Antibiotic prescribing practices in periodontal surgeries with and without bone grafting

Hai, Justine Hoda; Lee, Cliff; Kapila, Yvonne L.; Chaffee, Benjamin W.; Armitage, Gary C.

doi:10.1002/jper.19-0195

Cited by 21 publications

(17 citation statements)

References 32 publications

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“…However, this was not our goal since we wanted only to assess DPs' evidence-based practices related to prescription of AP. Third, it is well known that a desirable response rate must be higher than 60%; we believe that our response rate (52.6%) is satisfactory considering that DPs are a group with very low survey response rates [38][39][40][41] and that our response rate was similar to or higher than the 27.2-32% reported in analogous surveys [18,[42][43][44].…”

Section: Strengths and Limitationsmentioning

confidence: 58%

Appropriateness of Antibiotic Prescription for Prophylactic Purposes among Italian Dental Practitioners: Results from a Cross-Sectional Study

et al. 2021

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The primary objective of this study was to investigate the pattern of antibiotic prescription for prophylaxis purposes among Italian DPs (dental practitioners). A nationwide cross-sectional study was conducted using a multi-stage sampling design. A structured questionnaire was used to collect socio-demographic data and information about antibiotic prophylaxis (AP) prescriptions for selected dental diagnoses and surgical procedures. The presence of an indication and appropriateness of AP were defined according to international guidelines. In total, 563 DPs answered the questionnaire (response rate 52.6%). The proportions of DPs who prescribed AP in the presence of an indication ranged from 39.1% for luxation injury with soft tissue trauma to 73.1% for dental implants, whilst DPs who prescribed AP in healthy patients ranged from 41.9% in luxation injury with soft tissue trauma to 70.3% for bone grafting. The course of AP reported by DPs was not consistent with the guidelines in 70.9% of explored procedures. A high proportion of AP prescriptions before dental procedures were unnecessary. This highlights the urgent need to incorporate recommendations for best practices into national and local protocols as soon as they are established. Specific antibiotic stewardship strategies targeted to DPs should be implemented and assessed for effectiveness in improving prescribing of antibiotics.

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Section: Strengths and Limitationsmentioning

confidence: 58%

Appropriateness of Antibiotic Prescription for Prophylactic Purposes among Italian Dental Practitioners: Results from a Cross-Sectional Study

et al. 2021

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“…The observation that soaking scaffolds in 5% honey results in increased bacterial growth in KA medium, suggests the potential of worse patient outcomes. However, prophylactic antibiotic treatment such as gentamicin commonly follows bone graft or biomaterial implantation [76, 77]. We therefore sought to determine whether soaking scaffolds in 5% honey would be likely to increase the bacterial burden even in the presence of antibiotics or, conversely, if honey may increase the sensitivity of P. aeruginosa to antibiotics.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of P. aeruginosa attachment on mineralized collagen scaffolds and addition of manuka honey to increase mesenchymal stem cell osteogenesis

Dewey

Collins

Tiffany

et al. 2022

Preprint

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The design of biomaterials to regenerate bone is likely to increasingly require modifications that reduce bacterial attachment and biofilm formation as infection during wound regeneration can significantly impede tissue repair and typically requires surgical intervention to restart the healing process. Here, we investigate the ability of a mineralized collagen biomaterial to natively resist infection as well as how the addition of manuka honey affects bacterial colonization and mesenchymal stem cell osteogenesis. We incorporate manuka honey into these scaffolds via either direct fabrication into the scaffold microarchitecture or via soaking the scaffold in a solution of Manuka honey after fabrication. Direct incorporation results in a change in the surface characteristics and porosity of mineralized collagen scaffolds. Soaking scaffolds in honey concentrations greater than 10% had significant negative effects on mesenchymal stem cell metabolic activity but soaking or incorporating 5% honey had no impact on endothelial cell tube formation. Soaking and incorporating 5% honey into scaffolds reduced metabolic activity of mesenchymal stem cells, however, soaking 5% honey into scaffolds increased calcium and phosphorous mineral formation, osteoprotegerin release, and alkaline phosphatase activity. The addition of manuka honey did not prevent P. aeruginosa attachment but may be able to limit attachment of other common wound-colonizing bacteria. Overall, our results demonstrate the potential for soaking mineralized collagen scaffolds in 5% manuka honey to increase osteogenesis of mesenchymal stem cells.

