Owens’ hands, arms and legs were swollen and the skin on his arms became discolored. His granddaughter, Aisha Lewis, said she was reluctant to apply hand lotion to Owens for fear it would break out his skin.
Flournova continues to be haunted by her mother’s suffering. One question keeps repeating in his mind: Why do dentists still prescribe clindamycin?
do what you are told
Abt said dental schools have been teaching dentists for decades to prescribe antibiotics to prevent procedure-related infections.
Dentists were taught to prescribe certain medications. Penicillin is called amoxicillin because of its efficacy and safety record. Dentists were taught to prescribe clindamycin for patients like Owens, whose medical records listed a penicillin allergy.
Because bacteria from the mouth can travel throughout the body, Abt said dentists have been taught to prescribe antibiotics for patients with certain heart conditions to prevent a rare but dangerous infection of the heart’s lining and valves called infective endocarditis. Antonia F. Cheng, MD, MBA, chair and professor of orthopedic surgery at the University of Texas Southwestern, said dentists routinely prescribe antibiotics to people with artificial joints, even if they are healthy, for fear that the joints will become infected.
As the risks of clindamycin become more clear, experts have begun to reconsider these recommendations. In 2015, researchers reported that a single dose of clindamycin can cause serious complications, including death, associated with: C. It’s difficult.
“Dentists did not believe that their prescriptions were related to resistance or treatment. C difficile Because they perceived their prescriptions to be short-term. ” Katie J. Suda, PharmD, a professor at the University of Pittsburgh School of Medicine, says: “They felt it Administration of antibiotics before dental procedures was not associated with adverse events. ”
Dentists are divided into separate silos
hospital made great progress against C difficile And antimicrobial resistance has increased in recent decades, mainly due to Necessary to implement antibiotic stewardship Programs aimed at reducing inappropriate antibiotic use.
However, dentists mainly work in private clinics outside hospitals and rarely participate in administrative activities. “Dentistry is at the beginning of antibiotic stewardship,” said Emily McDonald, MD, MPH, medical officer in the Office of Antibiotic Stewardship at the Centers for Disease Control and Prevention.
While dentists can check databases to see if someone has been prescribed opioids, there is usually no way for dentists to know which antibiotics a patient has taken, said Erin Kennedy, DDS, director of the Dental Safety Institute. That’s because it doesDoctors and dentists tend to use incompatible electronic health record systems that do not allow them to share information.
Without access to a patient’s medical records, the dentist may not know whether the patient has received previous treatment. C difficile, Unless patients voluntarily provide that information, Kennedy said, the infection is a major risk factor for recurrence.
Also, dentists may not recognize complications caused by inappropriate antibiotic use, said Christian Lillis, co-founder and CEO of the Peggy Lillis Foundation. C. It’s difficult. Hospital-based doctors and nurses may be more aware of risks such as: C difficile That’s because patients with infectious diseases like Owens tend to be hospitalized.
“If I get diarrhea after going to the dentist, I don’t call the dentist. I go to the hospital or the ER,” says family member Lilith. He started the foundation after his mother’s death. in 2010 C difficile “My mother had passed away three weeks before the dentist knew.”
Updated guidelines
In recent years, professional societies have I have endeavored to educate Healthcare providers complain about the risks of antibiotics and recommend that dentists limit their use to a relatively small number of patients who need them most or who are at greatest risk.
“Antibiotics are an extremely valuable resource and a finite resource,” said Dr. Purnima Kumar, ADA spokesperson and professor of periodontology and oral medicine at the University of Michigan School of Dentistry. “They should be reserved for when they are needed, and they should always be saved for patients who need them.”
However, there are nuances in the ADA’s recommendations for clindamycin.
Although ADA guidelines still mention clindamycin; can be used for treatmentsociety is ruled it out as a preventive strategysaid B. Jason Kyles, DDS, clinical assistant professor of oral and maxillofacial pathology, radiology, and medicine at New York University School of Dentistry.
ADA guidelines state that antibiotics are not necessary to treat dental infections that cause pain or swelling, except in limited circumstances. Guidelines include clindamycin As a possible option for treating patients allergic to penicillin.
“The ADA completely disclaims the recommendation for clindamycin to prevent heart and joint infections and strongly discourages the treatment of heart and joint infections unless there are absolutely no other safe options,” Kyles said. Clindamycin is “now” Rather, it is considered a last resort. Dentists are encouraged to use alternatives. ”
Some dentists prescribe antibiotics more often than necessary due to external pressures, such as fear of litigation if a patient develops a serious infection.
Sometimes there is pressure from the patient. Some people expect antibiotics to be administered before and after invasive dental procedures, especially if they are used to receiving prescriptions. Changing patient expectations is not easy, Kumar said.
