Worldwide pattern of antibiotic prescription in endodontic infections

Abstract

Background: Odontogenic infections, and especially endodontic infections, are polymicrobial, involving a combination of Gram-positive and Gram-negative facultative anaerobes and strictly anaerobic bacteria. Therefore, antibiotics can be used as an adjunct to endodontic treatment. However, most chronic and even acute endodontic infections can be successfully managed by disinfection of the root-canal system, which eliminates the source of infection, followed by abscess drainage or tooth extraction, without the need for antibiotics. The literature provides evidence of inadequate prescribing practices by dentists. The aim of this concise review was to analyse the worldwide pattern of antibiotic prescription in endodontic infections. Methods: Comprehensive searches were conducted in MEDLINE/PubMed, Wiley Online Database, Web of Science and Scopus. The databases were searched up to 13 March 2016 for studies in which dentists used systemic antibiotics to treat endodontic lesions and which reported data on the type of antibiotic prescribed and on the diagnosis of the endodontic disease treated. Results: The electronic and hand searches identified 69 titles, of which 25 were included in the final analysis. Amoxicillin was reported as the drug of choice for endodontic infections in most countries, and clindamycin and erythromycin were the choice for patients allergic to penicillin. Dentists worldwide prescribe antibiotics for non-indicated conditions, such as pulpitis. Conclusion: Antibiotics are overprescribed for the management of endodontic infections. It is necessary to improve antibiotic-prescribing habits in the treatment of endodontic infections, as well as to introduce educational initiatives to encourage the coherent and proper use of antibiotics in such conditions.

Dental students’ knowledge regarding the indications for antibiotics in the management of endodontic infections

“…The average duration for the antibiotic therapy proposed by the final year dental students responding the survey was 7.0 AE 2.0 days, 7 days being the more frequent (69%), without significant differences amongst the dental schools (P > 0.05). This results are similar to those obtained in the surveys carried out amongst Spanish endodontists (Rodr ıguez-N uñez et al 2009) and oral surgeons (Segura-Egea et al 2010) and are in accordance with the results obtained in the studies carried out in other countries (Segura-Egea et al 2017). However, 20% of students were confused about the duration of antibiotic treatment, prescribing antibiotics for more than 7 days.…”

“…This situation requires not only amending antibiotic-prescribing habits of dentists in the treatment of endodontic infections, but also assessing whether dental students are being taught correctly about the indications of systemic antibiotics in the treatment of pulpitis and apical periodontitis. Otherwise, it would be necessary to modify the dental curriculum to improve dental student learning about the coherent and proper use of antibiotics in the treatment of endodontic infections and the threat of antibiotic resistance (Segura-Egea et al 2017). New generations of dentist and endodontists must be fully aware of the increasing problem of antibiotic resistance, as they will be the future antibiotic prescribers (WHO 2012).…”

Azithromycin and erythromycin susceptibility and macrolide resistance genes in Prevotella from patients with periodontal disease

“…Both antibiotics are widely used in the dental practice. ERM is frequently used in penicillin‐allergic patients in endodontic treatment (Segura‐Egea et al, ), and several clinical trials have been conducted in recent years to evaluate the effectiveness of AZM as an adjuvant to SRP. These trials have demonstrated the validity of using AZM against the major periodontopathogens, and properties such as its quick uptake by fibroblasts, its long half‐life, its immunomodulatory and anti‐inflammatory effects, its simple dosage regime and limited side effects have raised AZM as an appealing alternative to the treatment with amoxicillin and metronidazole (Doyle et al, ; Herrera, Alonso, León, Roldán, & Sanz, ; Hirsch, Deng, & Laohachal, ; O'Rourke, ).…”

“…Given the increased use of AZM in the clinical practice and the environmental pressure exerted as a result of such increase, there is a need to monitor AZM resistance among periodontal bacteria such as Prevotella spp., which could also help to determine the effectiveness of this antibiotic in the clinical practice (ECDC, EFSA, & EMA, ). Moreover, ERM resistance also has clinical relevance in endodontic infections since it is an antibiotic of choice for patients allergic to β‐lactams (Segura‐Egea et al, ).…”

Think before you prescribe: how dentistry contributes to antibiotic resistance

“…Yet, worldwide, dentists continue to prescribe antibiotics for localized infection without systemic involvement with the highest rates in Croatia (80%) and lowest in the USA (33%). The only study of Australian prescribing habits in endodontics was completed almost 20 years ago, which identified that 39% of dentists prescribed antibiotics for a localized swelling without systemic symptoms . Antibiotics in dentistry are generally required as an adjunct to surgical intervention (debridement or drainage) to prevent the spread of infection, when there is systemic involvement or if the patient is medically compromised and might be at risk of complications.…”