Dentistry Students for Antimicrobial Stewardship Society

05/21/2022

COVID has had a large impact on every aspect of our lives but how about in shaping antibiotic resistance? In this article written by Molly Sargen, the effects of the pandemic on antibiotic resistance is explored. There has been an increase in antibiotic usage, with an increase in the emergence of resistant strains.


But there are also positive impacts of the pandemic on antibiotic resistance. Since our general hygiene has improved, there will be a reduction in the amount of infection and potential spread of diseases. In addition, the increased uptake of vaccines means diseases that require antibiotics such as whooping cough can be prevented with vaccine uptake. Read more about the impact of the pandemic on antibiotic resistance here: https://sitn.hms.harvard.edu/flash/2021/how-covid-19-is-shaping-antibiotic-resistance/

05/12/2022

As we all know, the profession of dentistry is one of the biggest culprits for fostering antibiotic resistance, due to the large volume of antibiotic prescriptions that are written. As a result of antibiotic resistance in general, the scientific community has been exploring possible alternatives in recent years.
The attached paper is a brief one-page summary of current research directives regarding antibiotic alternatives. Current research areas involve methods that stimulate the host’s own defense mechanisms, enzyme-based therapeutics, and those which use potentiators or antivirulence factors.

04/25/2022

Why should dentists care about antimicrobial Stewardship?

Did you know that dentists rank in the top 5 prescribers for antibiotics? Rates of dentistry-related antibiotic use are also stable despite the changes made to guidelines around the prescription of antibiotics for infective endocarditis and prosthetic joints in 2007 and 2013. What’s even more concerning is that following more conservative antibiotic prescribing guidelines, Suda and colleagues reported that 80.9% of antibiotics prescribed for these conditions were still unnecessary.

To put this into perspective, there is a 30% over prescription of antibiotics in a medical outpatient setting, dentistry overshadows this by 50.9% - highlighting the need for more antimicrobial stewardship in our profession.

Read the full study conducted by Suda and colleagues here:

This cohort study assesses the appropriateness of antibiotic prophylaxis prescriptions for infection prophylaxis before dental procedures using Truven, a US national integrated health claims database.

04/17/2022

Did you know antibiotic resistance is thought to have evolved long before naturally occurring antibiotics and their derivatives were used to treat human disease? In order to better select and utilize the next generation of drugs, it is important to understand the history of resistance; how it emerges and is spread through populations. In the article below, the authors illustrate the evolution of resistance and why, despite the "inevitability" of it, we can hope to find solutions using surveillance, data sharing, and risk management.

To read more:

Antibiotic natural products are ancient and so is resistance. Consequently, environmental bacteria harbor numerous and varied antibiotic resistance elements. Nevertheless, despite long histories of antibiotic production and exposure, environmental bacteria are not resistant to all known antibiotics....

04/09/2022

Did you know only 12% of dentists correctly prescribe antibiotics? It’s evident that clear and comprehensive guidelines are essential to combat antibiotic resistance but what are the burdens of incorrect use of antibiotics? In the review article written by Murray et al. the assessment of global burden of antimicrobial resistance is described. It is the leading cause of death around the world with highest burden in low-resource settings. The pathogen-drug combination, methicillin-resistant S. aureus, caused more than 100,000 deaths in 2019.

To learn more, read the full article here:

To our knowledge, this study provides the first comprehensive assessment of the global burden of AMR, as well as an evaluation of the availability of data. AMR is a leading cause of death around the world, with the highest burdens in low-resource settings. Understanding the burden of AMR and the lea...

04/02/2022

The announcement of publicly funded dental care is great news to many Canadians. However, might this have an effect on antibiotic use in Canadian dental offices?

Although this is not a topic that appears to have been studied in the literature, we can turn to the field of medicine for insight into how antibiotic use may change. The cross-sectional study linked below showed that antibiotic prescription, in the US, is highly correlated to several factors, one being insurance status of the patient. Clinicians in several fields of medicine were found to prescribe antibiotics more to those with medical insurance. Therefore, the question must be asked, with more Canadians visiting the dentist in the future under publicly funded programs, will inappropriate antibiotic prescription increase in the field of dentistry? Only time will tell.

To test the potential association between time spent with a doctor and antibiotic overprescriptions in case of the common cold, runny nose, bronchitis, chest colds, flu, sore throats, and fluid in the middle ear.Cross-sectional studyOffice-based physicians ...

03/27/2022

Given how quickly antimicrobial resistance (AMR) is evolving, multiple prevention strategies are needed on board.
* In our last post we introduced an article discussing some of the challenges in producing new effective drugs given the conditions governed by the pharmaceutical market (check out our post below to read more).
Thus, focusing efforts on researching underlying resistance mechanisms and on developing new antibiotics is now insufficient. Rather, an integrated strategy including therapies and prevention tools is required.

