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Ahmad W, Pishevar N, Cochrane LJ, Reynolds A, Kim J, Korostenskij I, Geiser VL, Carson MD, Warner AJ, Chen P, Yao H, Alekseyenko A, Hathaway-Schrader JD, Novince CM. Antibiotic prophylaxis dysregulates dental implant placement surgery-induced osteoimmune wound healing and attenuates the alveolar bone-implant interface in mice. J Clin Periodontol 2023; 50:1670-1684. [PMID: 37667415 PMCID: PMC10840745 DOI: 10.1111/jcpe.13875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 08/12/2023] [Accepted: 08/19/2023] [Indexed: 09/06/2023]
Abstract
AIM Antimicrobial-induced shifts in commensal oral microbiota can dysregulate helper T-cell oral immunity to affect osteoclast-osteoblast actions in alveolar bone. Antibiotic prophylaxis is commonly performed with dental implant placement surgery to prevent post-surgical complications. However, antibiotic prophylaxis effects on osteoimmune processes supporting dental implant osseointegration are unknown. The aim of the study was to discern the impact of antibiotic prophylaxis on dental implant placement surgery-induced osteoimmune wound healing and osseointegration. MATERIALS AND METHODS We performed SHAM or dental implant placement surgery in mice. Groups were administered prophylactic antibiotics (amoxicillin or clindamycin) or vehicle. Gingival bacteriome was assessed via 16S sequencing. Helper T-cell oral immunity was evaluated by flow cytometry. Osteoclasts and osteoblasts were assessed via histomorphometry. Implant osseointegration was evaluated by micro-computed tomography. RESULTS Dental implant placement surgery up-regulated TH 1, TH 2 and TREG cells in cervical lymph nodes (CLNs), which infers helper T-cell oral immunity contributes to dental implant placement osseous wound healing. Prophylactic antibiotics with dental implant placement surgery caused a bacterial dysbiosis, suppressed TH 1, TH 2 and TREG cells in CLNs, reduced osteoclasts and osteoblasts lining peri-implant alveolar bone, and attenuated the alveolar bone-implant interface. CONCLUSIONS Antibiotic prophylaxis dysregulates dental implant placement surgery-induced osteoimmune wound healing and attenuates the alveolar bone-implant interface in mice.
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Affiliation(s)
- Waqar Ahmad
- Department of Oral Health Sciences, College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Stomatology-Division of Periodontics, College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Pediatrics-Division of Endocrinology, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Novin Pishevar
- Department of Oral Health Sciences, College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Stomatology-Division of Periodontics, College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Pediatrics-Division of Endocrinology, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Leonard J. Cochrane
- Department of Oral Health Sciences, College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Stomatology-Division of Periodontics, College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Pediatrics-Division of Endocrinology, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Andrew Reynolds
- Department of Oral Health Sciences, College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Stomatology-Division of Periodontics, College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Pediatrics-Division of Endocrinology, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Joseph Kim
- Department of Oral Health Sciences, College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Stomatology-Division of Periodontics, College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Pediatrics-Division of Endocrinology, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Ivan Korostenskij
- Department of Oral Health Sciences, College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
- Biomedical Informatics Center, Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Vincenza L. Geiser
- Department of Oral Health Sciences, College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Stomatology-Division of Periodontics, College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Pediatrics-Division of Endocrinology, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Matthew D. Carson
- Department of Oral Health Sciences, College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Stomatology-Division of Periodontics, College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Pediatrics-Division of Endocrinology, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Amy J. Warner
