The Impact of Antimicrobial Resistance on Pediatric Oral Health Outcomes
DOI:
https://doi.org/10.56294/mw2024529Keywords:
Antimicrobial resistance, Pediatric dentistry, Oral infections, Antibiotic stewardship, AntibioticsAbstract
According to predictions, antimicrobial resistance (AMR) may overtake all other causes of death globally by 2050, posing a serious danger to public health globally. This review examines the prevalence, mechanisms, and management of antibiotic resistance in pediatric oral infections. The oral cavity harbors diverse microbial communities, and inappropriate antibiotic use in dental practice contributes to the selection of resistant bacteria. Common oral pathogens, including Streptococci and anaerobes, have demonstrated varying levels of resistance to frequently prescribed antibiotics like amoxicillin, penicillin, and metronidazole. The review outlines foundational principles for antibiotic usage in pediatric dentistry, emphasizing prevention, adjunctive therapy, proper selection, and dosing. Specific clinical scenarios, such as pulpal infections, facial swelling, dental trauma, and periodontal disease, are discussed, providing guidance on appropriate antibiotic management. The challenges of managing antibiotic-resistant oral infections are addressed, highlighting the need for improved surveillance, responsible prescribing practices, and development of new antimicrobial agents. Emerging trends in antibiotic management, including the potential of metal nanoparticles and artificial intelligence, are explored. The review concludes by stressing the importance of judicious antibiotic use in pediatric dentistry, balancing effective treatment with broader public health implications. Continuous professional education and adaptation to emerging evidence are crucial for optimal care delivery and contribution to antibiotic stewardship initiatives.
References
Prestinaci F, Pezzotti P, Pantosti A. Antimicrobial resistance: a global multifaceted phenomenon. Pathog Glob Health. 2015;109(7):309-18.
Antimicrobial Resistance Collaborators. The burden of bacterial antimicrobial resistance in the WHO African region in 2019: a cross-country systematic analysis. Lancet Glob Health. 2024 Feb;12(2):e201-e216.
Ferdinand AS, McEwan C, Lin C, Betham K, Kandan K, Tamolsaian G, Pugeva B, McKenzie J, Browning G, Gilkerson J, Coppo M, James R, Peel T, Levy S, Townell N, Jenney A, Stewardson A, Cameron D, Macintyre A, Buising K, Howden BP. Development of a cross-sectoral antimicrobial resistance capability assessment framework. BMJ Glob Health. 2024 Jan 16;9(1):e013280.
Salam MA, Al-Amin MY, Salam MT, Pawar JS, Akhter N, Rabaan AA, Alqumber MAA. Antimicrobial Resistance: A Growing Serious Threat for Global Public Health. Healthcare (Basel). 2023 Jul 5;11(13):1946.
Ruckert A, Lake S, Van Katwyk SR. Developing a protocol on antimicrobial resistance through WHO's pandemic treaty will protect lives in future pandemics. Global Health. 2024 Jan 31;20(1):10.
Lim JS, Chai YY, Ser WX, Haeren AV, Lim YH, Raja T, Foo JB, Hamzah S, Sellappans R, Yow HY. Novel drug candidates against antibiotic-resistant microorganisms: A review. Iran J Basic Med Sci. 2024;27(2):134-150.
Llor C, Bjerrum L. Antimicrobial resistance: risk associated with antibiotic overuse and initiatives to reduce the problem. Ther Adv Drug Saf. 2014 Dec;5(6):229-41.
S.A. Okaiyeto, P.P. Sutar, C. Chen, J.-B. Ni, J. Wang, A.S. Mujumdar, J.-S. Zhang, M.-Q. Xu, X.-M. Fang, C. Zhang. Antibiotic Resistant Bacteria in Food Systems: Current Status, Resistance Mechanisms, and Mitigation Strategies. Agric. Commun. 2024; 2(1) : 100027.
S. Hussein, S.K. Ahmed, K. Qurbani, A. Fareeq, R.A. Essa. Infectious diseases threat amidst the war in Gaza. J. Med. Surgery, Public Heal, 2024; 2:100067.
