followed by Amoxicillin with Calvulanic acid (brand name in Sudan is Amoclan or Augmentin). There was a wide variety of dosage, ix frequency and duration for all the antibiotics used in the treatment of acute dental infections. Conclusion: The results obtained from both questionnaires have shown that the prescribing of antibiotics by some GDP’s is not based on sound clinical principles. Most of those surveyed used antibiotics routinely for conditions where local treatment would suffice. It appears that there is a need for interventions to promote rational use of antibiotics in the dental field in Sudan.