Empirical antimicrobial therapy of acute dentoalveolar abscess

Matijevic, Stevo; Lazić, Zoran; Kuljić-Kapulica, N; Nonković, Zorka

doi:10.2298/vsp0907544m

Cited by 16 publications

(25 citation statements)

References 18 publications

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“…The predominance of the penicillin group among the antibiotics prescribed in emergency dental service could be explained by the fact that acute odontogenic infections are usually characterised by abscess formation, which is caused primarily by strict anaerobes. Therefore, in most cases, the antibiotic is determined empirically without performing the time‐consuming antibiogram, which is not feasible in emergency dental services . It should be noted that penicillins were predominantly prescribed in conjunction with clavulanic acid, while the prescription of penicillin only was negligible ( Table ).…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, in 1,600 most cases, the antibiotic is determined empirically without performing the time-consuming antibiogram, which is not feasible in emergency dental services. 18 It should be noted that penicillins were predominantly prescribed in conjunction with clavulanic acid, while the prescription of penicillin only was negligible ( Table 1). However, the combination of penicillin and clavulanic acid is considered unnecessary for treatment of odontogenic infection according to Scottish and UK guidelines 19,20 as there is no evidence of their superior effectiveness but presents an increased risk of Clostridium difficile infection.…”

Section: Discussionmentioning

confidence: 99%

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Antibiotic prescription in emergency dental service in Zagreb, Croatia – a retrospective cohort study

Bjelovucic¹,

Par

Rubcic³

et al. 2019

International Dental Journal

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Objectives To analyse prescription of antibodies in emergency dental service according to antibiotic type, working diagnosis, patient visit time and patient demographic characteristics. Additionally, prescription practices among individual dentists were analysed. Methods The data in this retrospective cohort study were collected from electronic medical records and analyzed using descriptive statistics. Statistical analyses were conducted using the chi‐square test and the Z‐test with post‐hoc Bonferroni adjustment (α =0.05). Results The study covered 20,879 patient visits during a 1.5‐year period (from 1 June 2015 to 1 December 2016). Antibiotics were prescribed in 10,188 (48.8%) visits. In 6,202 (29.7%) visits, no dental treatment was performed and only an antibiotic was prescribed. The antibiotics most frequently prescribed were from the penicillin group and also contained clavulanic acid (70.5%); the second most frequently prescribed antibiotic was clindamycin (15.0%). The most common diagnoses for which an antibiotic was prescribed were acute apical abscess, pericoronitis and retained root; for these diagnoses, an antibiotic was prescribed in 79.8%, 64.3% and 63.3% of visits, respectively. Prescription of an antibiotic was significantly more frequent during Sundays and holidays (55.6% of visits) than during working days (33.2% of visits). Prescription of an antibiotic increased from the age of 1 towards the age of 75 and decreased thereafter. Female dentists prescribed antibiotics slightly but significantly (P < 0.001) more frequently than male dentists (50.8% and 46.8% of visits, respectively). High heterogeneity was observed among dentists regarding their criteria for prescribing antibiotics; individual dentists prescribed antibiotics in 15.0%–72.1% of the total number of visits. Conclusion Multiple possible issues in the prescription of antibiotics were observed, ranging from administration for inappropriate indications to noncritical and excessive prescription.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Antibiotic prescription in emergency dental service in Zagreb, Croatia – a retrospective cohort study

Bjelovucic¹,

Par

Rubcic³

et al. 2019

International Dental Journal

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“…All studies demonstrated clinical success with the use of the varying regimens of oral antibiotics and surgical intervention. Clinical improvement was noted in two studies after 2-3 days [4,30], in one study after 5 days [29], in two studies after 5-7 days [24,31], and in three studies after 7 days [28,32,33]. Kumari et al [32] demonstrated that the cohort of patients who received incision and drainage only without oral antibiotics did not present any statistically significant differences in the examined parameters with respect to the group that received surgical intervention with a broad-spectrum combination antibiotic (amoxicillin with clavulanic acid and metronidazole).…”