- Department of Oral Health Sciences, College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Stomatology-Division of Periodontics, College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Pediatrics-Division of Endocrinology, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Peng Chen
- Department of Oral Health Sciences, College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Bioengineering, College of Engineering, Clemson University, Clemson, South Carolina, USA
| | - Hai Yao
- Department of Oral Health Sciences, College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Bioengineering, College of Engineering, Clemson University, Clemson, South Carolina, USA
| | - Alexander Alekseyenko
- Department of Oral Health Sciences, College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
- Biomedical Informatics Center, Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jessica D. Hathaway-Schrader
- Department of Oral Health Sciences, College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Stomatology-Division of Periodontics, College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Pediatrics-Division of Endocrinology, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Chad M. Novince
- Department of Oral Health Sciences, College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Stomatology-Division of Periodontics, College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Pediatrics-Division of Endocrinology, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
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Solomonov M, Batashvili G, Shuster A, Slutzky H, Moshonov J, Buchkovskii O, Lvovsky A, Azizi H, Levin A, Ben Itzhak J, Shemesh A. Systemic antibiotics in endodontics-International questionnaire study: Choice of types, dosage, loading and duration. AUST ENDOD J 2023; 49 Suppl 1:58-63. [PMID: 36151950 DOI: 10.1111/aej.12686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/07/2022] [Accepted: 09/03/2022] [Indexed: 11/30/2022]
Abstract
The aim of the study was to investigate the systematic antibiotics (SAs) prescribing practices in the endodontic practice worldwide. 7500 general practitioners, postgraduate students and endodontists from Israel and the former Soviet Union (FSU) states were invited to fill in an online questionnaire. The first-choice SA was amoxicillin (80.12%) among the Israeli (p < 0.05) and amoxicillin + clavulanic acid (88.92%) among the FSU respondents (p < 0.05). The first-choice SA for patients with penicillin allergy was clindamycin (78.2%) among Israeli and azithromycin (35.96%) among the FSU respondents (p < 0.05). Most of the respondents from Israel as well as from the FSU reported prescribing SA for 5-7 days. Only 6.24% of the former and 2.59% of the latter reported prescribing SA until the symptoms disappeared (p > 0.05). The usage of SAs is often not in accordance with existing international guidelines and differs among different dentist's populations.
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Affiliation(s)
- Michael Solomonov
- Department of Endodontics, Israel Defense Forces (IDF), Medical Corps, Tel Hashomer, Israel
- "Bina" Program, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Gabriel Batashvili
- Department of Endodontics, Israel Defense Forces (IDF), Medical Corps, Tel Hashomer, Israel
- "Bina" Program, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Amir Shuster
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Department of Oral and Maxillofacial Surgery, Goldschleger School of Dental Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Hagay Slutzky
- Department of Prosthodontics, Goldschleger School of Dental medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Joshua Moshonov
- Department of Endodontics, Hadassah School of Dental Medicine, Hebrew University, Jerusalem, Israel
| | - Oleg Buchkovskii
- Department of Endodontics, Israel Defense Forces (IDF), Medical Corps, Tel Hashomer, Israel
- "Bina" Program, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Alex Lvovsky
- Department of Endodontics, Israel Defense Forces (IDF), Medical Corps, Tel Hashomer, Israel
- "Bina" Program, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hadas Azizi
- Department of Endodontics, Israel Defense Forces (IDF), Medical Corps, Tel Hashomer, Israel
- "Bina" Program, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Avi Levin
- Department of Endodontics, Israel Defense Forces (IDF), Medical Corps, Tel Hashomer, Israel
- "Bina" Program, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Joe Ben Itzhak
- Department of Endodontics, Israel Defense Forces (IDF), Medical Corps, Tel Hashomer, Israel
