- Email: [email protected]
INFORMING PATIENTS: Response from ADA Council on Science
COMMENTARIES
Natalie Heaivilin, DDS Assistant Clinical Professor Hospital Dentistry and GPR Program Department of Oral and Maxillofacial Surgery School of Dentistry University of California San Francisco 1. Varsi C, Gammon D, Wibe T, Ruland CM. Patients’ reported reasons for non-use of an internet-based patient-provider communication service: qualitative interview study. J Med Internet Res 2013;15(11):e246. 2. Paul MJ, Dredze M. Discovering health topics in social media using topic models. PLoS One 2014;9(8):e103408. 3. Heaivilin N, Gerbert B, Page JE, Gibbs JL. Public health surveillance of dental pain via Twitter (published online ahead of print July 18, 2011). J Dent Res 2011;90(9):1047-1051. doi:10.1177/0022034511415273.
INFORMING PATIENTS
I am writing regarding the July JADA For the Patient page, “Clostridium difficile Infection” (JADA 2014;145[7]:784). Clindamycin, cephalosporin and ampicillin are the most common antibiotics associated with pseudomembranous colitis. Clindamycin, because of its broad-spectrum activity against aerobic, anaerobic and beta-lactamase–producing pathogens, is the recommended alternative for patients with dental infection who have a penicillin allergy. Because clindamycin is prescribed often, I would like to point out that patients should be informed under the “What Can I Do to Prevent Infection?” section of the Patient page that they can take the following in conjunction
with clindamycin: yogurt with live cultures, probiotics, a yeast supplement (for example, Saccharomyces boulardii) or a combination of these. However, caution should be exercised for individuals who are immunocompromised or who have gastrointestinal disorders or compromised intestinal barriers to avoid probiotic sepsis. Furthermore, the recommended clindamycin dosage for severe dental infections of 300 milligrams every six to eight hours is an extremely high dosage. I would encourage fellow practitioners to prescribe more conservatively (for example, 150 mg every six to eight hours) whenever possible. Daniel J. Kim, DDS Ramsey, N.J.
Response from ADA Council on Science: We thank Dr. Kim for his letter. Although Clostridium difficile (C. diff) has been associated with infections in health care facilities, long-term exposure to antibiotic alone is not enough for C. diff infection. Actual infection by the microorganism is needed. Infection occurs by direct or indirect contact with spores of C. diff localized in the feces of infected patients. Antibiotic treatment for C. diff should be monitored closely. According to the Centers for Disease Control and Prevention1 (CDC), infection returns in 20 percent of treated patients. Infection can be prevented by washing hands and cleaning sur-
JADA 145(11)
faces that have been in contact with infected patients. Nonsymptomatic patients may also serve as source of contamination/infection. The CDC Healthcare Infection Control Practices Advisory Committee2 has specific recommendations for disinfection in health care facilities. When prescribing antibiotics, some clinicians recommend add-on treatments—including probiotics— to prevent secondary infections. However, there is very little scientific information about the effectiveness of these approaches. In regards to clindamycin, there are no current National Institutes of Health recommendations for patients beyond having a regular diet.3 Patients should consult with their physician on the benefits of these treatments. More information on approaches against antibiotic resistance is available in the CDC report Antibiotic Resistance Threats in the United States, 2013.4 1. Centers for Disease Control and Prevention. Healthcare-associated infections (HAIs). www.cdc.gov/hai/organisms/cdiff/Cdiffpatient.html. Accessed Sept. 24, 2014. 2. Centers for Disease Control and Prevention. Guideline for disinfection and sterilization in healthcare facilities, 2008. www.cdc. gov/hicpac/Disinfection_Sterilization/3_2cont aminatedDevices.html. Accessed Sept. 24, 2014. 3. U.S. National Library of Medicine, National Institutes of Health. Clindamycin. MedlinePlus. www.nlm.nih.gov/medlineplus/druginfo/ meds/a682399.html#special-dietary. Accessed Sept. 25, 2014. 4. Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2013. www.cdc.gov/drugresistance/ threat-report-2013/pdf/ar-threats-2013-508.pdf. Accessed Sept. 24, 2014.
