Antibiotics in Endodontics: a review (original) (raw)
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In a prospective, double-blind trial, penicillin and clindamycin were compared in treatment of moderate to severe orofacial infections of odontogenic origin, which yielded pus on aspiration. Among 27 patients randomized to receive penicillin, 22 (81%) had a successful outcome, and five (19%) were improved. In the 28 clindamycin-treated patients, 23 (82%) had a successful outcome, and five (18%) were improved. No failures were noted in either group. One patient who was receiving penicillin and two who were receiving clindamycin developed diarrhea. Bacteriologic results showed an average of 6.1 organisms per culture (2.5 aerobes and 3.6 anaerobes). Resistance rates for anaerobic isolates were 8.9% to penicillin and 1.9% to clindamycin. It was concluded that penicillin and clindamycin produce similar good results in treating odontogenic infection when the rate of penicillin resistance among oral anaerobic bacteria is at a relatively low level.
Antimicrobial therapy in patients sensitive to penicillin
Journal of Chronic Diseases, 1967
THE TREATMENT of infections in patients with suspected allergy to penicillin has become a very common and taxing problem in modern medical practice. [l-3] Unfortunately, the magnitude of this problem probably will increase in the future with the increasing use of semi-synthetic derivatives of 6-amino penicillanic acid, which have continued to make the penicillins the therapy of choice against an ever increasing number of pathogens. It is the purpose of this review to examine critically the currently available methods of treatment in patients sensitive to penicillin who have infections for which penicillin or one of its congeners is the drug of choice. Particular emphasis will be placed on assessing the efficacy of alternative antimicrobials which are not crossallergenic with penicillin.
Special Care in Dentistry, 2004
Bacterial endocarditis (BE) is a rare and life-threatening heart infection that can be caused by oral microorganisms. Patients with specific cardiac valvular abnormalities as well as those with a history of recurrent episodes of endocarditis are considered to be at high-risk for developing BE. Antibiotic prophylaxis is recommended for high-risk individuals when bleeding is anticipated during dental procedures. Penicillins are the antibiotics of choice in preventing endocarditis, while other medications are indicated for patients with penicillin allergies. This case presentation outlines antibiotic prophylaxis prior to restorative care for a 44-year-old man who had a prosthetic heart valve, history of recurrent infective endocarditis and penicillin allergy. Intravenously administered vancomycin and gentamicin were prescribed due to the patients' level of risk and bleeding propensity. This article was written to raise the awareness of dental practitioners to the antibiotic prophylaxis options available for the treatment of patients with cardiac and associated systemic conditions.
Dentistry and Antibiotics: A Review
Saudi Journal of Oral and Dental Research
The dentist in the course of everyday practice is frequently called upon to treat a variety of infections which may be caused by viruses, bacteria, and sometimes fungi. The ability to treat these infections successfully has been totally revolutionizes since the discovery and subsequent clinical application of certain chemical substances which are produced by the microorganisms and has the ability to suppress or actually kill other microorganisms, these chemical substances are known as antibiotics. Approximately 10% of all antibiotic prescriptions are linked with dental infections and there"s a widespread abuse of antibiotics in medical and dental field. The inappropriate use of antibiotics leads to increased treatment costs, increased risk of adverse events associated to the antibiotic used and most significantly development and propagation of antimicrobial resistance. The definitive indications to be used of antibiotics in dentistry are limited and specific. The purpose of this review article is to discuss about the legitimate use of antibiotics in dental practice for control of oral infection, antibiotic prophylaxis in case of systemic conditions and the overuse and misuse of antibiotics.
