Antibiotic indication in endodontics by Colombian dentists with different levels of training: a survey

Abstract

Aim: This study investigated how Colombian dentists with different academic levels indicate antibiotics with therapeutic purposes in endodontics. Materials and method: A cross-sectional survey was conducted among 559 dentists in the form of an online questionnaire. Results: Three hundred and twenty questionnaires were answered (57.2%). There were significant differences among respondents. For irreversible pulpitis, 140 dentists (43.7%) said they prescribe antibiotics (57.5% of general practitioners, 20.1% of specialists and 38.9% of those with Master’s and/or PhD degrees), while for symptomatic apical periodontitis, 183 (57.2%) did so (74.1% of general practitioners, 28.4% of specialists and 50.0% of those with Master’s and/or PhD degrees) (p < 0.05). Amoxicillin was the most frequently prescribed antibiotic, and its association with clavulanic acid was the most often cited for acute periradicular abscess with systemic involvement. Conclusions: The greatest misunderstandings in prescribing antibiotics occurred among general practitioners. Considering all clinical conditions that do not require antibiotics, 60% of general practitioners and 34% of specialists, on average, indicated antibiotics. Keywords: antimicrobial stewardship - dental pulp disease - bacteria - dental infection control - antibacterial drug resistance

Systemic Antibiotic Use in Acute Irreversible Pulpitis: Evaluating Clinical Practices and Molecular Insights

“…Di Giuseppe G's 2021 study conducted in Italian prisons found that 85.7% of prisoners diagnosed with symptomatic irreversible pulpitis with or without symptomatic apical periodontitis were prescribed antibiotics [21]. Dias NM's 2022 research conducted in Colombia reported that 43.7% of dentists prescribed antibiotics for irreversible pulpitis with symptomatic apical periodontitis and that 57.2% prescribed them for symptomatic acute apical periodontitis [11]. Finally, Dibaji F's 2021 cross-sectional study involving 400 general dentists in Iran indicated that antibiotic prescription ranged from 48.5% for articles of painful irreversible pulpitis to 97.3% for articles of pulp necrosis with acute apical periodontitis and preoperative symptoms [3].…”

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

“…Finally, 39 studies fulfilled the inclusion criteria and were selected for the systematic review and meta-analysis [13,[15][16][17][18][19][20].…”

“…All studies were cross-sectional surveys and level 4 evidence, according to the Center for Evidence-Based Medicine at Oxford [78]. Regarding the prescribers, seven studies included in the sample only endodontists [18,50,52,55,59,73,74], two studies [20,76] included two separated samples, endodontists and general practitioners, considered as two different studies in the meta-analysis, one study included only dental surgeons [75], and the rest included general practitioners.…”

“…Thirty-five studies, two of them considered doubly [20,76], including 13,738 respondents, provide data about the percentage of antibiotic prescriptions in cases of a chronic apical abscess (asymptomatic apical periodontitis, sinus tract presence and no/mild symptoms). Figure 2B shows the forest plot of the corresponding meta-analysis.…”

“…Literature provides evidence of inadequate prescribing practices by dentists for a number of factors, ranging from inadequate knowledge to social factors [12][13][14]. Moreover, several surveys carried out with dentists from different countries have shown that antibiotics are being prescribed inappropriately in the treatment of periapical pathology [13,[15][16][17][18][19][20]. To improve the prescription of antibiotics in the treatment of endodontic infections, the European Society of Endodontology (ESE) published an official position based on scientific evidence established by a committee of experts [6,9].…”