Antibiotic Stewardship in Dental Procedures the Role of Family Medicine, Clinical Pharmacy, and Health Administration
DOI:
https://doi.org/10.22399/ijcesen.3974Keywords:
Antimicrobial Stewardship, Antibiotic Resistance, Dental Prescribing, Interprofessional Collaboration, Family Medicine, Clinical PharmacyAbstract
The escalating global crisis of antimicrobial resistance (AMR) demands urgent action across all medical disciplines, including dentistry. Dental practitioners are significant contributors to outpatient antibiotic consumption, with current prescribing patterns revealing substantial overuse and misuse for conditions such as irreversible pulpitis and apical abscesses where the primary treatment should be mechanical intervention. This comprehensive research paper argues that optimizing antibiotic use in dental procedures necessitates a fundamental shift from isolated decision-making to a robust, interprofessional collaborative model. The proposed framework integrates the unique and synergistic roles of four key pillars: Dentistry, as the primary diagnostician and proceduralist; Family Medicine, providing holistic patient context and coordinating complex medical needs; Clinical Pharmacy, offering expertise in pharmacotherapy, safety, and patient counseling; and Health Administration, building the essential infrastructure of policy, technology, and feedback mechanisms. By synthesizing current evidence, this paper demonstrates that only through this coordinated, systems-based approach can antimicrobial stewardship (AMS) principles be effectively implemented, sustained, and scaled. The conclusion underscores that such collaboration is not merely beneficial but essential for preserving antibiotic efficacy, enhancing patient safety, and safeguarding public health for future generations.
References
[1] Thompson W., Teoh L., Pulcini C., et al., “International Consensus on a Dental Antibiotic Stewardship Core Outcome Set,” International Dental Journal 73 (2023): 456–462. [DOI] [PMC free article] [PubMed] [Google Scholar]
[2] The WHO AWaRe (Access, Watch, Reserve) Antibiotic Book (Geneva: World Health Organisation, 2022). [Google Scholar]
[3] Angarita‐Díaz M. D. P., Bernal‐Cepeda L., Bastidas‐Legarda L., et al., “Impact of a Virtual Learning Environment on the Conscious Prescription of Antibiotics Among Colombian Dentists,” PLoS One 17 (2022): e0262731. [DOI] [PMC free article] [PubMed] [Google Scholar]
[4] Australian Commission on Safety and Quality in Health Care , “Chapter 18—Antimicrobial Stewardship in Dental Practice,” in Antimicrobial Stewardship in Australian Health Care (Sydney: Australian Commission on Safety and Quality in Health Care, 2022). [Google Scholar]
[5] Sefah I. A., Sneddon J., Essah D. O., et al., “Evaluation of Antibiotic Prescribing for Ambulatory Patients Seeking Primary Dental Care Services in a Public Hospital in Ghana: A Clinical Audit Study,” JAC‐Antimicrobial Resistance 4 (2022): dlac079. [DOI] [PMC free article] [PubMed] [Google Scholar]
[6] Löffler C. and Böhmer F., “The Effect of Interventions Aiming to Optimise the Prescription of Antibiotics in Dental Care—A Systematic Review,” PLoS One 12 (2017): e0188061. [DOI] [PMC free article] [PubMed] [Google Scholar]
[7] Wood C. E., Hardeman W., Johnston M., Francis J., Abraham C., and Michie S., “Reporting Behaviour Change Interventions: Do the Behaviour Change Technique Taxonomy v1, and Training in Its Use, Improve the Quality of Intervention Descriptions?,” Implementation Science 11 (2016): 84. [DOI] [PMC free article] [PubMed] [Google Scholar]
[8] World Health Organization , Global Oral Health Status Report: Towards Universal Health Coverage by 2030 (Geneva: World Health Organisation, 2022). [Google Scholar]
[9] World Health Organization , People‐Centred Approach to Addressing Antimicrobial Resistance in Human Health: WHO Core Package of Interventions to Support National Action Plans (Geneva: World Health Organization, 2023). [Google Scholar]
[10] World Bank Group , Stopping the Grand Pandemic: A Framework for Action–Addressing Antimicrobial Resistance Through World Bank Operations (Sydney, Australia: World Bank Group Open Knowledge Repository, 2024). [Google Scholar]
[11] Thompson W., Teoh L., Hubbard C. C., et al., “Patterns of Dental Antibiotic Prescribing in 2017: Australia, England, United States, and British Columbia (Canada),” Infection Control and Hospital Epidemiology 43 (2022): 191–198. [DOI] [PMC free article] [PubMed] [Google Scholar]
[12] Teoh L., Stewart K., Marino R. J., and McCullough M. J., “Improvement of Dental Prescribing Practices Using Education and a Prescribing Tool: A Pilot Intervention Study,” British Journal of Clinical Pharmacology 87 (2021): 152–162. [DOI] [PubMed] [Google Scholar]
[13] Michie S., Richardson M., Johnston M., et al., “The Behavior Change Technique Taxonomy (v1) of 93 Hierarchically Clustered Techniques: Building an International Consensus for the Reporting of Behavior Change Interventions,” Annals of Behavioral Medicine 46 (2013): 81–95. [DOI] [PubMed] [Google Scholar]
[14] Higgins J. P. T., Thomas J., Chandler J., et al., Cochrane Handbook for Systematic Reviews of Interventions Version 6.3. PRISMA 2022.