- "Bina" Program, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Avi Shemesh
- Department of Endodontics, Israel Defense Forces (IDF), Medical Corps, Tel Hashomer, Israel
- "Bina" Program, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Miyazaki R, Sukegawa S, Nakagawa K, Nakai F, Nakai Y, Ishihama T, Miyake M. Risk Factors for Delayed-Onset Infection after Mandibular Wisdom Tooth Extractions. Healthcare (Basel) 2023; 11:871. [PMID: 36981527 PMCID: PMC10048475 DOI: 10.3390/healthcare11060871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 03/19/2023] Open
Abstract
Wisdom tooth extraction is one of the most commonly performed procedures by oral maxillofacial surgeons. Delayed-onset infection (DOI) is a rare complication of wisdom tooth extraction, and it occurs ~1–4 weeks after the extraction. In the present study, risk factors for DOI were investigated by retrospectively analyzing the cases of 1400 mandibular wisdom tooth extractions performed at Kagawa University Hospital from April 2015 to June 2022. Inclusion criteria were patients aged >15 years with a wisdom tooth extraction per our procedure. The exclusion criteria were patients with insufficient medical records, a >30-mm lesion around the wisdom tooth shown via X-ray, colonectomy, radiotherapy treatment of the mandible, the lack of panoramic images, and lesions other than a follicular cyst. The DOI incidence was 1.1% (16 cases), and univariate analyses revealed that the development of DOI was significantly associated with the Winter classification (p = 0.003), position (p = 0.003), hypertension (p = 0.011), and hemostatic agent use (p = 0.004). A multivariate logistic regression analysis demonstrated that position (OR = B for A, 7.75; p = 0.0163), hypertension (OR = 7.60, p = 0.013), and hemostatic agent use (OR = 6.87, p = 0.0022) were significantly associated with DOI development. Hypertension, hemostatic use, and position were found to be key factors for DOI; long-term observation may thus be necessary for patients with these risk factors.
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Cooper L, Stankiewicz N, Sneddon J, Smith A, Seaton RA. Optimum length of treatment with systemic antibiotics in adults with dental infections: a systematic review. Evid Based Dent 2022:10.1038/s41432-022-0801-6. [PMID: 36071280 DOI: 10.1038/s41432-022-0801-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/01/2021] [Indexed: 06/15/2023]
Abstract
Introduction Guidelines on the length of treatment of dental infections with systemic antibiotics vary across different countries. We aimed to determine if short-duration (3-5 days) courses of systemic antibiotics were as effective as longer-duration courses (≥7 days) for the treatment of dental infections in adults in outpatient settings.Methods We searched Ovid Medline, Ovid Embase, Cochrane, trials registries, Google Scholar and forward and backward citations for studies published between database inception and 30 March 2021. All randomised clinical trials (RCT) and non-randomised trials which compared length of treatment with systemic antibiotics for dental infections in adults in outpatient settings published in English were included.Results One small RCT met our defined inclusion criteria. The trial compared three-day versus seven-day courses of amoxicillin in adults with odontogenic infection requiring tooth extraction. There was no significant difference between groups in terms of participant-reported pain or clinical assessment of wound healing.Discussion While a number of observational studies were supportive of shorter-course therapy, only one small RCT concluded that a three-day course of amoxicillin was clinically non-inferior versus seven days for the treatment of odontogenic infection requiring tooth extraction. Limited conclusions on shorter-course therapy can be drawn from this study as all participants commenced amoxicillin two days before tooth extraction which is not common clinical practice. The variability in guidelines for use of antimicrobials in dental infections suggests that guidelines are based on local or national historical practice and indicates the need for further research to determine the optimum length of treatment. RCTs are required to investigate if short-duration courses of antibiotics are effective and to provide evidence to support consistent guidance for dental professionals.
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Affiliation(s)
- Lesley Cooper
- Scottish Antimicrobial Prescribing Group, Healthcare Improvement Scotland, Delta House, 50 West Nile Street, Glasgow, G1 2NP, UK.
