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

Cope, Anwen; Francis, Nick; Wood, Fiona; Mann, Mala; Chestnutt, Ivor Gordon

doi:10.1002/14651858.cd010136.pub2

Cited by 57 publications

(63 citation statements)

References 36 publications

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“…Comparatively, a cross‐sectional study from the UK reported that general dental practitioners prescribed antibiotics for acute apical abscess with no systematic involvement (14.4%), with systematic involvement (9.8%) and chronic apical abscess (13.8%) . A Cochrane review on systemic antibiotic administration in the therapy of periapical lesions identified only two representative studies, which were considered of low quality; thus, it was concluded that there is insufficient evidence to determine the effectiveness of systemic antibiotics in the treatment of acute apical abscess . It is interesting to note that antibiotics were also prescribed for pulpitis in 25.6% of cases ( Figure ).…”

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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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%

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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“…Despite little evidence supporting antibiotic therapy as management of most types of dental infections – a recent systematic review on the topic concluded the quality of available evidence is “very low” [26] - it is estimated that 8 to10% of all primary care antibiotic prescriptions are for treatment of dental infections [27, 28]. Antibiotic prescription patterns for dental infections in the acute care setting are less well quantified.…”

Section: Discussionmentioning

confidence: 99%

Acute dental infections managed in an outpatient parenteral antibiotic program setting: prospective analysis and public health implications

et al. 2017

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BackgroundThe number of Acute Dental Infections (ADI) presenting for emergency department (ED) care are steadily increasing. Outpatient Parenteral Antibiotic Therapy (OPAT) programs are increasingly utilized as an alternative cost-effective approach to the management of serious infectious diseases but their role in the management of severe ADI is not established. This study aims to address this knowledge gap through evaluation of ADI referrals to a regional OPAT program in a large Canadian center.MethodsAll adult ED and OPAT program ADI referrals from four acute care adult hospitals in Calgary, Alberta, were quantified using ICD diagnosis codes in a regional reporting system. Citywide OPAT program referrals were prospectively enrolled over a five-month period from February to June 2014. Participants completed a questionnaire and OPAT medical records were reviewed upon completion of care.ResultsOf 704 adults presenting to acute care facilities with dental infections during the study period 343 (49%) were referred to OPAT for ADI treatment and 110 were included in the study. Participant mean age was 44 years, 55% were women, and a majority of participants had dental insurance (65%), had seen a dentist in the past six months (65%) and reported prior dental infections (77%), 36% reporting the current ADI as a recurrence. Median length of parenteral antibiotic therapy was 3 days, average total course of antibiotics was 15-days, with a cumulative 1326 antibiotic days over the study period. There was no difference in total duration of antibiotics between broad and narrow spectrum regimes. Conservative cost estimate of OPAT care was $120,096, a cost savings of $597,434 (83%) compared with hospitalization.ConclusionsADI represent a common preventable cause of recurrent morbidity. Although OPAT programs may offer short-term cost savings compared with hospitalization, risks associated with extended antibiotic exposures and delayed definitive dental management must also be gauged.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-017-2303-2) contains supplementary material, which is available to authorized users.

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“…As dentists prescribe approximately 10% of antibiotics dispensed in primary care, it is important not to underestimate the potential contribution of the dental profession to the development of antibiotic‐resistant bacteria (Cope et al . ). For example, in the UK, it has been reported that 40% of dentists prescribed antibiotics at least three times each week, and 15% prescribed antibiotics on a daily basis (Lewis ).…”

Section: Introductionmentioning

confidence: 97%

Antibiotics in Endodontics: a review

Segura-Egea

Gould

Şen³

et al. 2017

Int Endodontic J

167

223

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The overuse of antibiotics and the emergence of antibiotic‐resistant bacterial strains is a global concern. This concern is also of importance in terms of the oral microbiota and the use of antibiotics to deal with oral and dental infections. The aim of this paper was to review the current literature on the indications and use of antibiotics and to make recommendations for their prescription in endodontic patients. Odontogenic infections, including endodontic infections, are polymicrobial, and in most cases, the prescription of antibiotics is empirical. This has led to the increasing use of broad‐spectrum antibiotics even in cases where antibiotics are not indicated, such as symptomatic irreversible pulpitis, necrotic pulps and localized acute apical abscesses. In case of discrete and localized swelling, the primary aim is to achieve drainage without additional antibiotics. Adjunctive antibiotic treatment may be necessary in the prevention of the spread of infection, in acute apical abscesses with systemic involvement and in progressive and persistent infections. Medically compromised patients are more susceptible to complication arising from odontogenic infections and antimicrobials have a more specific role in their treatment. Therefore, antibiotics should be considered in patients having systemic diseases with compromised immunity or in patients with a localized congenital or acquired altered defence capacity, such as patients with infective endocarditis, prosthetic cardiac valves or recent prosthetic joint replacement. Penicillin VK, possibly combined with metronidazole to cover anaerobic strains, is still effective in most cases. However, amoxicillin (alone or together with clavulanic acid) is recommended because of better absorption and lower risk of side effects. In case of confirmed penicillin allergy, lincosamides such as clindamycin are the drug of choice.

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

Cited by 57 publications

References 36 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

Acute dental infections managed in an outpatient parenteral antibiotic program setting: prospective analysis and public health implications

Antibiotics in Endodontics: a review

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