CDA Essentials 2018 • Volume 5 • Issue 1

27 Issue 1 | 2018 | I ssues and P eople for patients with known allergies to penicillin. The survey report authors note that overuse of clindamycin can promote excess risk of antibiotic resistance in addition to C. difficile infection. To minimize use of clindamycin, dentists can encourage their patients to get tested for penicillin allergy says Dr. Aaron Burry, CDA associate director of professional affairs. “True penicillin allergy is rare,” he says. “Encouraging patients to get tested lets us identify patients who are in fact allergic, which can help decrease unnecessary use of broad-spectrum antibiotics like clindamycin.” What’s next? The next steps include quantifying what dentists are really doing in their clinical practice in terms of antibiotic prescribing says Dr. Carlos Quiñonez, one of the study authors and associate professor in the faculty of dentistry at the University of Toronto. “This research, which used self-reported data, was a great start at getting a sense of the issues and challenges in this area,” he says. “We now need to quantify the issue more robustly to establish a true baseline that can be used to see if any interventions aimed at influencing prescribing practices are having an effect.” According to Dr. Quiñonez, it’s important to increase awareness about appropriate antibiotic prescribing practices for both dentists and medical providers, through education and promotion of evidence-based guidelines by professional and regulatory groups. “Dentists are influenced by a variety of clinically related factors, but the top two appear to be the patient’s medical providers, such as a generalist or specialist physician, and the patient’s condition,” says Dr. Quiñonez. Non-clinical factors—especially patient demands or expectations—also have an influence on dentists’ prescribing decisions. Dr. Benoit Soucy, CDA director of clinical and scientific affairs, says that’s why it’s also important to increase public awareness about appropriate antibiotic use for dental conditions. “That’s where different stakeholders have to act, in terms of educating the public about when antibiotics are recommended or not.” a References Coalition Letter to Government CDA Joins Call for Action on Antibiotics CDA, along with more than 30 Canadian health organizations, is a signatory to a letter that calls on Prime Minister Justin Trudeau and Foreign Affairs Minister Chrystia Freeland to position Canada as an international leader in “ensuring that the right antibiotic is used at the right dose at the right time, and only when necessary.” In particular, the letter strongly encourages Canada to add antimicrobial stewardship and resistance to the agenda for the 2018 G-7 summit in Charlevoix, Quebec. a To read the letter, visit healthcarecan.ca 1. World Health Organization. Antimicrobial resistance fact sheet (updated October 2017). Available: who.int/mediacentre/factsheets/fs194/en 2. Hicks LA, Bartoces MG, Roberts RM, Suda KJ, Hunkler RJ, Taylor TH Jr , et al. US outpatient antibiotic prescribing variation according to geography, patient population, and provider specialty in 2011. 2015. Clin Infect Dis. 60(9):1308-16. Epub 2015 Mar 5. 3. Farmer J, Singhal S, Sutherland S, Patrick D, Soucy B, Lalji F, Stein K, et al. The antibiotic prescribing practices of dentists in Canada. 2017. Report provided to the Canadian Dental Association. 4. Canadian Orthopedic Association, the Canadian Dental Association, and the Association of Medical Microbiology and Infectious Disease Canada (2016). Consensus Statement: Dental Patients with Total Joint Replacement (July 2016). Available: cda-adc.ca/en/about/position_statements/jointreplacement 5. Stein K, Singhal S, Lalji F, Sutherland S, Quiñonez C. 2016. The use and misuse of antibiotics in dentistry: a systematic review. 2017. Report provided to the Canadian Dental Association. 6. Esposito M, Grusovin MG, Worthington HV. Interventions for replacing missing teeth: antibiotics at dental implant placement to prevent complications. 2013. Cochrane Database Syst Rev. Jul 31;(7). doi: 10.1002/14651858.CD004152.pub4 7. American Heart Association. 2007. Prevention of Infective Endocarditis Guidelines from the American Heart Association. Available: circ.ahajournals.org/ content/circulationaha/116/15/1736.full.pdf 8. Canadian Dental Association. 2014. CDA Position on Prevention of Infective Endocarditis (February 2014). Available: cda-adc.ca/en/about/position_ statements/infectiveendocarditis