| | - Nikolai Stankiewicz
- Bramcote Dental Practice, Woodcock Street, Castle Cary, Somerset, BA7 7BJ, UK
| | - Jacqueline Sneddon
- Scottish Antimicrobial Prescribing Group, Healthcare Improvement Scotland, Delta House, 50 West Nile Street, Glasgow, G1 2NP, UK
| | - Andrew Smith
- College of Medical, Veterinary & Life Sciences, Glasgow Dental Hospital & School, University of Glasgow, 378 Sauchiehall Street, Glasgow, G2 3JZ, UK
| | - R Andrew Seaton
- Scottish Antimicrobial Prescribing Group, Healthcare Improvement Scotland, Delta House, 50 West Nile Street, Glasgow, G1 2NP, UK; Queen Elizabeth University Hospital, Govan Road, Glasgow, NHS Greater Glasgow and Clyde, UK
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Griskaitis M, Furuya-Kanamori L, Allel K, Stabler R, Harris P, Paterson DL, Yakob L. β-Lactam-Resistant Streptococcus pneumoniae Dynamics Following Treatment: A Dose-Response Meta-analysis. Clin Infect Dis 2022; 75:1962-1970. [PMID: 35438765 PMCID: PMC9710638 DOI: 10.1093/cid/ciac293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Patient exposure to antibiotics promotes the emergence of drug-resistant pathogens. The aim of this study was to identify whether the temporal dynamics of resistance emergence at the individual-patient level were predictable for specific pathogen-drug classes. METHODS Following a systematic review, a novel robust error meta-regression method for dose-response meta-analysis was used to estimate the odds ratio (OR) for carrying resistant bacteria during and following treatment compared to baseline. Probability density functions fitted to the resulting dose-response curves were then used to optimize the period during and/or after treatment when resistant pathogens were most likely to be identified. RESULTS Studies of Streptococcus pneumoniae treatment with β-lactam antibiotics demonstrated a peak in resistance prevalence among patients 4 days after completing treatment with a 3.32-fold increase in odds (95% confidence interval [CI], 1.71-6.46). Resistance waned more gradually than it emerged, returning to preexposure levels 1 month after treatment (OR, 0.98 [95% CI, .55-1.75]). Patient isolation during the peak dose-response period would be expected to reduce the risk that a transmitted pathogen is resistant equivalently to a 50% longer isolation window timed from the first day of treatment. CONCLUSIONS Predictable temporal dynamics of resistance levels have implications both for surveillance and control.
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Affiliation(s)
| | | | - Kasim Allel
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Richard Stabler
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Patrick Harris
- UQ Centre for Clinical Research, University of Queensland, Brisbane, Australia
| | - David L Paterson
- UQ Centre for Clinical Research, University of Queensland, Brisbane, Australia
| | - Laith Yakob
- Correspondence: L. Yakob, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK ()
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Böhmer F, Hornung A, Burmeister U, Köchling A, Altiner A, Lang H, Löffler C. Factors, Perceptions and Beliefs Associated with Inappropriate Antibiotic Prescribing in German Primary Dental Care: A Qualitative Study. Antibiotics (Basel) 2021; 10:antibiotics10080987. [PMID: 34439037 PMCID: PMC8389002 DOI: 10.3390/antibiotics10080987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 11/21/2022] Open
Abstract
Dentists account for up to 10% of all prescribed antibiotics in primary care, with up to 80% being inappropriate. Targeted approaches to change prescription behavior are scarce. This study aimed at identifying specific barriers and facilitators for prudent antibiotic use in German dentistry by using qualitative methods. Nine in-depth interviews and two focus group discussions with another nine dentists were conducted and analyzed thematically. Dentists described being conflicted by the discordance of available treatment time and the necessity of thorough therapy. Lacking the opportunity of follow-up led to uncertainty. Dentists felt a lack of medical competency concerning prophylaxis for infectious endocarditis. A lack of empowerment to make therapeutic decisions interfered with guideline-conformity. The communication with fellow physicians is conflictual and improvement was wished for. In consequence, dentists felt pressure by potential medico-legal liability. Patients demanding quick and easy pain relief put extra strain on the interviewed dentists. Our hypotheses concord with preliminary data, mainly from the UK, but highlighted specifically medico-legal concerns and interprofessional communication as even greater barriers as described before. Tailored interventional concepts based on our findings may have the potential to lower antibiotic prescriptions in German primary dental care.
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Affiliation(s)
- Femke Böhmer
- Institute of General Practice, Rostock University Medical Center, 18057 Rostock, Germany; (A.A.); (C.L.)