http://jada.ada.org
November 2014
1109
Natalie Heaivilin, DDS Assistant Clinical Professor Hospital Dentistry and GPR Program Department of Oral and Maxillofacial Surgery School of Dentistry University of California San Francisco 1. Varsi C, Gammon D, Wibe T, Ruland CM. Patients’ reported reasons for non-use of an internet-based patient-provider communication service: qualitative interview study. J Med Internet Res 2013;15(11):e246. 2. Paul MJ, Dredze M. Discovering health topics in social media using topic models. PLoS One 2014;9(8):e103408. 3. Heaivilin N, Gerbert B, Page JE, Gibbs JL. Public health surveillance of dental pain via Twitter (published online ahead of print July 18, 2011). J Dent Res 2011;90(9):1047-1051. doi:10.1177/0022034511415273.
INFORMING PATIENTS
I am writing regarding the July JADA For the Patient page, “Clostridium difficile Infection” (JADA 2014;145[7]:784). Clindamycin, cephalosporin and ampicillin are the most common antibiotics associated with pseudomembranous colitis. Clindamycin, because of its broad-spectrum activity against aerobic, anaerobic and beta-lactamase–producing pathogens, is the recommended alternative for patients with dental infection who have a penicillin allergy. Because clindamycin is prescribed often, I would like to point out that patients should be informed under the “What Can I Do to Prevent Infection?” section of the Patient page that they can take the following in conjunction
with clindamycin: yogurt with live cultures, probiotics, a yeast supplement (for example, Saccharomyces boulardii) or a combination of these. However, caution should be exercised for individuals who are immunocompromised or who have gastrointestinal disorders or compromised intestinal barriers to avoid probiotic sepsis. Furthermore, the recommended clindamycin dosage for severe dental infections of 300 milligrams every six to eight hours is an extremely high dosage. I would encourage fellow practitioners to prescribe more conservatively (for example, 150 mg every six to eight hours) whenever possible. Daniel J. Kim, DDS Ramsey, N.J.
Response from ADA Council on Science: We thank Dr. Kim for his letter. Although Clostridium difficile (C. diff) has been associated with infections in health care facilities, long-term exposure to antibiotic alone is not enough for C. diff infection. Actual infection by the microorganism is needed. Infection occurs by direct or indirect contact with spores of C. diff localized in the feces of infected patients. Antibiotic treatment for C. diff should be monitored closely. According to the Centers for Disease Control and Prevention1 (CDC), infection returns in 20 percent of treated patients. Infection can be prevented by washing hands and cleaning sur-
JADA 145(11)
faces that have been in contact with infected patients. Nonsymptomatic patients may also serve as source of contamination/infection. The CDC Healthcare Infection Control Practices Advisory Committee2 has specific recommendations for disinfection in health care facilities. When prescribing antibiotics, some clinicians recommend add-on treatments—including probiotics— to prevent secondary infections. However, there is very little scientific information about the effectiveness of these approaches. In regards to clindamycin, there are no current National Institutes of Health recommendations for patients beyond having a regular diet.3 Patients should consult with their physician on the benefits of these treatments. More information on approaches against antibiotic resistance is available in the CDC report Antibiotic Resistance Threats in the United States, 2013.4 1. Centers for Disease Control and Prevention. Healthcare-associated infections (HAIs). www.cdc.gov/hai/organisms/cdiff/Cdiffpatient.html. Accessed Sept. 24, 2014. 2. Centers for Disease Control and Prevention. Guideline for disinfection and sterilization in healthcare facilities, 2008. www.cdc. gov/hicpac/Disinfection_Sterilization/3_2cont aminatedDevices.html. Accessed Sept. 24, 2014. 3. U.S. National Library of Medicine, National Institutes of Health. Clindamycin. MedlinePlus. www.nlm.nih.gov/medlineplus/druginfo/ meds/a682399.html#special-dietary. Accessed Sept. 25, 2014. 4. Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2013. www.cdc.gov/drugresistance/ threat-report-2013/pdf/ar-threats-2013-508.pdf. Accessed Sept. 24, 2014.
http://jada.ada.org
November 2014
1109