This 2021 Nature review presents how vaccines, in combination with novel antibiotics, diagnostic tools, monoclonal antibodies, microbiota interventions and bacteriophages can help combat AMR. Prophylactic vaccines, by reducing infectious disease cases, reduce antibiotic use and thus the spread of AMR. The authors examine the impact of existing vaccines on AMR and discuss the potential impact of future vaccines that are being developed against resistant bacterial pathogens.

To learn more, please check out the full article:

In this Review, Rappuoli and colleagues discuss evidence that vaccines can have a major role in fighting antimicrobial resistance, they describe the current state of development of vaccines against antimicrobial-resistant bacterial pathogens and discuss possible opportunities to overcome obstacles t...

03/15/2022

If antimicrobial resistance is a huge problem…why are we not seeing any new antibiotics?

Usually when there’s a gap in the market, an unmet need, the biomedical industry is quick to tap into the potential and develop new products. However, with the rising antibiotic resistance crisis there’s a growing gap to fill that isn’t getting filled. Have we exhausted all our antibiotic options? Is antibiotic drug discovery too difficult? Is there no hope left?

Well…surprisingly (or unsurprisingly) a big factor in this is financial incentive. As indicated in the Nature article attached, the last new antibiotic class was discovered in the 1980s and a lot of this has to do with the low profitability of antibiotics. For example, a bad business model would include something along the lines of spending $1.5 billion to develop a new drug to only get $46 million per year in return. Now you might argue that over the coming years, a company could make their $1.5 billion back - however, patents also expire which means competitor companies can then develop the same drug and sell it for less without the $1.5 billion debt. Great for consumers, terrible for drug companies. This is a large reason why large pharmaceutical companies have stopped investing in antibiotic drug discovery.

Interested in learning more? Read the full article from Nature here:

A lack of financial incentive has meant large pharmaceutical companies have left the market

03/11/2022

Antibiotic resistance is a growing global problem that must be addressed from every angle. A review article from 2020 states that dentistry accounts for approximately 3-11% of all antibiotic prescriptions. In addition, 66% of antibiotics prescribed in a dental setting are not clinically indicated. As future-dentists, we must understand the impact of our therapeutic decisions on this global problem.

In order to combat this problem, we must:
- Obtain an accurate diagnosis before prescribing
- Use the appropriate antibiotic for the infection
- Use the narrowest spectrum antibiotic available

To learn more, read the full article here:
Sukumar, S., Martin, F. E., Hughes, T. E., & Adler, C. J. (2020). Think before you prescribe: How dentistry contributes to antibiotic resistance. Australian Dental Journal, 65(1), 21-29.

03/03/2022

In the past week, there has been one news story that has dominated them all: the Russia-Ukraine conflict. In this time of uncertainty as to the possible outbreak of a war; this got us wondering, what has been the historical effect of war on antibiotic use, production, and subsequent antimicrobial resistant as a result of war?
For an interesting and light read, check out this article from Discover Magazine which tells a story about how antibiotic use during the Cold War is still having impacts on antibiotic resistance today! Although it is not explicitly related to dentistry, the main points can be inferred to apply to our profession.

How the decades-long conflict led to today's increasingly impotent antibiotics.

02/13/2022

COVID-19…Antimicrobial resistance…Should we be worried!?!

The misuse and overuse of antibiotics continues to increase the burden of untreatable infections in this new era of antimicrobial resistance (AMR). Although the relationship between COVID-19 and AMR isn’t clear yet, in a review article by Adebisi et al., it was found that secondary infections of bacterial origin play a role in mortality and morbidity associated with COVID-19. In hospital settings it is becoming difficult to discern between hospital-acquired pneumonia and ventilator-associated pneumonia making overprescription of antimicrobials a concern. Some studies also describe the use of antimicrobials as part of the treatment for hospitalized COVID-19 patients which suggests that antimicrobial use in this context is appropriate - further leading to the overuse of antimicrobials. It is important to recognize that only a minority of COVID-19 patients require antibiotics, recall that antibiotics will not do anything for infections of viral origin, and antibiotic prophylaxis is not necessary for individuals for mild to moderate COVID-19.

AMR continues to be a threat overlooked in society, it is important for antimicrobial stewardship programs to step up and for strengthened prescribing practices to be developed in order to lessen this growing burden.

To learn more, read the full article here:

03/16/2021

The overgrowth of Candida species, which often results in oral thrush, can be caused and exacerbated by many factors, such as xerostomia, poor oral hygiene, and dental materials like orthodontic wires. Although we have effective antifungal medications to treat oral candidiasis, such as nystatin and clotrimazole, it is imperative to avoid over-relying on these agents to prevent the formation of resistant Candida species. Therefore, the scientific community should continuously aim to discover and investigate the antimicrobial potential of various natural compounds. In this paper, the authors investigated the antifungal activity of green propolis and its ability to prevent adhesion and biofilm formation on orthodontic materials, such as steel and resin.

This study evaluated the effect of green propolis extract on the adhesion and biofilm formation of Candida species in dentistry materials. Phytochemical analysis of green propolis extract was performed by high-performance liquid chromatography. Adhesion was quantified by counting the number of yeast...