Section: Outcomes Of Oral Antibiotics For Dentoalveolar Infectionsmentioning

confidence: 91%

“…The characteristics of the eight included studies are shown in Table 1 [4,24,[28][29][30][31][32][33]. There were three prospective, double-blinded, randomised clinical studies, two prospective, randomised studies, two prospective studies and one retrospective study.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…All studies involved surgical or dental intervention to address the cause of the infection by extraction or incision/drainage through the root canal system or soft tissue, in addition to the prescription of antibiotics. All studies included cohorts that were administered antibiotics, except for two studies, i.e., Kumari et al [32] and Matijevic et al [31], which both presented a cohort of patients who received surgical intervention only.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Oral Antibiotic for Empirical Management of Acute Dentoalveolar Infections—A Systematic Review

et al. 2021

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Concerns regarding increasing antibiotic resistance raise the question of the most appropriate oral antibiotic for empirical therapy in dentistry. The aim of this systematic review was to investigate the antibiotic choices and regimens used to manage acute dentoalveolar infections and their clinical outcomes. A systematic review was undertaken across three databases. Two authors independently screened and quality-assessed the included studies and extracted the antibiotic regimens used and the clinical outcomes. Searches identified 2994 studies, and after screening and quality assessment, 8 studies were included. In addition to incision and drainage, the antibiotics used to manage dentoalveolar infections included amoxicillin, amoxicillin/clavulanic acid, cefalexin, clindamycin, erythromycin, metronidazole, moxifloxacin, ornidazole and phenoxymethylpenicillin. Regimens varied in dose, frequency and duration. The vast majority of regimens showed clinical success. One study showed that patients who did not receive any antibiotics had the same clinical outcomes as patients who received broad-spectrum antibiotics. The ideal choice, regimen and spectrum of empirical oral antibiotics as adjunctive management of acute dentoalveolar infections are unclear. Given that all regimens showed clinical success, broad-spectrum antibiotics as first-line empirical therapy are unnecessary. Narrow-spectrum agents appear to be as effective in an otherwise healthy individual. This review highlights the effectiveness of dental treatment to address the source of infection as being the primary factor in the successful management of dentoalveolar abscesses. Furthermore, the role of antibiotics is questioned in primary space odontogenic infections, if drainage can be established.

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Systemic antibiotics for symptomatic apical periodontitis and acute apical abscess in adults

Cope

Francis

Wood

et al. 2014

Cochrane Database of Systematic Reviews

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Background Dental pain can have a detrimental effect on quality of life. Symptomatic apical periodontitis and acute apical abscess are common causes of dental pain and arise from an inflamed or necrotic dental pulp, or infection of the pulpless root canal system. Clinical guidelines recommend that the first-line treatment for teeth with these conditions should be removal of the source of inflammation or infection by local, operative measures, and that systemic antibiotics are currently only recommended for situations where there is evidence of spreading infection (cellulitis, lymph node involvement, diffuse swelling) or systemic involvement (fever, malaise). Despite this, there is evidence that dentists frequently prescribe antibiotics in the absence of these signs. There is concern that this could contribute to the development of antibiotic-resistant bacterial colonies within both the individual and the community. This review is an update of the original version that was published in 2014. Objectives To evaluate the effects of systemic antibiotics provided with or without surgical intervention (such as extraction, incision and drainage of a swelling, or endodontic treatment), with or without analgesics, for symptomatic apical periodontitis and acute apical abscess in adults.

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Empirical antimicrobial therapy of acute dentoalveolar abscess

Cited by 16 publications

References 18 publications

Antibiotic prescription in emergency dental service in Zagreb, Croatia – a retrospective cohort study

Antibiotic prescription in emergency dental service in Zagreb, Croatia – a retrospective cohort study

Oral Antibiotic for Empirical Management of Acute Dentoalveolar Infections—A Systematic Review

Systemic antibiotics for symptomatic apical periodontitis and acute apical abscess in adults

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