RECOMMENDATIONS OF ANTIBIOTIC TREATMENT IN PAEDIATRIC DENTISTRY
The child has series of differential characteristics and this facilitate faster diffusion of oral infection: the greater proportion of water in the tissues, and their increased bone sponginess. Odontogenic infections usually are mixed, with multiple organisms, anaerobic and aerobic bacteria, with different characteristics. Pediatric patients with aggressive periodontal diseases may require antimicrobial therapy in conjunction with local treatment, if is present signs of systemic involvement (fever, asymmetry and facial swelling, regional lymphadenitis), with the use of mechanical debridement. Amoxicillin is the first choice antibiotic, especially amoxicillin. Alternative antibiotic for use in penicillin-allergic patient is erythromycin. Penicillin has been substituted by other antibiotics - clindamycin, the newer macrolides: clarithromycin and azithromycin, and cephalosporin: cephalexin and cefadroxil. Metronidazole is useful only against anaerobic bacteria, and should be reserved for situations in which only anaerobic bacteria are suspected. Contrary to healthy children, factors related to host risk: systemic illness, malnutrition and immunosuppressed patients must be evaluated when determining the risk for infection, and need antibiotics even if infection is only suspected. In light of the growing problem of drug resistance, the clinician should consider altering or discontinuing antibiotics following determination of either ineffectiveness or cure prior to completion of a full course of therapy. For reaching optimal therapeutic concentration, especially in the bone infections, our reason is: do not duplicate optimal dozes, but do elongated the time of antibiotic treatment, minimum 7 days, and maximum 14 days.
International Journal of Applied Dental Antibiotics, overuse and prevention
Antibiotics, overuse and prevention , 2020
Anti-microbial prophylaxis in oral and maxillofacial surgery procedure rules out the anticipation of the contamination of the careful injury, either because of the qualities of the medical procedure or the general condition of the patient. This hazard increments with the sullying of the careful activity zone, making it important to suggest a prophylactic treatment of the disease in clean-polluted and tainted medical procedures and treatment of the contamination in filthy surgeries. Moreover, a legitimate careful strategy decreases the advancement of the postsurgical contamination. The elective anti-infection therapy ranges from penicillin-derivates with beta lactamase inhibitors (amoxycillin-clavulanate, ampicillin-sulbactam) to second or third era cephalosporins, quinolones or clindamycin. The sign for the utilization of these anti-infection agents relies upon the kind of medical procedure in oral and maxillofacial medical procedure, as per the level of tainting. Thus in oral surgery and surgery of the salivary glands the literature demonstrates that there is not a better prognosis when using prophylactic antibiotherapy instead of not using it in healthy patients. In traumatology this prophylaxis is justified in compound fractures and those communicating with paranasal sinuses. In orthognathic surgery there is disagreement according to the criteria of using antibiotic prophylaxis, but short term treatment is preferred in case of using it. In oncological surgery it has been demonstrated the reduce in incidence of postsurgical infection using prophylactic preoperative antibiotherapy, mostly in those cases in which oral mucosa and cervical area contact.
Zenodo (CERN European Organization for Nuclear Research), 2023
Purpose of the study: Very often patients present for treatment with acute orofacial infections which have either beeninadequately treated or patients have inappropriately taken multiple courses of antibiotics without resolution of their problem. We wanted to study the efficacy of two basic antibiotics which were effective against beta-lactamase producing organisms, that is Amoxycillin-Clavulinic acid and Clindamycin along with local measures for these resistant infections. This study is conducted to compare the efficacy of Clindamycin and Amoxicillin-Clavulinic acid in the treatment of resistant orofacial infections and propose the use of these drugs empirically as first line of therapy To evaluate the efficacy of Clindamycin which is in limited use for severe odontogenic infections and in infections spreading to the bone. To propose the use of antibiotic empirically in resistant infection. Patients and Methods: Patients with one or more fascial space infections presenting with draining sinus, cellulitis or a consolidated swelling ,patients who received beta lactam antibiotics for three days or more and with unresolved infections were included in this study. Of the forty patients included in the study, twenty received Amoxicillin Clavulinic acid and twenty received Clindamycin .The efficacy was compared based on improvement in clinical symptoms with the use of various parameters