Antibiotic Prescribing Practices of Filipino Dentists

There are reports that dentists overprescribe antibiotics which may contribute to antibiotic resistance. This is an exploratory study on antibiotic prescribing practices of Filipino dentists using an online platform to form a basis for antimicrobial stewardship policy for dentists. A link to an online questionnaire using Survey Monkey was posted in a Closed Group Facebook account of Filipino dentists. Two hundred thirty (230) dentists participated. Data was analyzed by Survey Monkey. Amoxicillin is the first choice of antibiotics(71.18%), andclindamycin is the second (57.27%). Most respondents follow the indications for antibiotic therapy, however, some will prescribe antibiotics for conditions without indications. For dental procedures, 88.99% will prescribe for periodontal surgery, 75.45% for endodontic surgery, 68.3% for extraction of a tooth with chronic infection, 87.17% for third molar surgery, 26.7% for routine endodontics, and 23.56% for periodontal treatment without surgery. Not all of the respondents would prescribe for medical conditions that require antibiotic prophylaxis, while 60.36% will prescribe when in doubt in diagnosis, under time pressure (25.68%), and 48.67% considers patient preference. Only 10.48% of the respondents are very familiar with antimicrobial stewardship, while majority (69.74%) have not attended a lecture for antimicrobial stewardship for dentists.There is inappropriate antibiotic prescribing of participants on certain dental diseases, procedures, and medical conditions. Most respondents are not very familiar and have not attended a lecture on antimicrobial stewardship for specifically for dentists

Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries

Background: Pancreatic surgery remains associated with high morbidity rates. Although postoperative mortality appears to have improved with specialization, the outcomes reported in the literature reflect the activity of highly specialized centres. The aim of this study was to evaluate the outcomes following pancreatic surgery worldwide.Methods: This was an international, prospective, multicentre, cross-sectional snapshot study of consecutive patients undergoing pancreatic operations worldwide in a 3-month interval in 2021. The primary outcome was postoperative mortality within 90 days of surgery. Multivariable logistic regression was used to explore relationships with Human Development Index (HDI) and other parameters.Results: A total of 4223 patients from 67 countries were analysed. A complication of any severity was detected in 68.7 percent of patients (2901 of 4223). Major complication rates (Clavien-Dindo grade at least IIIa) were 24, 18, and 27 percent, and mortality rates were 10, 5, and 5 per cent in low-to-middle-, high-, and very high-HDI countries respectively. The 90-day postoperative mortality rate was 5.4 per cent (229 of 4223) overall, but was significantly higher in the low-to-middle-HDI group (adjusted OR 2.88, 95 per cent c.i. 1.80 to 4.48). The overall failure-to-rescue rate was 21 percent; however, it was 41 per cent in low-to-middle-compared with 19 per cent in very high-HDI countries.Conclusion: Excess mortality in low-to-middle-HDI countries could be attributable to failure to rescue of patients from severe complications. The authors call for a collaborative response from international and regional associations of pancreatic surgeons to address management related to death from postoperative complications to tackle the global disparities in the outcomes of pancreatic surgery (NCT04652271; ISRCTN95140761)