Pharmacokinetic/Pharmacodynamic Evaluation of Antimicrobial Treatments of Orofacial Odontogenic Infections

Efficacy of preoperative antibiotics in prevention of dental implant failure: a Meta-analysis of randomized controlled trials

BACKGROUND

Dental implants are commonly used for replacement of missing teeth. Despite the published data highlighting the high success rate of dental implants, failures do occur. Some of these failures are believed to be a result of bacterial contamination at the site of implant insertion. Various antibiotic regimens have already been suggested to prevent failure due to infection.

OBJECTIVE

This meta-analysis aims to examine the efficacy of preoperative antibiotics in prevention of dental implant failure secondary to infections.

METHODOLOGY

An exhaustive search was conducted on electronic database including PubMed Medline, Google Scholar, Scopus, and Cochrane on July 15, 2019. All the randomized controlled trials (RCT) comparing preoperative antibiotics with no antibiotics/placebo in dental implants were included in the study. The primary outcome for assessment was implant failure. A random effect meta-analysis was conducted for risk ratios of dichotomous data.

RESULTS

A total 8544 abstracts were screened following which 16 full text articles were reviewed and 5 RCTs were included in the analysis. Meta-analysis results indicated that the preoperative antibiotics resulted in statistically significantly lower number of implant failures.

CONCLUSION

Preoperative antibiotics effectively reduce the implant failure rate. However, it is recommended to conduct large-scale RCT to determine the efficacy of preoperative antibiotics in dental implants.

Pharmacokinetic/pharmacodynamic parameters for treatment optimization of infection due to antibiotic resistant bacteria: a summary for practical purposes in children and adults

In the last years, there has been a tremendous increase in the incidence of bacterial infections due to resistant strains, especially multi-drug resistant Gram-negative bacilli. In Europe, a north to south and a west to east gradient was noticed, with more than one third of the K. pneumonia isolates being resistant to carbapenems in few countries. New antibiotics are lacking and, as a consequence, pharmacokinetic/pharmacodynamic parameters, normalized to pathogen minimal inhibitory concentration, are used with increased frequency to treat infections due to difficult-to-treat pathogens. These parameters are available at least for the adult population, but sparse in many different publications. This review wants to provide a comprehensive and 'easy to read' text for everyday practice, briefly summarizing the presently available knowledge on pharmacokinetic/pharmacodynamic parameters (normalized for minimal inhibitory concentration values) of different class drugs, that can be applied for an effective antibacterial treatment infections due to antibiotic-resistant pathogens.

Prophylactic antibiotic regimen and dental implant failure: a meta-analysis

The aim of this meta-analysis was to investigate whether there are any positive effects of prophylactic antibiotic regimen on implant failure rates and post-operative infection when performing dental implant treatment in healthy individuals. An electronic search without time or language restrictions was undertaken in March 2014. Eligibility criteria included clinical human studies, either randomised or not. The search strategy resulted in 14 publications. The I(2) statistic was used to express the percentage of the total variation across studies due to heterogeneity. The inverse variance method was used with a fixed- or random-effects model, depending on the heterogeneity. The estimates of relative effect were expressed in risk ratio (RR) with 95% confidence interval. Six studies were judged to be at high risk of bias, whereas one study was considered at moderate risk, and six studies were considered at low risk of bias. The test for overall effect showed that the difference between the procedures (use versus non-use of antibiotics) significantly affected the implant failure rates (P = 0.0002), with a RR of 0.55 (95% CI 0.41-0.75). The number needed to treat (NNT) to prevent one patient having an implant failure was 50 (95% CI 33-100). There were no apparent significant effects of prophylactic antibiotics on the occurrence of post-operative infections in healthy patients receiving implants (P = 0.520). A sensitivity analysis did not reveal difference when studies judged as having high risk of bias were not considered. The results have to be interpreted with caution due to the presence of several confounding factors in the included studies.

Evaluation of Antimicrobial Treatments in Children with Acute Otitis Media in Spain: A Pharmacokinetic-Pharmacodynamic (PK/PD) Approach

Pharmacokinetic/pharmacodynamic (PK/PD) principles are priceless tools for evaluating the effectiveness of different antimicrobial treatments for different infections. However, very few studies deal with pediatric dosages and take into account the unbound drug serum levels. Our study is focused on the most frequent antibiotic dosing schedules used in Spain for the treatment of acute otitis media (AOM) in children, where high rates of penicillin and macrolide resistance exist among pneumococcal isolates. Pharmacokinetic parameters of antibiotics in children where obtained from the literature. The minimum inhibitory concentrations (MIC90) of antibiotics for pediatric strains of Streptococcus pneumoniae and Haemophilus influenzae were obtained from the SAUCE 2 project. Only ceftriaxone (50 mg/kg single intramuscular dose) and high doses of co-amoxiclav (27-33 mg/kg q8h) provided adequate efficacy indexes (tss(%)>MIC) for both S. pneumoniae and H. influenzae in AOM in children. These results are consistent with MEF (medium ear fluid) levels obtained from the literature. Our results confirm the utility of serum unbound levels to predict efficacy of antibiotics in children with AOM.

