Penicillin, the first commercially available antibiotic, was discovered in 1928 by Alexander Fleming.8 While the introduction of antibiotics revolutionized healthcare, their overuse has produced serious adverse health outcomes including adverse drug reactions, disruption of commensal flora resulting in opportunistic secondary infections and antibiotic resistance.9-13 As the use of antibiotics increased, microorganisms developed the ability to evade the mechanisms of action of the antibiotics and/or antimicrobial agents used to combat them.13 The prevalence of this antimicrobial resistance has increased with the increase in antibiotic use and the genetic material coding for such resistance has been transferred amongst bacteria in the environment. This allows those microorganisms to preferentially flourish despite antibiotic therapy. Infections caused by antibiotic-resistant organisms often require use of costly and more toxic alternative therapies. In 2019 the Centres for Disease Control and Prevention (CDC) published an updated report categorizing the current antibiotic resistance threats (Figure 1).14
Currently, the main causes of antibiotic resistance include inappropriate prescribing, inadequate compliance by patients who receive antibiotic prescriptions, overuse of antibiotics in livestock farming, and environmental antimicrobial use. The CDC recommends that healthcare providers follow published clinical guidelines regarding antibiotic prescription and stewardship, perform appropriate diagnostic tests to guide antibiotic therapy, utilize anti-infective protections, and inform patients of the importance of proper antibiotic use and disposal.15 Given these concerns, it is critical that dental healthcare providers understand the risks of antibiotic resistance and the steps that can be applied to improve patient outcomes and decrease risks for the community as a whole.