A Clinical Imperative: Educate Your Patients About Antibiotics

We often give antibiotics to patients with cardiac ailments and prosthetic joints before a procedure that might introduce bacteria into their bloodstream, such as a root canal.

But do your patients take their medicine as directed? If not, they may be contributing to the development of antibiotic-resistant bacterial strains. Furthermore, since patients see their dentist more frequently than their doctor, you are their primary medical educator. Are you doing your part?

The World Health Organization (WHO) recently released a report detailing the widespread lack of public understanding about antibiotic usage and resistance. Contained in the report is a survey of almost 10,000 adults that asked basic questions about the application and use of antibiotics. Here are some highlights of the disturbing results:

• Three quarters of respondents think antibiotic resistance occurs from their own body, and not bacteria.
• Nearly half believe that antibiotic resistance is only a problem for people who take antibiotics regularly.
• Two thirds believe antibiotics can successfully treat viral infections, particularly the common cold.
• Over half think that their actions will not influence antibiotic resistance, and two thirds believe the problem will be solved by researchers before it poses a major threat.

Here's a microbiology refresher: antibiotic resistance is often induced when a patient takes an incomplete course of antibiotics; for example, a patient stops taking her prescription as soon as she starts to feel better. Most of the bacteria will be killed, but some may have a varying number of resistance plasmids to the antibiotic. By stopping the medication early, these bacteria are not continually challenged by both the drug and the body's immune system. If a sufficient population of these bacteria grow and multiply, the resistance genes will proliferate, resulting in a resistant strain.

In addition, the beneficial bacteria that often out-compete harmful species are killed off by the antibiotics, making the body more vulnerable to subsequent infections (such as C. difficile).This effect is often seen in the farming industry as well as in humans, where antibiotics are administered sub-therapeutically to livestock in order to trigger weight gain. This practice results in rapid accumulation of resistant bacterial strains.

This process is causing alarm across the globe. Recently, researchers report that many meat samples from China contain bacteria resistant to polymyxins, which are the absolute last resort defense against gram-negative, multi-resistant bacteria.

Everyone's help is needed to keep antibiotics effective, and prevent the spread of dangerous diseases. Here are the points you should make sure every patient knows:

• Antibiotic resistant bacteria are a major threat to health. You can stop bacteria developing antibiotic resistance by your actions.
• Antibiotics are only effective against bacterial infections. Don't demand them from your doctor to treat a cold, or other viral infections.
• Take the entire course of antibiotics exactly as directed.
• Eat probiotic foods, such as unpasteurized yogurt, kimchi and sauerkraut during your course of antibiotics and long afterwards, if you can.

As a dental practitioner, you are both a community fixture and medical professional. You have an enormous amount of influence and ability to guide the progress of local, regional and world health. Are you going to use it?

Sources:
Diabetes? Heart disease? Osteoporosis? Your dentist may know before you do. Retrieved December 1, 2015, from https://www.deltadentalins.com/oral_health/dentists-detect.html
Paterson, D., & Harris, P. (2015). Colistin resistance: A major breach in our last line of defence. The Lancet Infectious Diseases.
WHO multi-country survey reveals widespread public misunderstanding about antibiotic resistance. Retrieved December 1, 2015, from http://www.who.int/mediacentre/news/releases/2015/antibiotic-resistance/en/