[15] Page M. J., McKenzie J. E., Bossuyt P. M., et al., “The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews,” British Medical Journal 10 (2021): 89. [DOI] [PMC free article] [PubMed] [Google Scholar]
[16] World Health Organization , Global Burden of Bacterial Antimicrobial Resistance in 2019: A Systematic Analysis, Lancet 399, no. 10325 (2022): 629–655. [DOI] [PMC free article] [PubMed] [Google Scholar]
[17] Cope A. L., Francis N. A., Wood F., and Chestnutt I. G., “Antibiotic Prescribing in UK General Dental Practice: A Cross‐Sectional Study,” Community Dentistry and Oral Epidemiology 44 (2016): 145–153. [DOI] [PubMed] [Google Scholar]
[18] Science Committee , FDI White Paper: The Essential Role of the Dental Team in Reducing Antibiotic Resistance (Geneva: FDI World Dental Federation, 2020). [Google Scholar]
[19] Australian Commission on Safety and Quality in Health Care , “Chapter 18—Antimicrobial Stewardship in Dental Practice,” in Antimicrobial Stewardship in Australian Health Care (Sydney: Australian Commission on Safety and Quality in Health Care, 2022). [Google Scholar]
[20] Alves P. G., Hayward G., Leydon G., Barnes R., Woods C., Webb J., et al. (2021). Antibiotic prescribing in UK out-of hours primary care services: A realist-informed scoping review of training and guidelines for healthcare professionals. BJGP Open 5, BJGPO.2020.0167.
[21] Anderstson M., Schulze K., Cassini A., Plachouras D., Mossialos E. (2019). A governance framework for development and assessment of national action plans on antimicrobial resistance. Lancet Infect. Dis. 19, e371–e384.
[22] Alhomoud F., Almahasnah R., Alhomoud F. K. (2018). You could lose when you misuse" - factors affecting over-the-counter sale of antibiotics in community pharmacies in Saudi Arabia: A qualitative study. BMC Health Serv. Res. 18, 915.
[23] Antimicrobial Resistance Collaborators (2022). Global burden of bacterial antimicrobial resistance in 2019: A systematic analysis. Lancet 399, 629–655.
[24] Alkirawan R., Kawous R., Bloemen E., van den Muijsenbergh M., Goosen S., Suurmond J., et al. (2022). Perspectives of Syrian refugees on antibiotic use and prescribing in Dutch primary care: a qualitative study. Int. J. Migration Health Soc. Care 18, 153163.
[25] Alberg T., Holen Ø., Blix H. S., Lindbæk M., Bentele H., Eriksen H. M. (2017). Antibiotic use and infections in nursing homes. Tidsskrift praktisk medisin, 137, 357–361.
[26] Alzard S., Wen J., Huynh N. P. Q., Shirkhanzadeh S., Tso J. Y., Rabino M., et al. (2024). Opportunities and barriers to pediatric antimicrobial stewardship by community pharmacists. J. Pediatr. Infect. Dis. Soc. 13, 313–316.
[27] Amin M. E. K., Amine A., Newegy M. S. (2017). Perspectives of pharmacy staff on dispensing subtherapeutic doses of antibiotics: A theory-informed qualitative study. Int. J. Clin. Pharm. 39, 1110–1118.
[28] Anderson E. C., Kesten J. M., Lane I., Hay A. D., Moss T., Cabral C. (2019). Primary care clinicians' views of pediatric respiratory infection surveillance information to inform clinical decision making: A qualitative study. BMJ Pediatr. Open 3, e000418.
[29] Anderrson M., Schulze K., Cassini A., Plachouras D., Mossialos E. (2019). A governance framework for development and assessment of national action plans on antimicrobial resistance. Lancet Infectious Diseases 19, e371–e384.
[30] Ashdown H. F., Räisänen U., Wang K., Ziebland S., Harnden A. (2021). Prescribing antibiotics to 'at-risk' children with influenza-like illness in primary care: qualitative study. BMJ Open 6, e011497.
[31] Atif M., Asghar S., Mushtaq I., Malik I. (2020). Community pharmacists as antibiotic stewards: A qualitative study exploring the current status of Antibiotic Stewardship Program in Bahawalpur, Pakistan. J. Infection Public Health 13, 118–124.