- Correspondence:
| | - Anne Hornung
- Rostock University Library, Rostock University Medical Center, 18059 Rostock, Germany;
| | - Ulrike Burmeister
- Department of Operative Dentistry and Periodontology, Rostock University Medical Center, 18057 Rostock, Germany; (U.B.); (H.L.)
| | - Anna Köchling
- Clinic for Psychosomatic Medicine and Psychotherapy, Rostock University Medical Center, 18147 Rostock, Germany;
| | - Attila Altiner
- Institute of General Practice, Rostock University Medical Center, 18057 Rostock, Germany; (A.A.); (C.L.)
| | - Hermann Lang
- Department of Operative Dentistry and Periodontology, Rostock University Medical Center, 18057 Rostock, Germany; (U.B.); (H.L.)
| | - Christin Löffler
- Institute of General Practice, Rostock University Medical Center, 18057 Rostock, Germany; (A.A.); (C.L.)
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Angarita-Díaz MDP, Bernal-Cepeda L, Rodriguez-Paz M, Vergara-Mercado M, Herrera-Herrera A, Forero-Escobar D, Mora-Reina J, Ochoa-Acosta EM, Maya-Giraldo M, Caceres-Matta S, Tamayo J, Martinez-Cajas C, Fortich-Mesa N, Bermudez-Reyes P, Vergara-Bobadilla H. Prescribing antibiotics by dentists in Colombia: Toward a conscientious prescription. J Public Health Dent 2020; 81:100-112. [PMID: 33104249 DOI: 10.1111/jphd.12416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 09/15/2020] [Accepted: 10/09/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Inappropriate prescription of antibiotics contributes to antibiotic resistance. Therefore, the objective of this study was to determine the awareness, attitudes, and intention to practice of dentists prescribing antibiotics in Colombia in order to design a virtual learning environment on this subject. METHODS In a descriptive study across seven cities, 700 dentists from different Colombian cities were requested to complete a validated questionnaire containing five sections: general information, awareness on antibiotic effectiveness and antibiotic resistance, attitudes regarding prescription decision, intention to practice concerning clinical cases, and complementary information. The level of awareness, attitudes, and intention to practice was determined and Chi-square test was used to determine the existence of significant differences among cities. RESULTS The majority of dentists showed a medium level regarding the number of correct answers on awareness (62.4 percent) and attitudes (88.7 percent) and a high level on intention to practice (91.7 percent). Common errors within the awareness section included the meaning of the term "antibiotic resistance" (35 percent) and most dentists were not convinced that such resistance could be derived from prescription of antibiotics (51.2 percent). In the attitudes section, only 45 percent declared that they prescribe antibiotics based mainly on symptoms, and the intention to practice section showed a significant percentage of unnecessary prescription (51 percent for pacemaker users) or absence of prescription (53.9 percent for ventricular septal defect) in antibiotic prophylaxis for infectious endocarditis (IE). CONCLUSION The dentists interviewed should be trained and made aware of antibiotic resistance, microbiological and clinical foundations, and current antibiotic prophylaxis guidelines.