Asghar A, Khalid A, Baqar Z, Hussain N, Saleem MZ, Sairash, Rizwan K. An insights into emerging trends to control the threats of antimicrobial resistance (AMR): an address to public health risks Arch Microbiol. 2024 Jan 22;206(2):72.
Founou RC, Blocker AJ, Noubom M, Tsayem C, Choukem SP, Dongen MV, Founou LL. The COVID-19 pandemic: a threat to antimicrobial resistance containment. Future Sci OA. 2021 Jun 10;7(8):FSO736.
Tang KWK, Millar BC, Moore JE. Antimicrobial Resistance (AMR). Br J Biomed Sci. 2023 Jun 28;80:11387.
Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022 Feb 12;399(10325):629-655.
Standing Medical Advisory Committee; Subgroup on Antimicrobial Resistance. (1998). The Path of Least Resistance. The Stationery Office, London, UK.
WHO (2023). Antimicrobial resistance. Available at: https://www.who.int/westernpacific
/health-topics/antimicrobial-resistance. (Accessed 9 June, 2023).
Guo MY, Shi XH, Gao W, Tian JL, Yuan L, Yang J, Wumaier D, Cao J, Abulimiti R, Zhang WL, Yao KH. The dynamic change of serotype distribution and antimicrobial resistance of pneumococcal isolates since PCV13 administration and COVID-19 control in Urumqi, China. Front Cell Infect Microbiol. 2023 Jan 31;13:1110652.
Su W, Liu Y, Wang Q, Yuan L, Gao W, Yao KH, Yang YH, Ma L. Antibiotic susceptibility and clonal distribution of Staphylococcus aureus from pediatric skin and soft tissue infections: 10-year trends in multicenter investigation in China. Front Cell Infect Microbiol. 2023 Jul 13;13:1179509.
Wu X, Wang C, He L, Xu H, Jing C, Chen Y, Lin A, Deng J, Cao Q, Deng H, Cai H, Chen Y, Yang J, Zhang T, Huang Y, Hao J, Yu H. Antimicrobial resistance profile of methicillin-resistant Staphylococcus aureus isolates in children reported from the ISPED surveillance of bacterial resistance, 2016-2021. Front Cell Infect Microbiol. 2023 Jan 19;13:1102779.
Wang H, Cheng H, Huang B, Hu X, Chen Y, Zheng L, Yang L, Deng J, Wang Q. Characterization of resistance genes and plasmids from sick children caused by Salmonella enterica resistance to azithromycin in Shenzhen, China. Front Cell Infect Microbiol. 2023 Mar 29;13:1116172.
Kawata S, Morimoto S, Kosai K, Kawamoto Y, Nakashima Y, Morinaga Y, Yanagihara K, Yoshida LM, Moriuchi H. The fecal carriage rate of extended-spectrum β-lactamase-producing or carbapenem-resistant Enterobacterales among Japanese infants in the community at the 4-month health examination in a rural city. Front Cell Infect Microbiol. 2023 Jun 14;13:1168451.
Xiao R, Li Y, Liu X, Ding Y, Lai J, Li Y, Kang W, Zou P, Wang J, Du Y, Zhang J, Wang Y. Antibiotic susceptibility of Escherichia coli isolated from neonates admitted to neonatal intensive care units across China from 2015 to 2020. Front Cell Infect Microbiol. 2023 May 22;13:1183736.
Jiang TT, Sun L, Wang TY, Qi H, Tang H, Wang YC, Han Q, Shi XQ, Bi J, Jiao WW, Shen AD. The clinical significance of macrolide resistance in pediatric Mycoplasma pneumoniae infection during COVID-19 pandemic. Front Cell Infect Microbiol. 2023 May 12;13:1181402.
Weidmann MD, Green DA, Berry GJ, Wu F. Assessing respiratory viral exclusion and affinity interactions through co-infection incidence in a pediatric population during the 2022 resurgence of influenza and RSV. Front Cell Infect Microbiol. 2023 Jun 14;13:1208235.
Xiao J, Fiscella KA, Gill SR. Oral microbiome: possible harbinger for children's health. Int J Oral Sci. 2020 Apr 30;12(1):12.
