Waterpik’s Maxwell O’Neill: Is prevention the cure for antimicrobial resistance?
All healthcare professionals know that antibiotics are crucial to modern medicine, however, it is equally well known that we face a global crisis due to increasing microbial resistance. A report published by the Interagency Coordination Group on Antimicrobial Resistance (IACG) shows that drug resistant infections kill at least 700,000 people a year and that could rise to 10 million people per year by 2050 .
Bacteria adapt and evolve, meaning a certain level of antimicrobial resistance (AMR) can be expected. However, the widely reported and persistent misuse and overuse of antibiotics in humans and animals means that the pace of resistance has accelerated and governments, academics, the life sciences industry, international health agencies and healthcare providers are being asked to prioritise the AMR challenge with a co-ordinated global response.
Over the last decade, international agents have developed strategies and guidance that identify and recommend evidence-based interventions and, in 2017, the AMR Industry Alliance was established to advance and develop new antimicrobial medicines, safe and effective alternatives to antimicrobials, plus diagnostics, vaccines, waste management, alternative practices and research into human, animal and plant health .
The Alliance is committed to four key areas: research and science, access, manufacturing and appropriate use. It ensures that investment is focused on the research and development of advanced diagnostics and AMR-relevant products including antibiotics and antifungals, as well as novel approaches, innovation, vaccines, diagnostic platforms and assays to address microorganisms that pose the greatest threats to human health – beyond the COVID crisis.
They must address supply chain challenges and raise awareness about – and prevent substandard or fake medical products from being supplied from – the black market, which can contribute to the spread of drug-resistant infections and endanger patients.
The alliance has set up a new manufacturing framework and is successfully meeting targets to reduce the environmental risks posed by antibiotics in waste-water emissions from factories and manufacturing plants. It is also supporting programmes and initiatives aimed at educating patients, clinicians and the general public about the safe and appropriate use of antimicrobials .
Antibiotics make up the vast majority of medicines prescribed by dentists and account for seven per cent of all community prescriptions of antimicrobials . Although this represents a relatively small proportion of overall use it is, however, significant. Antibiotics such as amoxicillin, penicillin, metronidazole, amoxicillin and clavulanate are commonly prescribed to manage orofacial pain, infections and inflammatory conditions.
However, the National Centre for Disease Control and Prevention estimates that approximately one-third of these prescriptions may be unnecessary . The Faculty of General Dental Practice (FGDP) UK also states that there is increasing evidence regarding the inappropriate use of antimicrobials in dentistry which may contribute to antimicrobial resistance .
It has been confirmed that dental conditions requiring antibiotics are limited. Pulpitis and periapical periodontitis, for example, are common dental infections that require fillings, root canal therapy or extraction, yet some dentists still prescribe antibiotics. In most cases, dental and periodontal diseases are best managed by operative intervention or more ideally, oral hygiene measures .
The modern mantra of prevention comes to the fore once more. Educating patients to maintain optimum oral health contributes to the prevention of disease and in turn, slows down the pace of antimicrobial resistance. To perform a thorough oral hygiene routine, patients are advised to brush twice a day with a fluoride toothpaste and to clean interdentally every day.
All dental professionals can help reduce the risk of antimicrobial resistance by first ensuring the appropriate use of antibiotics, and second, by providing effective oral hygiene education to help patients prevent dental decay and disease in the first place.
Maxwell O’Neill is a professional educator for Waterpik. He adds: “Some patients find flossing tiresome or difficult, but the Waterpik Water Flosser is more effective for removing plaque and for reducing gingival inflammation and bleeding than both string floss and interdental brushes.”
1] Interagency Coordination Group on Antimicrobial Resistance (IACG) Report to the Secretary-General of the United Nations. No time to wait: securing the future from drug resistant infections. April 2019. https://www.who.int/antimicrobial-resistance/interagency-coordination-group/IACG_final_report_EN.pdf?ua=1 [Accessed 31st March 2020]
2] AMR Industry Alliance. AMR Industry Alliance 2020 Progress report. January 2020. https://www.medicinesforeurope.com/wp-content/uploads/2020/01/AMR-Industry-Alliance-2020-Progress-Report-Prepublication-Copy_embargo-til-16Jan2020.pdf [Accessed 31st March 2020]
3] Sweeney L.C Antibiotic resistance in general dental practice – a cause for concern? J Antimicrob Chemother. 2004 Apr;53(4):567-76. https://www.ncbi.nlm.nih.gov/pubmed/14985274 [Accessed 31st March 2020]
4] Saeed dar-Odeh N. et al. Antibiotic prescribing practices by dentists: a review. Ther Clin Risk Manag. 2010; 6: 301–306. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909496/#b3-tcrm-6-301 [Accessed 31st March 2020]
5] Faculty of General Dental Practice (FGDP) UK. Prescribing Antimicrobials. Antimicrobial Prescribing for General Dental Practitioners, chapter 3. 2014. https://www.fgdp.org.uk/antimicrobial-prescribing-standards/prescribing-antimicrobials#Prescribing%20Antimicrobials [Accessed 31st March 2020]
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