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Affiliation(s)
| | | | | | | | | | - Diana Forero-Escobar
- School of Dentistry, Cooperative University of Colombia, Villavicencio, Colombia
| | - Julián Mora-Reina
- School of Dentistry, Cooperative University of Colombia, Villavicencio, Colombia
| | | | | | | | - Julián Tamayo
- School of Dentistry, University Institute of Colombian Colleges, Cali, Colombia
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Milic T, Raidoo P, Gebauer D. Antibiotic prophylaxis in oral and maxillofacial surgery: a systematic review. Br J Oral Maxillofac Surg 2020; 59:633-642. [PMID: 34016464 DOI: 10.1016/j.bjoms.2020.09.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 09/15/2020] [Indexed: 12/12/2022]
Abstract
Surgical site infections are a complication of oral and maxillofacial procedures, with the potential for significant morbidity and mortality. Use of preoperative, perioperative, and postoperative antibiotic prophylaxis to reduce the incidence of surgical site infections must be balanced with considerations of a patients' risk of antibiotic-related adverse events. This review aimed to provide evidence-based recommendations for antibiotic prophylaxis. Searches were conducted using MEDLINE, the Cochrane Library, EMBASE, and PUBMED for maxillofacial procedures including: treatment of dental abscesses, extractions, implants, trauma, temporomandibular joints, orthognathics, malignant and benign tumour removal, and bone grafting, limited to articles published since 2000. A total of 98 out of 280 retrieved papers were included in the final analysis. Systematic reviews were assessed using AMSTAR criteria. Randomised controlled trials were assessed for bias using Cochrane Collaborative tools. The overall quality of evidence was assessed using GRADE. Prophylactic antibiotic use is recommended in surgical extractions of third molars, comminuted mandibular fractures, temporomandibular joint replacements, clean-contaminated tumour removal, and complex implants. Prophylactic antibiotic use is not routinely recommended in fractures of the upper or midface facial thirds. Further research is required to provide recommendations in orthognathic, cleft lip, palate, temporomandibular joint surgery, and maxillofacial surgical procedures in medically-compromised patients.
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Affiliation(s)
- T Milic
- Royal Perth Hospital, Department of Oral and Maxillofacial Surgery, Oral Health and Equity, Department of Human Sciences, Victoria Square, Perth, WA 6000.
| | - P Raidoo
- Royal Perth Hospital, Department of Oral and Maxillofacial Surgery, Oral Health and Equity, Department of Human Sciences, Victoria Square, Perth, WA 6000.
| | - D Gebauer
- Royal Perth Hospital, Department of Oral and Maxillofacial Surgery, Oral Health and Equity, Department of Human Sciences, Victoria Square, Perth, WA 6000.
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Chen Z, Jiang J, Xu J, Yang X, Yang Y, Wang K, Song H, Yang B, Cho P. Antibiotic eye drops prescription patterns by orthokeratology practitioners in China and the development of antibiotic usage guidelines. Cont Lens Anterior Eye 2020; 44:101354. [PMID: 32798156 DOI: 10.1016/j.clae.2020.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/29/2020] [Accepted: 07/31/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To investigate antibiotic eye drops prescribing patterns of contact lens practitioners in Mainland China for orthokeratology (ortho-k) patients and to develop guidelines for their use. METHODS A questionnaire on their antibiotic prescribing habits was administered to eye care practitioners (ECP) involved in ortho-k lens fitting nationwide via an official online account. Multiple logistic regression models were used to assess the relationships between prescribing habits and demographics. RESULTS A total of 555 ECP completed the survey, of whom 50.5 % were optometrists (non-medical degree). About 30 % of the respondents routinely prescribed antibiotic eye drops for prophylactic use before and/or after commencement of ortho-k treatment. Forty one percent of the respondents dispensed antibiotics to patients for emergency use without giving written instructions, 48.5 % used antibiotic eye drops to wet fluorescein strips during ortho-k lens fitting, and 44.9 % considered treating corneal infiltrate(s) with antibiotics to be appropriate. A set of guidelines, including when to use antibiotic eye drops during ortho-k lens treatment and their proper use, stratified by different corneal conditions, was developed. CONCLUSIONS Inappropriate use of antibiotic eye drops appeared to be common among ortho-k practitioners in Mainland China. Taking into account deficiencies and errors identified from the survey, a set of guidelines based on best practice was developed and can serve to provide advice for proper use of antibiotics in ortho-k practice.