D'Agostino S, Ferrara E, Valentini G, Stoica SA, Dolci M. Exploring Oral Microbiome in Healthy Infants and Children: A Systematic Review. Int J Environ Res Public Health. 2022 Sep 10;19(18):11403.
Dar-Odeh N, Fadel HT, Abu-Hammad S, Abdeljawad R, Abu-Hammad OA. Antibiotic Prescribing for Oro-Facial Infections in the Paediatric Outpatient: A Review. Antibiotics (Basel). 2018 Apr 25;7(2):38.
Di Spirito F, Amato A, Di Palo MP, Contaldo M, D'Ambrosio F, Lo Giudice R, Amato M. Oral Lesions Following Anti-SARS-CoV-2 Vaccination: A Systematic Review. Int J Environ Res Public Health. 2022 Aug 17;19(16):10228.
Sayegh A, Dini EL, Holt RD, Bedi R. Oral cleanliness, gingivitis, dental caries and oral health behaviours in Jordanian children. J Int Acad Periodontol. 2002 Jan;4(1):12-8.
Di Spirito F. Oral-Systemic Health and Disorders: Latest Prospects on Oral Antisepsis. Appl. Sci. 2022;12(16):8185.
Hurley S, Westgarth D. When David met Sara Part 2. Br Dent J. 2015 Nov 27;219(10):477-8.
Barone A., Chatelain S., Derchi G., Di Spirito F., Martuscelli R., Porzio M., Sbordone L. Antibiotic’s Effectiveness after Erupted Tooth Extractions: A Retrospective Study. Oral Dis. 2020;26:967–973.
D’Ambrosio F., Di Spirito F., De Caro F., Lanza A., Passarella D., Sbordone L. Adherence to Antibiotic Prescription of Dental Patients: The Other Side of the Antimicrobial Resistance. Healthcare. 2022;10:1636.
Centers for Disease Control and Prevention. Antibiotic/ Antimicrobial Resistance Threats in the United States, 2019. Available at: https://www.cdc.gov/drugresistance/pdf/
threats-report/2019-ar-threats-report-508.pdf . Accessed January 24, 2022.
Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ. 2010 May 18;340:c2096.
Aidasani B, Solankis M, Khetarpal S, Ravi Pratap S. An- tibiotics: Their use and misuse in paediatric dentistry. A systematic review. Eur J Paediatr Dent 2019;20(2):133-8.
Suda KJ, Calip GS, Zhou J, et al. Assessment of the appropriateness of antibiotic prescriptions for infection prophylaxis before dental procedures. JAMA Netw Open 2019;2(5):e193909.
Wilson WR, Gweitz M, Lockhart PB, et al. Prevention of viridans group streptococcal infective endocarditis: A scientific statement from the American Heart Associa- tion. Circulation 2021;143(20):e963-e978.
Squire JD, Gardner PJ, Moutsopoulos NM, Leiding JW. Antibiotic prophylaxis for dental treatment in patients with immunodeficiency. J Allergy Clin Immunol Pract 2019;7(3):
819-23.
Centers for Disease Control and Prevention. Antibiotic Prescribing and Use. Antibiotic Use in Outpatient Settings, 2017. Available at: https://www.cdc.gov/antibiotic-use/
stewardship-report/pdf/stewardship-report.pdf . Accessed June 30, 2022.
Lovegrove MC, Geller A, Fleming-Dutra KE, Shehab N, Sapiano MRP, Budnitz DS. US emergency department visits for adverse drug events from antibiotics in children, 2011-2015. J Pediatric Infect Dis Soc 2019;8(5): 384-91.
Ahmadi H, Ebrahimi A, Ahmadi F. Antibiotic Therapy in Dentistry. Int J Dent. 2021 Jan 28;2021:6667624.
Akhavan BJ, Khanna NR, Vijhani P. Amoxicillin. [Updated 2021 Aug 17]. In: StatPearls [Internet]. Treasure Island, Fla.: StatPearls Publishing; 2022 Jan. Available at: “https:// www.ncbi.nlm.nih.gov/books/NBK482250/”. Accessed June 30, 2022.
Fouad AF, Abbott PV, Tsilingaridis G, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth. Dental Traumatology 2020;36(4): 331-42.
