Combating Antibiotic Resistance
Part 1
Background.The ADA Council on Scientific Affairs developed this report to provide dental professionals with current information on antibiotic resistance and related considerations about the clinical use of antibiotics that are unique to the practice of dentistry.
Overview.
This report addresses the association between the overuse of antibiotics and the development of resistant bacteria. The Council also presents a set of clinical guidelines that urges dentists to consider using narrow-spectrum antibacterial drugs in simple infections to minimize disturbance of the normal microflora, and to preserve the use of broad-spectrum drugs for more complex infections.
Conclusions and Practice Implications.
The Council recommends the prudent and appropriate use of antibacterial drugs to prolong their efficacy and promotes reserving their use for the management of active infectious disease and the prevention of hematogenously spread infection, such as infective endocarditis or total joint infection, in high-risk patients.
Part 2
Search for new antibiotics. To combat the occurrence of resistant bacteria, biotechnology and pharmaceutical companies must constantly research, develop and test new antimicrobials in order to maintain a pool of effective drugs on the market.
Stop the use of antibiotics as growth-promoting substances in farm animals. Of major concern is the use of antibiotics as feed additives given to farm animals to promote animal growth and to prevent infections rather than cure infections. The use of such antibiotics contributes to the emergence of antibiotic-resistant bacteria that threaten human health and decreases the effectiveness of the same antibiotics used to combat human infections.
Use the right antibiotic in an infectious situation as determined by antibiotic sensitivity testing, when possible.
Stop unnecessary antibiotic prescriptions. Unnecessary antibiotic prescriptions have been identified as causes for an enhanced rate of resistance development. Unnecessary prescriptions of antibiotics are made when antibiotics are prescribed for viral infections (antibiotics have no effect on viruses). This gives the opportunity for indigenous bacteria (normal flora) to acquire resistance that can be passed on to pathogens.
Finish antibiotic prescriptions. Unfinished antibiotic prescriptions may leave some bacteria alive or may expose them to sub-inhibitory concentrations of antibiotics for a prolonged period of time. Mycobacterium tuberculosis is a slow growing bacteria which infects the lung and causes tuberculosis. This disease kills more adults than any other infectious disease. Due to the slow growing nature of the infection, treatment programs last for months or even years. This has led to many cases on unfinished prescriptions and 5% of strains now observed are completely resistant to all known treatments and hence incurable.
Several other possible solutions have been proposed or implemented to combat antibiotic resistance.
In the pharmaceutical industry, past and current strategies to combat resistance have not been effective. Pharmaceutical companies are seeking new, less costly strategies to develop antibiotics.
A decrease in the number of prescriptions for antibiotics, especially in small children, is occurring. Several countries such as the UK have regulations concerning the use of antibiotics in animal feed.
Large scale public health education efforts are underway to stress the importance of finishing prescriptions. Indeed, in many places, failure to finish tuberculosis prescriptions can result in jail time.
Combating Antibiotic Resistance
