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.

Keywords: Antibiotics prescription; apical periodontitis; pulpitis.

Figure 1.

Flow chart showing the selection process for the studies included in the review.

Figure 2.

First-choice antibiotics used worldwide for the treatment of endodontic infections in non-penicillin-allergic and penicillin-allergic patients. Two antibiotics are given for each country; the upper one is that given to non-penicillin-allergic patients and the lower one is that given to penicillin-allergic patients. There are no data from China, Indonesia, Brazil, Bangladesh, Russia, Japan and Mexico.