Compliance with Prescribed Medication

Author: Dr. David Dickerhoff, DDS, MAGD, FOCOI

I have the opportunity to attend numerous continuing education classes. The mantra of being a lifelong student resonates throughout my daily activities. I attended one class recently that addressed the problem of non-compliance with taking prescribed medications. The study had been set up to analyze the chances of achieving compliance through evaluating how the medication had been prescribed. Some medications have the ability to be prescribed at differing time intervals and this study looked at achieving compliance at differing dosing regimens. As it turns out, the study found that even at dosing of just once daily (qd), the percentage of correct compliance was only 72%. This number declines precipitously as dosing went from twice daily (bid) to three times daily (tid) and finally at four times daily (qid) it bottomed out at 46%. The clinical case they were looking at was a dental abscess (a dead tooth that has an infection located outside of tooth structure) where we as clinicians were challenged to detail how we would treat the case with antibiotics. Well, of course the correct answer was to treat the infection cause first rather than rely upon antibiotics which would have the unintended result of developing a subsequent infection unresponsive to desired antibiotic therapy (a superinfection). Removing dead tissue from the tooth through pulpectomy or root canal therapy as well as incising and draining the infection from the gum-line would have made your subsequent selection of antibiotic therapy more favorable.

Regardless, when antibiotics are prescribed, having a discussion with your care provider on the indications and contraindications of this therapy is paramount to its success. Trends within medicine and dentistry are to use antibiotics for a shorter duration, shorter dosing patterns and better follow up. We in dentistry, use antibiotics from the tetracycline family often as they are especially effective on bugs that localize and mature within the gum tissue. But because the effective drug is bound up in the stomach by dairy products (products that are divalent such as calcium and sodium), they are made ineffective if taken within an hour of mealtime or two hours after. Metronidazole (Flagyl) is an antibiotic that gives a strong antibuse reaction (nausea and vomiting) if taken with alcohol.

The bottom line will always be to have a great relationship with your care provider. If he or she is intimidated by your questions or concerns, find another care provider! Finding the right medication and dosing schedule requires lots of knowledge, probing, questions and discussion. Be willing to work with your doctor to know the right decision that fits your lifestyle and diagnosis.