Antibiotic prescription in the treatment of odontogenic infection by health professionals: a factor to consensus

Objective: To observe the attitude of dentists and family doctors in prescribing antibiotics for the treatment of dental infections. Study Design: A poll was performed to determine the differences in the prescription of antibiotics for the treatment of odontogenic infection by dentists and family doctors of the primary care department of the Catalan Health Care Service. Results: A hundred polls were distributed among family doctors, and another 100 ones among primary care dentists assigned to the Catalan Health Care Service of the Generalitat de Catalunya. Of the total of questionnaires distributed, 63 were retuned and answered from dentists and 71 from family doctors. Eighty-one percent of dentists included in the opinion poll considered amoxicillin as the first antibiotic choice for the treatment of odontogenic infections, while 73.2% of family doctors preferred the combination of amoxicillin and clavulanic acid. With regard to antibiotics of choice in patients allergic to penicillin, 67.7% of family doctors preferred macrolides (25.4% opted for clarithromycin, 25.4% for erythromycin and 16.9% for spiramycin). However, clindamycin was the antibiotic most frequently prescribed by dentists (66.7%), followed by erythromycin (28.6%). Conclusions: The results of this study show a large discrepancy in the criteria for the treatment of odontogenic infections on the part of leading professionals involved in the management of this condition. Although the most common prescription involved beta-lactam antibiotics in both groups, several significant differences have been detected with regard to the second antibiotic choice.

Key words:Odontogenic infections, antibiotics, antimicrobials.

Antibiotic prescribing practices by dentists: a review

Antibiotics are prescribed by dentists for treatment as well as prevention of infection. Indications for the use of systemic antibiotics in dentistry are limited, since most dental and periodontal diseases are best managed by operative intervention and oral hygiene measures. However, the literature provides evidence of inadequate prescribing practices by dentists, due to a number of factors ranging from inadequate knowledge to social factors. Here we review studies that investigated the pattern of antibiotic use by dentists worldwide. The main defects in the knowledge of antibiotic prescribing are outlined. The main conclusion is that, unfortunately, the prescribing practices of dentists are inadequate and this is manifested by over-prescribing. Recommendations to improve antibiotic prescribing practices are presented in an attempt to curb the increasing incidence of antibiotic resistance and other side effects of antibiotic abuse.

Penetration of moxifloxacin into rat mandibular bone and soft tissue

OBJECTIVE

Based on its in vitro activity and spectrum of activity, the new 8-methoxyquinolone antibiotic moxifloxacin (MXF) seems suited for the antibiotic therapy of odontogenic infections. Penetration into the relevant tissue is another prerequisite for clinical efficacy. For this reason, the levels of MXF in plasma, soft tissue, and mandibular bone were determined in an animal model with Wistar rats.

MATERIAL AND METHODS

Samples of 49 rats were analyzed. Tissue samples were homogenized and proteins were precipitated. The pharmacokinetic evaluation was conducted based on non-compartmental analysis.

RESULTS

The concentration-time courses of tissues show a more plateau-shaped curve compared to plasma. Calculated AUC (area under the curve) ratios tissue:plasma were M. masseter:plasma = 2.64 and mandibles:plasma = 1.13.

CONCLUSIONS

Administration of antibiotics is considered an important part of therapy during and/or after surgical procedures in the maxillofacial area. Because of the good penetration into bone and muscle tissues demonstrated in Wistar rats, MXF might be an option for clinical application in this indication.

Treatment of delayed-onset infections after impacted lower third molar extraction

PURPOSE

To describe the treatment of delayed-onset infections after lower third molar removal.

PATIENTS AND METHODS

A retrospective study was made of 33 delayed-onset infections after impacted lower third molar extraction diagnosed between 2001 and 2005 in the Oral Surgery and Implantology Department of the School of Dentistry of the University of Barcelona, Spain.

RESULTS

Antibiotic treatment was effective in 22 patients, whereas the remaining 11 needed an additional surgical procedure to resolve this postoperative complication. Patients with prolonged use of antibiotics after the onset of the infection were more likely to require surgical intervention.

CONCLUSIONS

Patients with delayed-onset infections should be treated initially with antibiotics for 7 days. If the infection does not respond favorably within that time, surgical debridement of the extraction site should be done.