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“…In the era of increasing antimicrobial resistance, public health needs demand a reduction in the use of unnecessary antibiotic usage through antibiotic stewardship [ 45 ]. Although adjunctive systemic antibiotics have been shown to lead to enhanced clinical and radiographic outcomes following non-surgical periodontal therapy [ 3 ], a recent S3-level clinical guideline calls for a rather restrictive use in the non-surgical phase [ 6 ]; however, no evidence-based guidelines deal with the adjunctive prophylactic use of antibiotics in conjunction with periodontal surgery [ 12 , 13 , 46 , 47 ]. Despite their common use in practice, it has been unclear if their use in this scenario is justifiable.…”

Section: Discussionmentioning

confidence: 99%

“…However, this aspect has been rather under-researched compared with the use of antibiotics during the non-surgical phase [ 9 , 10 , 11 ]. Therefore, in the reality of clinical practice, antibiotics are often empirically prescribed in the case of regenerative periodontal surgery, with no clear evidence to support it [ 12 , 13 ]. However, to date, the potential benefits of systemic antibiotics as an adjunct to regenerative periodontal surgery have not been systematically appraised.…”

Section: Introductionmentioning

confidence: 99%

Adjunctive Effect of Systemic Antibiotics in Regenerative/Reconstructive Periodontal Surgery—A Systematic Review with Meta-Analysis

et al. 2021

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Background and Objective: Systemic antibiotics (AB) are often used in conjunction with regenerative/reconstructive periodontal surgery of intrabony defects and furcations; however, their potential benefits have not been systematically assessed. Materials and Methods: Data were retrieved from two recent systematic reviews (a total of 105 randomized clinical trials (RCTs) on clinical and radiographic outcomes in intrabony defects (ID) and molars with furcation involvement (FI) treated by surgical access with regenerative techniques. Pair-wise meta-analysis of RCTs with and without AB was performed. Meta-regressions from single-arm (subgroup) RCTs including study arms with or without adjunctive AB were also conducted. Results: No statistically significant benefits of systemic AB with regard to PPD, CAL and bone gain were detected in ID by pair-wise meta-analysis. Meta-regression revealed increased PPD reduction (−0.91 mm, 95% CI = −1.30; −0.51, p < 0.001), CAL gain (−0.92 mm, 95% CI = −1.32; −0.52, p < 0.001) and bone gain (−1.08 mm, 95% CI = −1.63; −0.53, p < 0.001) in ID but not in any of the outcomes in FI for arms treated with AB vs. study arms treated with no AB. No clear differences in adverse events were detected between AB and non-AB groups. Conclusion: There is only weak indirect evidence that AB may provide additional benefits in terms of clinical improvements in the regenerative/reconstructive periodontal surgery of intrabony defects and no evidence for a benefit in furcations. Until new data are gained and in the context of antibiotic stewardship, it may be questionable to justify the adjunctive use of systemic antibiotics.

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Antibiotic prescribing practices in periodontal surgeries with and without bone grafting

Cited by 21 publications

References 32 publications

Appropriateness of Antibiotic Prescription for Prophylactic Purposes among Italian Dental Practitioners: Results from a Cross-Sectional Study

Appropriateness of Antibiotic Prescription for Prophylactic Purposes among Italian Dental Practitioners: Results from a Cross-Sectional Study

Evaluation of P. aeruginosa attachment on mineralized collagen scaffolds and addition of manuka honey to increase mesenchymal stem cell osteogenesis

Adjunctive Effect of Systemic Antibiotics in Regenerative/Reconstructive Periodontal Surgery—A Systematic Review with Meta-Analysis

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