When antibiotics are prescribed, six things can happen and only one of them is good.
In one of several articles he prepared for the March Journal of the California Dental Association, Dr. Thomas J. Pallasch spelled out the six possible outcomes when antibiotics are used, with only the first one being positive.
- – The antibiotic may aid the immune system to gain control of the infection;
- – toxicity or allergy may occur;
- – already resistant microbes may be selected for, and a superinfection may result;
- – the antimicrobial may promote microbial chromosomal mutations;
- – gene transfer may be encouraged from resistant to nonresistant microbes;
- – latent-resistance genes may be expressed.
"The global problem of microbial resistance to antibiotics is serious, not only in its extent, but also in the rapidity with which microorganisms are attaining and maintaining resistance," warns Dr. Pallasch, a professor of pharmacology and periodontics at the University of Southern California School of Dentistry, and contributing editor to the CDA Journal.
He notes that dentists prescribe about 10 percent of all the common antibiotics, including penicillins, cephalosporins, macrolides and tetracyclines.
Antibiotic misuse in dentistry, he says, mainly involves prescribing them in "inappropriate situations" or for too long. He says inappropriate uses include:
- – giving antibiotics after a dental procedure is complete in an otherwise healthy patient to "prevent" an infection, which in all likelihood will not occur anyway (read: to "prevent a lawsuit," in many cases);
- – using antibiotics as "analgesics," particularly in endodontics;
- – employing antibiotics for pro-phylaxis in patients not at risk for metastatic bacteremias;
- – using antimicrobials to treat chronic adult periodontitis, which almost totally is responsive to mechanical treatment;
- – using antimicrobial therapy in lieu of mechanical therapy in periodontitis management;
- – using antibiotics and antimicrobials chronically in periodontitis;
- – using antibiotics instead of surgical incision and drainage of infections;
- – using antibiotics to "prevent" claims of negligence.
"It is not time to panic," Dr. Pallasch assures, "but it is time for all to realize that the problem cannot be solved without a concerted effort on the part of all concerned: patients, parents, health professionals, veterinarians, food producers and governments."