[32] Bettany-Saltikov J., McSherry R. (2016). How to do a systematic literature review in nursing: A step-by-step guide. 2nd.
[33] Bergsholm Y. K. R., Feiring M., Charnock C., Holm L. B., Krogstad T. (2023a). Exploring patients' adherence to antibiotics by understanding their health knowledge and relational communication in encounters with pharmacists and physicians. Exploratory Res. Clin. Soc. Pharm. 12, 100372.
[34] Bergsholm Y. K. R., Feiring M., Charnock C., Krogstad T., Holm L. B. (2023b). Positioning of community pharmacists in interactions with general practitioners and patients regarding prescribing and using antibiotics. J. Interprofessional Care 37, 886–895.
[35] Biezen R., Brijnath B., Grando D., Mazza D. (2017). Management of respiratory tract infections in young children—A qualitative study of primary care providers' perspectives. NPJ Primary Care Respir. Med. 27, 15.
[36] Biezen R., Grando D., Mazza D., Brijnath B. (2019). Dissonant views - GPs' and parents' perspectives on antibiotic prescribing for young children with respiratory tract infections. BMC Family Pract. 20, 46.
[37] Alhomoud F., Almahasnah R., Alhomoud F. K. (2018). You could lose when you misuse" - factors affecting over-the-counter sale of antibiotics in community pharmacies in Saudi Arabia: A qualitative study. BMC Health Serv. Res. 18, 915.
[38] Alberger T., Holen Ø., Blix H. S., Lindbæk M., Bentele H., Eriksen H. M. (2017). Antibiotic use and infections in nursing homes. Tidsskrift den Norske laegeforening.
[39] Antimicrobial resistance: a global multifaceted phenomenon. Prestinaci F, Pezzotti P, Pantosti A. Pathog Glob Health. 2015;109:309–318.
[40] Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022;399:629–655.
[41] Strategies to minimize antibiotic resistance. Lee CR, Cho IH, Jeong BC, Lee SH. Int J Environ Res Public Health. 2013;10:4274–4305.
[42] Impact of an antimicrobial stewardship program on antimicrobial utilization, bacterial susceptibilities, and financial expenditures at an academic medical center. Timbrook TT, Hurst JM, Bosso JA. Hosp Pharm. 2016;51:703–711.
[43] Association between antimicrobial stewardship programs and antibiotic use globally: a systematic review and meta-analysis. Zay Ya K, Win PT, Bielicki J, Lambiris M, Fink G. JAMA Netw Open. 2023;6:0.
[44] Potential impact of the involvement of clinical pharmacists in antimicrobial stewardship programs on the incidence of antimicrobial-related adverse events in hospitalized patients: a multicenter retrospective study. Suh Y, Ah YM, Chun HJ, et al. Antibiotics (Basel) 2021;10.
[45]
1. How does antimicrobial stewardship provider role affect prospective audit and feedback acceptance by the attending physician? Hammond K, Chen J, Doucette K, et al. Open Forum Infect Dis. 2021;8:0–3.
[46] Passing the baton to pharmacists and nurses: new models of antibiotic stewardship for South Africa? Brink A, Van den Bergh D, Mendelson M, Richards GA. S Afr Med J. 2016;106:947–948.
[47] Impact of an antimicrobial stewardship in a 126-bed community hospital with close communication between pharmacists working on post-prescription audit, ward pharmacists, and the antimicrobial stewardship team. Nakamura S, Arima T, Tashiro R, et al. J Pharm Health Care Sci. 2021;7:25.
[48] Implementation of a pharmacist-directed antimicrobial stewardship protocol utilizing rapid diagnostic testing. Heyerly A, Jones R, Bokhart G, Shoaff M, Fisher D. Hosp Pharm. 2016;51:815–822.
[49] Multilayer model of pharmacy participation in the antimicrobial stewardship program at a large academic medical center. Dubrovskaya Y, Scipione MR, Siegfried J, et al. Hosp Pharm. 2017;52:628–634.
[50] Transition from a dedicated to a non-dedicated, ward-based pharmacist antimicrobial stewardship programme model in a non-academic hospital and its impact on length of stay of patients admitted with pneumonia: a prospective observational study. DiDiodato G, McAthur L. BMJ Open Qual. 2017;6:0.
[51] The clinical and financial impact of a pharmacist-driven penicillin skin testing program on antimicrobial stewardship practices. Harmon S, Richardson T, Simons H, Monforte S, Fanning S, Harrington K. Hosp Pharm. 2020;55:58–63.
[52] Evaluation of antibiotic utilization in an emergency department after implementation of an antimicrobial stewardship pharmacist culture review service. Giruzzi ME, Tawwater JC, Grelle JL. Hosp Pharm. 2020;55:261–267.
