Me voy al dentista: ¿antibiótico como prevención o como tratamiento?

Abstract

Odontogenic infections account for 10% of all antibiotic prescriptions in Spain. Despite the frequency and importance of these infections, there is often confusion between prophylaxis and treatment. The oral cavity is a complex ecosystem made up of over 500 bacterial species. It is essential to take the medical history, examine each infection, and know about previous illnesses that could change our therapeutic and/or prophylactic attitude. The use of prophylaxis with antibiotics in patients at risk of infective endocarditis has been accepted for many years. Nowadays this is being restricted, and in many cases the risks of taking preventive antibiotics outweigh its benefits. There are no serious studies to determine the best antibiotic and its dosage, thus the Spanish consensus guidelines have to be followed. It is not known how the misuse of antibiotics influences bacterial resistance, not only on pathogen strains, but also on the common oral flora.

Analysis of essential gene dynamics under antibiotic stress in Streptococcus sanguinis

“…By colonizing the oral cavity in abundance, S. sanguinis are exposed to antibiotics which persist at sub-inhibitory concentrations for long periods of time, either directly through antibiotic ingestion by patients or indirectly through anthropogenic antibiotic usage and consumption of antibiotics through animal food products [ 10, 11 ]. It was estimated that out of the total antibiotic prescriptions for clinical purposes, 7 and 10 % of total prescriptions are provided by dentists in the UK [ 12 ] and Spain [ 13 ], respectively. Ampicillin and amoxicillin are β-lactam antibiotics that differ only in one hydroxyl group but share the same spectrum of activity against Gram-positive bacteria, despite different intestinal absorption rates [ 14 ].…”

Diseño Y Validación De Un Cuestionario Para Determinar Conocimientos, Actitudes Y Prácticas en La Prescripción De Antibióticos en Odontología

“…17 Several authors express the need for additional studies to establish protocols for the use of antibiotics. 18 During content validity by experts, like in the rigorous validation process of a questionnaire to measure knowledge and attitudes on antibiotics prescription in physicians by López-Vázquez et al, 2016 10 and Teixeira et al, 2016, 11 the expert panel eliminated, added and reformulated questions, in addition to correcting grammar, syntax, organization, and logical sequence.…”

Prescripciones de antibióticos para patologías bucodentales

“…En pacientes alérgicos a la penicilina, la ada recomienda eritromicina o clindamicina [9,11,15,[25][26][27][28][29]. Sin embargo, para otros autores en los últimos años, la asociación de amoxicilina con ácido clavulánico resulta ser más apropiada, ya que permite restablecer la actividad del antibiótico ante las bacterias, manteniendo un amplio espectro de actividad [7,18].…”

“…La escasa acción de las cefalosporinas de primera generación sobre bacterias anaerobias Gram negativas le restan validez para el tratamiento; no así la clindamicina, que es un agente eficaz por su espectro de acción ante los patógenos habituales de la boca y son de elección en pacientes alérgicos a betalactámicos [11,18].…”

“…La patología infecciosa debe tratar de resolverse con el tratamiento odontológico propiamente dicho [13], dado que los antimicrobianos innecesarios aumentan el riesgo de efectos adversos y la resistencia bacteriana [14]; es decir, que no representan el principal tratamiento para erradicar la infección, a no ser que haya síntomas y signos clínicos de un proceso infeccioso en pacientes con estado general afectado, hipertermia mayor a 37,8ºC, linfoadenopatía regional, asimetría facial y pacientes inmunodeprimidos [15]. Al indicar el tratamiento antimicrobiano como complemento, se evitaría la extensión local y la contigüidad de la infección, lo que prevendría las complicaciones derivadas de la diseminación hematógena [6,11,[16][17][18].…”