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Inappropriate prescribing of antibiotics

30 July 2018
A dentist received a complaint from a patient’s mother, regarding the inappropriate and incorrect prescribing of antibiotics for her 16-year-old daughter on three separate occasions.

The dentist first saw the patient when she presented as an emergency with a buccal swelling of her lower right first molar (46). The patient was coming to the end of a period of orthodontic treatment and was due to have her fixed appliances removed two weeks later. The tooth had previously undergone root canal treatment. The dentist prescribed amoxicillin 250mg three times a day for three days. As the patient was going on holiday, the member also gave the patient a separate prescription for amoxicillin 250mg per day for five days. Both prescriptions were questioned by the pharmacist, and a new prescription was issued requesting the recommended dose of 500mg three times a day for five days.

One month later the patient presented as an emergency and was seen once again by the dentist. He prescribed metronidazole 250mg three times a day for three days. The pharmacist again questioned the prescription, and the dentist wrote a new prescription with the recommended dose of 200mg three times a day for five days.

The dentist had graduated in a different country and had only recently started working in Malaysia. It is imperative that all practising dentists familiarise themselves with appropriate local prescribing standards of the drugs they might prescribe. Good record keeping must include a thorough medical history including allergies and any ongoing or recent medication to avoid inappropriate prescribing, allergic reactions or other drug interactions. In the current climate, the justification of necessity of prescribing antibiotics is being closely monitored. It may be useful for reference to review the local therapeutic guidelines and check your records reflect the justification for the prescription and the ongoing treatment that may be required.

Learning points
  • Make sure you are familiar with the standard prescribing guidance wherever you practise.
  • There are a variety of online resources that provide access to recognised national guidelines.

These case studies are based on real events and provided here as guidance. They do not constitute legal advice but are published to help members better understand how they might deal with certain situations. This is just one of the many benefits dental members enjoy as part of their subscription. 
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