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Antibiotic stewardship em medicina dentária
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Abstract(s)
Os antibióticos são um dos pilares da medicina moderna, tendo contribuído de forma decisiva para o controlo de infeções e redução da mortalidade. Contudo, o seu uso excessivo e inadequado está na origem da crescente ameaça que é a resistência antibiótica, hoje considerada um dos maiores problemas de saúde pública. Na Medicina Dentária, estes medicamentos representam a segunda classe mais prescrita, estimando-se que cerca de 10% das prescrições mundiais sejam realizadas por médicos dentistas. Porém, estudos internacionais demonstram que até 80-90 % destas prescrições não seguem as diretrizes clínicas, revelando uma prática ainda marcada pela heterogeneidade e pelo uso injustificado da antibioterapia.
Nesta dissertação analisaram-se diferentes contextos internacionais, verificando-se que a inadequação da prescrição é um fenómeno transversal, embora com variações regionais.
Entre os principais fatores que explicam esta realidade encontram-se a ausência de protocolos uniformizados, lacunas na formação contínua dos clínicos, pressão dos doentes e, em alguns casos, limitações de acesso a cuidados de saúde oral. Foram igualmente discutidas a prevenção e as alternativas ao uso de antibióticos, nomeadamente as terapias minimamente invasivas e as novas abordagens como os peptídeos antimicrobianos, que apresentam potencial como adjuvantes no combate às infeções orais.
A revisão dos estudos de caso demonstra que os programas de Antibiotic Stewardship em contexto dentário reduzem significativamente as prescrições inadequadas, melhoram a adesão às diretrizes clínicas e aumentam a segurança dos doentes. Intervenções que combinam auditoria, feedback, educação e protocolos locais, revelaram um impacto positivo em hospitais e clínicas, reforçando a importância da Medicina Dentária nas estratégias globais de Stewardship.
Concluiu-se que a implementação sistemática de programas de Stewardship na Medicina Dentária é fundamental para consolidar uma prática clínica mais consciente, responsável e baseada na evidência científica. Apesar dos resultados encorajadores já observados, permanece ainda a necessidade de desenvolver estudos adicionais que avaliem a eficácia e aplicabilidade destas medidas em diferentes realidades clínicas e culturais.
Antibiotics are one of the pillar of modern medicine, having contributed decisively to infection control and the reduction of mortality. However, their excessive and inappropriate use is at the root of the growing threat of antibiotic resistance, which is currently considered as one of the greatest public health challenges. In Dentistry, these drugs represent the second most prescribed pharmacological class, with estimates suggesting that around 10% of all prescriptions worldwide are made by dentists. Nevertheless, international studies show that up to 80-90% of these prescriptions do not follow clinical guidelines, revealing a practice still marked by heterogeneity and unjustified use of antibiotic therapy. In this dissertation, different international contexts were analysed, confirming that inappropriate prescribing is a widespread phenomenon, although with regional variations. Among the main contributing factors are the absense of standardised protocols, gaps in the continuous education of clinicians, pressure from patients and, in some cases, limited access to oral healthcare. Prevention strategies and alternatives to the use of antibiotic were also discussed, particularly minimally invasive therapies and new approaches, such as antimicrobial peptides, which show potential as adjuvants in the management of oral infections. The review of case studies demonstrates that Antibiotic Stewardship programmes applied in dental settings can significantly reduce inappropriate prescriptions, improve adherence to clinical guidelines and enhance patient safety. Interventions combining audit, feedback, education and local protocols have shown a positive impact both in hospitals and in dental clinics, reinforcing the importance of Dentistry in global Stewardship strategies. It is concluded that the systematic implementation of Stewardship programmes in Dentistry is essencial to consolidate a more conscious, responsible and evidence-based clinical practice. However, despite the encouraging results already observed, there remains a pressing need to develop further studies to assess the effectiveness and applicability of these measures acrosse different clinical and cultural settings.
Antibiotics are one of the pillar of modern medicine, having contributed decisively to infection control and the reduction of mortality. However, their excessive and inappropriate use is at the root of the growing threat of antibiotic resistance, which is currently considered as one of the greatest public health challenges. In Dentistry, these drugs represent the second most prescribed pharmacological class, with estimates suggesting that around 10% of all prescriptions worldwide are made by dentists. Nevertheless, international studies show that up to 80-90% of these prescriptions do not follow clinical guidelines, revealing a practice still marked by heterogeneity and unjustified use of antibiotic therapy. In this dissertation, different international contexts were analysed, confirming that inappropriate prescribing is a widespread phenomenon, although with regional variations. Among the main contributing factors are the absense of standardised protocols, gaps in the continuous education of clinicians, pressure from patients and, in some cases, limited access to oral healthcare. Prevention strategies and alternatives to the use of antibiotic were also discussed, particularly minimally invasive therapies and new approaches, such as antimicrobial peptides, which show potential as adjuvants in the management of oral infections. The review of case studies demonstrates that Antibiotic Stewardship programmes applied in dental settings can significantly reduce inappropriate prescriptions, improve adherence to clinical guidelines and enhance patient safety. Interventions combining audit, feedback, education and local protocols have shown a positive impact both in hospitals and in dental clinics, reinforcing the importance of Dentistry in global Stewardship strategies. It is concluded that the systematic implementation of Stewardship programmes in Dentistry is essencial to consolidate a more conscious, responsible and evidence-based clinical practice. However, despite the encouraging results already observed, there remains a pressing need to develop further studies to assess the effectiveness and applicability of these measures acrosse different clinical and cultural settings.
Description
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Keywords
Resistência aos antibióticos Medicina dentária Antibiotic stewardship