like duration of pain, swelling, trismus, pus discharge. Results: In our study both Amoxicillin Clavulinic acid and Clindamycin showed similar good results with complete resolution of infection. The mandibular spaces were more frequently involved as compared to maxilla. The number of days pus discharge in the Clindamycin group was less (< 3days) and the improvement of mouth opening was better; both the results being statistically significant. Conclusion: With this study we conclude that both Amoxicillin Clavulinic acid and Clindamycin have proved to be equally effective in resistant orofacial infections. Clindamycin can be used as an empiric drug in resistant orofacial infections and in infections that have potentially spread to bone. For practical implications in patients with acute orofacial infections, infections involving bone and those infections that have not responded to inadequate/inappropriate treatment, Clindamycin can be preferred over Amoxicillinclavulanate. When Amoxicillin-Clavulanate is used, it may be better to combine it with Metronidazole
The use of systemic antibiotics in endodontics: a cross-sectional study
Revista Portuguesa de Estomatologia, Medicina Dentária e Cirurgia Maxilofacial, 2017
Portugal is one of the European countries with the highest antibiotic consumption rate and, consequently, the highest rates of bacterial resistance. Dentistry's contribution to that problem can be substantial because dentists prescribe approximately 10% of all common antibiotics. The purpose of this study was to characterize the prescription of systemic antibiotics for pulpal and periapical pathology in a sample of Portuguese dentists. Methods: A cross-sectional study was conducted in dentists working in the city of Viseu. A total of 135 questionnaires were distributed among all dental clinics and dental offices of Viseu. Results: The overall response rate was 70% (n = 95). The vast majority of dentists prescribed antibiotics for 8 days (78.9%). The most commonly prescribed antibiotic therapy was the association 875-mg amoxicillin with 125-mg clavulanic acid (82.1%). In cases of sensitivity to penicillin, the most prescribed antibiotics were 500-mg clarithromycin (34.7%) and 500-mg azithromycin (33.7%). A considerable percentage of dentists prescribed antibiotics for situations of irreversible pulpitis, pulp necrosis without systemic involvement, fistula and endodontic retreatment. Conclusions: A considerable part of the inquired dentists prescribed antibiotics inappropriately for endodontic inflammatory conditions such as pulpitis. This kind of behavior could contribute to the world problem of antimicrobial resistance. It is important that dentists understand the importance of restricting the use of antibiotics for cases of severe infection, when they are truly needed.
Journal of Endodontics, 2010
The aim of this study was to evaluate susceptibility of predominant endodontic pathogens isolated from teeth with symptomatic apical periodontitis to most commonly prescribed antibiotics. Methods: Among 58 patients with symptomatic apical periodontitis, 47 and 11 cases were caused by primary and secondary root canal infection, respectively. The microbial samples were taken either from the root canals (35 cases) or by aspiration from apical abscesses (23 cases). Culture methods were used to identify the microorganisms present in the samples. Antibiotic susceptibilities of all isolates were evaluated by using the E-test method. Results: Microorganisms were isolated from 49 of the 58 samples studied and included facultative and obligate anaerobes. Streptococci and obligate anaerobes were the predominant microorganisms in cases of primary infection. Enterococcus faecalis dominated in cases of secondary infection. All tested microorganisms were highly sensitive to penicillin G, amoxicillin, and ampicillin. Susceptibilities to clindamycin and erythromycin were 73.8% and 54.7%, respectively. About 40% of the isolates were resistant to tetracycline. More than 50% of all anaerobes were resistant to metronidazole. All E. faecalis isolates were resistant to clindamycin. Conclusions: Based on the study results, penicillin and amoxicillin are suitable antibiotics for treatment of endodontic infection when conventional root canal treatment alone is insufficient. Clindamycin could be advised for penicillin-allergic patients with primary endodontic infections.
Dentists commonly prescribe antibiotics for controlling and treating dental infections. But there is a widespread abuse of antibiotics in medical and dental field. The inappropriate use of antibiotics results in increased treatment costs, increased risk of adverse events related to the antibiotic used and most importantly development and propagation of antimicrobial resistance. The definitive indications for use of antibiotics in dentistry are limited and specific. This review discusses the various principles and rationale behind antibiotic therapy in different fields of dentistry with stress on rational antibiotic use in dentistry.