Antibiotic Administration Along with Endodontic Therapy in the Republic of Croatia: a Pilot Study

Abstract

Objective To evaluate the type and the frequency of antibiotic prescribing along with endodontic therapy in Croatia. The aim is, also, to assess the attitudes of Croatian doctors towards endodontic treatment of patients at risk of developing bacterial endocarditis. Material and methods Data were collected by a survey questionnaire. Results 8.4% of the examined practitioners stated that they prescribe antibiotics often, and 91.6% of them stated that they prescribed them never/ very rarely/rarely. Most of them (41%) prescribe antibiotics once or twice a month, 32.5% once or twice in several months and 20.5% once or twice a week. The most commonly used antibiotic was penicillin with clavulanic acid. Also, 26.2% of examined practitioners prescribed antibiotics for gangrene pulp, 51.2% of them for localized acute apical periodontitis without swelling, 85% of them for cellulitis, 75% of them for fever and enlarged lymph nodes, 16.9% of them for tooth with fistula and 94.1% of them for prophylaxis of infectious endocarditis. According to the results of study, 54.4% of dental practitioners did not prescribe antibiotics without intervention on susceptible tooth; 76% of participants often/almost always/ always accepted endodontic treatment of patients requiring antibiotic prophylaxis to prevent infectious endocarditis, and 96.7% of participants indicated they were familiar with recent instructions for antibiotic prophylaxis. Conclusion These findings point to inappropriate use of antibiotics in the practice of 83 dental practitioners questioned regarding the frequency of administration and indications. The most commonly used antibiotic was penicillin with clavulanic acid. A high percentage of surveyed practitioners stated that they were familiar with recent instructions for antibiotic prophylaxis. They also stated that they performed endodontic procedures on patients who were at risk of bacterial endocarditis. There is a noticeable need for targeted continuing education of dental practitioners in the Republic of Croatia.

Prevalence of infective endocarditis from dental procedures

“…It was impossible to determine if the patient had had risk factors indicating the need for antibiotic prophylaxis, from the information recorded in the clinical chart. While studies show that not all oral infections require antibiotic treatment, an increased chance of developing infective endocarditis depends on the specific clinical characteristics of the infection and the associated risk factors 7,8 . The American Heart Association recommends antibiotic prophylaxis only in cases classified as high risk 9 .…”

Prevalencia de endocarditis infecciosa a partir de procedimientos odontológicos

“…A partir de la información registrada en la historia clínica no fue posible determinar si el paciente presentaba factores de riesgo que indicaran la necesidad de profilaxis antibiótica. Si bien los estudios muestran que no todas las infecciones orales requieren de antibioticoterapia, depende de las características clínicas específicas de la infección y de los factores de riesgo asociados, que aumente la posibilidad de contraer endocarditis infecciosa 7,8 . La Asociación Americana del Corazón recomienda la profilaxis antibiótica sólo en casos clasificados como alto riesgo 9 .…”

Antibiotic Over-Prescription by Dentists in the Treatment of Apical Periodontitis: A Systematic Review and Meta-Analysis

“…The risk of bias was evaluated for each study (Table 3). Twenty-three studies were classified as high risk of bias [13,[16][17][18][19][20]46,49,50,[52][53][54]56,58,59,61,[66][67][68][69]71,74,76], thirteen had a moderate risk of bias [15,48,55,57,60,[63][64][65]70,72,73,75,77], and three studies reported low risk of bias [47,51,62]. The sum of points assigned to the 39 included studies was 170 out of a possible maximum of 312.…”