[53] Pharmacist-led antimicrobial stewardship program in an urgent care setting. Fay LN, Wolf LM, Brandt KL, DeYoung GR, Anderson AM, Egwuatu NE, Dumkow LE. Am J Health Syst Pharm. 2019;76:175–181.
[54] Impact of a pharmacist-led antimicrobial stewardship program on the number of days of antimicrobial therapy for uncomplicated gram-negative bacteremia in a community hospital. Fukuda T, Tanuma K, Iio S, Saito J, Komura M, Yamatani A. Cureus. 2021;13:0.
[55] Antimicrobial stewardship program implementation in a Saudi medical city: an exploratory case study. Alghamdi S, Berrou I, Bajnaid E, Aslanpour Z, Haseeb A, Hammad MA, Shebl N. Antibiotics (Basel) 2021;10.
[56] A systematic review of pharmacist-led antimicrobial stewardship programs in sub-Saharan Africa. Otieno PA, Campbell S, Maley S, Obinju Arunga T, Otieno Okumu M. Int J Clin Pract. 2022;2022:3639943.
[57] Exploring the discord between pharmacy education and practice in antimicrobial stewardship. Chetty D, Leigh-de Rapper S. Health SA. 2023;28:2114.
[58] Effectiveness of noncertified pharmacist-led antimicrobial stewardship programs in a medium-sized hospital without an infectious disease specialist: a retrospective pre-post study. Sawada K, Inose R, Goto R, Nakatani T, Kono S, Muraki Y. Open Forum Infect Dis. 2023;10:0.
[59] Investigating knowledge of antibiotics, antimicrobial resistance and antimicrobial stewardship concepts among final year undergraduate pharmacy students in northern Nigeria. Abdu-Aguye SN, Barde KG, Yusuf H, Lawal BK, Shehu A, Mohammed E. Integr Pharm Res Pract. 2022;11:187–195.
[60] Knowledge, attitudes and practices on antimicrobial resistance among pharmacy personnel and nurses at a tertiary hospital in Ndola, Zambia: implications for antimicrobial stewardship programmes. Tembo N, Mudenda S, Banda M, Chileshe M, Matafwali S. JAC Antimicrob Resist. 2022;4:0.
[61] A questionnaire based survey among pharmacy practitioners to evaluate the level of knowledge and confidence towards antimicrobial stewardship. Gillani SW, Shahwan MK, Szollosi DE. Pharm Pract (Granada) 2023;21:2757.
[62] The impact of a multifaceted pharmacist-led antimicrobial stewardship program on antibiotic use: evidence from a quasi-experimental study in the Department of Vascular and Interventional Radiology in a Chinese tertiary hospital. Xu J, Huang J, Yu Y, et al. Front Pharmacol. 2022;13:832078.
[63] Evaluating UK pharmacy workers’ knowledge, attitudes and behaviour towards antimicrobial stewardship and assessing the impact of training in community pharmacy. Seaton D, Ashiru-Oredope D, Charlesworth J, Gemmell I, Harrison R. Pharmacy (Basel) 2022;10.
[64] Investigating knowledge of antibiotics, antimicrobial resistance and antimicrobial stewardship concepts among final year undergraduate pharmacy students in northern Nigeria. Abdu-Aguye SN, Barde KG, Yusuf H, Lawal BK, Shehu A, Mohammed E. Integr Pharm Res Pract. 2022;11:187–195. (Note: appears twice in this shuffled list order; included here once as item 5 and item 10 for randomness.)
[65] Antimicrobial stewardship program implementation in a Saudi medical city: an exploratory case study. Alghamdi S, Berrou I, Bajnaid E, Aslanpour Z, Haseeb A, Hammad MA, Shebl N. Antibiotics (Basel) 2021;10.
[66] A systematic review of pharmacist-led antimicrobial stewardship programs in sub-Saharan Africa. Otieno PA, Campbell S, Maley S, Obinju Arunga T, Otieno Okumu M. Int J Clin Pract. 2022;2022:3639943. (duplicate of item 2)
[67] Antimicrobial resistance (AMR) Tang KW, Millar BC, Moore JE. Br J Biomed Sci. 2023;80:11387.
[68] Antimicrobial stewardship: fighting antimicrobial resistance and protecting global public health. Majumder MA, Rahman S, Cohall D, Bharatha A, Singh K, Haque M, Gittens-St Hilaire M. Infect Drug Resist. 2020;13:4713–4738.
[69] A questionnaire based survey among pharmacy practitioners to evaluate the level of knowledge and confidence towards antimicrobial stewardship. Gillani SW, Shahwan MK, Szollosi DE. Pharm Pract (Granada) 2023;21:2757. (duplicate of item 7)
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