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Affiliation(s)
- Zhi Chen
- Department of Ophthalmology and Vision Science, Fudan University Eye and ENT Hospital, Shanghai, China; NHC Key Laboratory of Myopia, Fudan University, Laboratory of Myopia, Chinese Academy of Medical Sciences, China.
| | - Jun Jiang
- The Eye Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jingjing Xu
- The Eye Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiao Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangzhou, China
| | - Yin Yang
- Department of Ophthalmology, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Medical College, University of Electronic Science and Technology, Chengdu, China
| | - Kai Wang
- Department of Ophthalmology, Peking University People's Hospital, College of Optometry, Peking University Health Science Center, Beijing, China
| | - Hongxin Song
- Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, National Engineering Research Center for Ophthalmology, Beijing, China
| | - Bi Yang
- Department of Optometry and Visual Science, West China School of Medicine, Sichuan University, Chengdu, China
| | - Pauline Cho
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region
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Patini R, Mangino G, Martellacci L, Quaranta G, Masucci L, Gallenzi P. The Effect of Different Antibiotic Regimens on Bacterial Resistance: A Systematic Review. Antibiotics (Basel) 2020; 9:E22. [PMID: 31936186 DOI: 10.3390/antibiotics9010022] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 12/24/2019] [Accepted: 01/06/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Infections caused by resistant bacteria are a growing public health problem that is linked to many different causes, among them the antibiotics' incorrect use plays an important role. According to the World Health Organization (WHO) the most dangerous behaviors are the early interruption of antibiotic therapy and the use of molecules without appropriate prescription. The authors conducted a systematic review to assess if antibiotic prescription with different regimens is connected to the onset of bacterial resistance. METHODS The authors performed an electronic and manual literature search on four databases (Web of Science, Scopus, PubMed, and Cochrane Register of Controlled Trials) from their inception to 15 June 2019. The date of the last search was 27 November 2019. Any article comparing cultural or genic analysis of resistance in patients that took antibiotics with at least two different regimens was included. No language restrictions were applied. Risk of bias for randomized controlled trials (RCTs) was assessed using the Cochrane collaboration's tool whereas case-control and cohort studies were evaluated through the Newcastle-Ottawa scale. RESULTS The initial search resulted in a total of 1744 titles. After careful evaluation of all results, only three studies satisfied the outcome of the present review. From the qualitative analysis of data, it emerges that even if antibiotics are administered for a shorter period than the conventional one the species that inhabit the oral cavity can adapt quickly and express genes of antibiotic resistance. Additional evidence from this analysis is that not only does the proportion of resistant bacteria increase in the oral cavity, but also in more distant districts such as the intestine. CONCLUSIONS Despite the great number of studies retrieved by electronic databases only few studies investigated the target of this review. The reason for this evidence is that it is not ethical to investigate and compare different antibiotic regimens, shorter or longer than the appropriate one. This evidence is applicable both to prophylactic administrations and to those aimed at treating infections. Besides this, the WHO affirms that, in the absence of infective complications, the prescription of antibiotic after every type of surgical intervention cannot be admitted and that studies dealing with antibiotic regimens that do not comply with drug's pharmacodynamics characteristics cannot be ethically admitted. PROSPERO acknowledgement of receipt [149149].
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11
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Tent PA, Juncar RI, Onisor F, Bran S, Harangus A, Juncar M. The pathogenic microbial flora and its antibiotic susceptibility pattern in odontogenic infections. Drug Metab Rev 2019; 51:340-355. [PMID: 30999773 DOI: 10.1080/03602532.2019.1602630] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Suppurative head and neck infections of odontogenic origin are the most frequent type of head and neck infections. According to the literature, 7-10% of all antibiotics are currently prescribed for their treatment. Since penicillin was invented, the overall antibiotic sensitivity and resistance pattern of the isolated pathogenic microflora has continuously changed. The response of microorganisms to antibiotics and the development of resistance to their action is a purely evolutive process characterized by genetic mutations, acquisition of genetic material or alteration of gene expression and metabolic adaptations. All this makes challenging and difficult the correct choice of empirical antibiotic treatment for head and neck space infections even today. The aim of this paper was to evaluate the literature and to evidence the most frequent locations of odontogenic head and neck infections, the dominant pathogenic microbial flora, the genetic mutations and metabolic changes necessary for bacteria in order to aquire antibiotic resistance and as well its susceptibility and resistance to common antibiotics. We also aimed to highlight the possible changes in bacterial resistance to antibiotics over time, and to assess whether or not there is a need for fundamental changes in the empirical antibiotic treatment of these infections and show which these would be.