Todd SR, Dahlgren FS, Traeger MS, et al. No visible dental staining in children treated with doxycycline for suspected Rocky Mountain Spotted Fever. J Pediatr 2015;166(5):1246-51.
American Academy of Pediatrics. Tetracyclines. In: Kim- berlin DW, Barnett ED, Lynfield R, Sawyer MH, eds. Red Book: 2021-2024 Report of the Committee on Infectious Diseases. Elk Grove Village, Ill.: American Academy of Pediatrics; 2021:905-6.
Stultz JS, Eiland LS. Doxycycline and tooth discoloration in children: Changing of recommendations based on evidence of safety. Ann Pharmacother 2019;53(11): 1162-6.
Zeng L, Xu P, Choonara I, et al. Safety of azithromycin in pediatrics: A systematic review and meta-analysis. Eur J Clin Pharmacol 2020;76(12):1709-21.
Bartold PM, du Bois AH, Gannon S, Haynes DR, Hirsch RS. Antibacterial and immunomodulatory properties of azithromycin treatment implications for periodontitis. Inflammopharmacology 2013;21(4):321-38.
Palmer NA, Pealing R, Ireland RS, Martin MV. A study of prophylactic antibiotic prescribing in National Health Service general dental practice in England. Br Dent J. 2000 Jul 8;189(1):43-6.
Handal T, Olsen I. Antimicrobial resistance with focus on oral beta-lactamases. Eur J Oral Sci. 2000 Jun;108(3):163-74.
Lana MA, Ribeiro-Sobrinho AP, Stehling R, Garcia GD, Silva BK, Hamdan JS, Nicoli JR, Carvalho MA, Farias Lde M. Microorganisms isolated from root canals presenting necrotic pulp and their drug susceptibility in vitro. Oral Microbiol Immunol. 2001 Apr;16(2):100-5.
Fosse T, Madinier I, Hitzig C, Charbit Y. Prevalence of beta-lactamase-producing strains among 149 anaerobic gram-negative rods isolated from periodontal pockets. Oral Microbiol Immunol. 1999 Dec;14(6):352-7.
Kinder SA, Holt SC, Korman KS. Penicillin resistance in the subgingival microbiota associated with adult periodontitis. J Clin Microbiol. 1986 Jun;23(6):1127-33.
Cvitkovitch DG. Genetic competence and transformation in oral streptococci. Crit Rev Oral Biol Med. 2001;12(3):217-43.
Teng LJ, Hsueh PR, Chen YC, Ho SW, Luh KT. Antimicrobial susceptibility of viridans group streptococci in Taiwan with an emphasis on the high rates of resistance to penicillin and macrolides in Streptococcus oralis. J Antimicrob Chemother. 1998 Jun;41(6):621-7.
Leistevuo J, Järvinen H, Osterblad M, Leistevuo T, Huovinen P, Tenovuo J. Resistance to mercury and antimicrobial agents in Streptococcus mutans isolates from human subjects in relation to exposure to dental amalgam fillings. Antimicrob Agents Chemother. 2000 Feb;44(2):456-7.
Järvinen H, Pienihäkkinen K, Huovinen P, Tenovuo J. Susceptibility of Streptococcus mutans and Streptococcus sobrinus to antimicrobial agents after short-term oral chlorhexidine treatments. Eur J Oral Sci. 1995 Feb;103(1):32-5.
Lobos O, Padilla A, Padilla C. In vitro antimicrobial effect of bacteriocin PsVP-10 in combination with chlorhexidine and triclosan against Streptococcus mutans and Streptococcus sobrinus strains. Arch Oral Biol. 2009 Mar;54(3):230-4.
Wahl MJ. Amalgam--resurrection and redemption. Part 2: The medical mythology of anti-amalgam. Quintessence Int. 2001 Oct;32(9):696-710.
Reichmann P, König A, Liñares J, Alcaide F, Tenover FC, McDougal L, Swidsinski S, Hakenbeck R. A global gene pool for high-level cephalosporin resistance in commensal Streptococcus species and Streptococcus pneumoniae. J Infect Dis. 1997 Oct;176(4):
1001-12.
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