Antibiotic Prescription Patterns in Ambulatory Dental Care in Kosovo Fehim Haliti 1 , Shaip Krasniqi 2 , Bashkim Gllareva 2 , Nora Shabani 2 , Lumnije Krasniqi 1 , Naim Haliti 2 1 Departament of Children Dentistry, University Dentistry Clinical Center of Kosovo, Prishtina, Kosovo, 2 Faculty of Medicine, University of Prishtina “Hasan Prishtina”, Kosovo Abstract Background: Globally, the level of antibiotic prescription in dental care is increasing annually, and evidence indicates a high level of antibiotic misuse. This survey evaluated the prescription of antibiotics in primary dental care of health system of Kosova. Methods: Antibiotic use data for 1825 registered patients over a 1-year period were randomly collected and analyzed. These data are presented as the Defined Daily Dose [DDD]/1,000 inhabitants/day. Results: The prescription rate of antibiotics for all registered patients was 7.9%. The total use of antibiotics in dental primary care was 2.17 DDD/1,000 inhabitants/day. A total of 6 individual antibiotics were identified in this survey. The most frequently used antibiotic was co-amoxiclav (J01CR02), with a 1.16 DDD, followed by amoxicillin (J01CA04), with a 0.78 DDD. Other individual antibiotics that were used significantly less frequently included ceftriaxone (J01DD04), with a 0.11 DDD, cefalexin (J01DB01), with a 0.09 DDD, procaine benzyl penicillin (J01CE09), with a 0.02 DDD, and gentamicin (J01GB03), with a 0.01 DDD. Conclusion: The results of this survey indicate that a high prescription rate is not rational in primary dental care in Kosovo. The prescription of antibiotics in Kosovo is exclusively empiric without prior sensitivity testing, which may negatively impact bacterial resistance profiles. The use of broad-spectrum antibiotics should be replaced with that of more narrow-spectrum antibiotics, and more restrictive prescription patterns should be applied. For qualitative improvement in the prescription of drugs in these groups, we recommend the implementation of a restrictive antibiotic policy. Key Words: Antibiotic use, Dentistry Introduction Antibiotics represent one of the most important drug groups in clinical practice, considering their role in the control of infectious diseases and their impact on public health. Dental care service includes different types of care, such as the treatment of odontogenic infections. Globally, the level of antibiotic prescription in dental care is increasing annually, and antibiotics are used extensively in the field of endodontics [1,2]. These prescription habits reflect the trends of overuse and misuse of antibiotics in dental practice. The extensive utilization of antibiotics in clinical practice has been determined to be a leading factor for the emergence of antibiotic resistance [3]. However, the relationship between the antibiotic prescription rate and bacterial resistance is relatively complex. Evidence indicates that antibiotic use influences resistance, but a persuasive, quantitative relationship between the volume of antibiotic use and bacterial resistance has not yet been established [4]. Antibiotic prescription by dental practitioners has an important impact on the rate of general antibiotic prescription use, and an attempt has been made to establish a surveillance system for the monitoring and control of the use of these drugs [5,6]. The rational and effective prescription of antimicrobials is imperative in dental practice, and it is necessary to implement an antimicrobial prescription monitoring system and antibiotic stewardship program. One important strategy for reaching the objective of rational antibiotic prescription is the implementation of drug utilization studies, as defined by the World Health Organization (WHO) [7]. Antibiotic utilization studies enable analyses of antibiotic use, provide feedback data on the distribution of prescriptions and measure the effects of restrictive measures on the level of antibiotic use [8,9]. Hence, such studies are considered a fundamental starting point in establishing an effective antibiotic stewardship program, with the main objectives of improving the treatment efficacy and decreasing bacterial resistance; this program can also be used as a pharmaco-epidemiological measure for implementation of a national restrictive antibiotic policy [10]. Systematic reviews of antibiotic use have revealed effective measures by integrating the results of studies demonstrating effective restrictive programs and decreased antibiotic use [11]. Despite the systematic monitoring and extensive antibiotic use programs in developed countries, the data on antibiotic use in most low- and middle-income countries are scarce and insufficient. Specifically, information on antibiotic use in dental practice is widely unavailable. Thus, the use of an antimicrobial prescription monitoring system and antibiotic stewardship program will enable the reduction of prescription errors, increase the safety of drugs and reduce the triggering of drug resistance. Therefore, our survey was conducted to determine the antibiotic prescription pattern in primary dental care in Kosovo, to analyze prescription habits, to identify eventual misuses of antibiotics and to facilitate the formulation of standards for the rational prescription of these drugs. Material and Methods Ethics statement This survey was performed according to the guidelines of the World Medical Association Declaration of Helsinki using an anonymous system of patient data collection. According to the local regulations in Kosovo, health workers who use descriptive surveys may collect data using an anonymous system with committee approval. Corresponding author: Naim Haliti, Departament of Forensic Medicine, University of Prishtina “Hasan Prishtina”, “Mother Theresa” str. Rrethi i Spitaleve pn, 10000 Prishtina, Kosovo, Tel: +381 38 500 600 2012; E-mail: naim.haliti@uni-pr.edu 1