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Affiliation(s)
- Paul Andrei Tent
- Dental Medicine, Universitatea din Oradea Facultatea de Medicina si Farmacie , Oradea , Romania
| | - Raluca Iulia Juncar
- Dental Medicine, Universitatea din Oradea Facultatea de Medicina si Farmacie , Oradea , Romania
| | - Florin Onisor
- Department of Oral and Maxilo-Facial surgery and Radiology, Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca , Romania
| | - Simion Bran
- Department of Oral and Maxilo-Facial surgery and Radiology, Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca , Romania
| | - Antonia Harangus
- Spitalul Clinic de Pneumoftiziologie Leon Daniello Cluj-Napoca , Cluj-Napoca , Romania
| | - Mihai Juncar
- Dental Medicine, Universitatea din Oradea Facultatea de Medicina si Farmacie , Oradea , Romania
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Dar-Odeh N, Fadel HT, Abu-Hammad S, Abdeljawad R, Abu-Hammad OA. Antibiotic Prescribing for Oro-Facial Infections in the Paediatric Outpatient: A Review. Antibiotics (Basel) 2018; 7:antibiotics7020038. [PMID: 29693642 PMCID: PMC6022866 DOI: 10.3390/antibiotics7020038] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 04/18/2018] [Accepted: 04/24/2018] [Indexed: 12/14/2022] Open
Abstract
There are many reports on the complications associated with antibiotics abuse during the treatment of paediatric patients, particularly those related to antimicrobial resistance. The dental profession is no exception; there is growing evidence that dental practitioners are misusing antibiotics in the treatment of their paediatric patients. This review is directed to dental practitioners who provide oral healthcare to children. It is also directed to medical practitioners, particularly those working in emergency departments and encountering children with acute orofacial infections. A systematic search of literature was conducted to explore the clinical indications and recommended antibiotic regimens for orofacial infections in paediatric outpatients. The main indications included cellulitis, aggressive periodontitis, necrotizing ulcerative gingivitis, and pericoronitis. Amoxicillin was found to be the most commonly recommended antibiotic for short durations of 3–5 days, with metronidazole or azithromycin being the alternative antibiotics in penicillin-sensitive patients.
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Affiliation(s)
- Najla Dar-Odeh
- Dental College & Hospital, Taibah University, Al Madinah Al Munawwarah 42353, Saudi Arabia.
- Faculty of Dentistry, University of Jordan, Amman 11942, Jordan.
| | - Hani T Fadel
- Dental College & Hospital, Taibah University, Al Madinah Al Munawwarah 42353, Saudi Arabia.
| | | | - Rua'a Abdeljawad
- Department of Pediatrics, Ibn Alhaitham Hospital, Amman 11942, Jordan.
| | - Osama A Abu-Hammad
- Dental College & Hospital, Taibah University, Al Madinah Al Munawwarah 42353, Saudi Arabia.
- Faculty of Dentistry, University of Jordan, Amman 11942, Jordan.
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13
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Naimi-Akbar A, Hultin M, Klinge A, Klinge B, Tranæus S, Lund B. Antibiotic prophylaxis in orthognathic surgery: A complex systematic review. PLoS One 2018; 13:e0191161. [PMID: 29385159 PMCID: PMC5791956 DOI: 10.1371/journal.pone.0191161] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 12/31/2017] [Indexed: 01/02/2023] Open
Abstract
Objective In orthognathic surgery, antibiotics are prescribed to reduce the risk of postoperative infection. However, there is lack of consensus over the appropriate drug, the dose and duration of administration. The aim of this complex systematic review was to assess the effect of antibiotics on postoperative infections in orthognathic surgery. Methods Both systematic reviews and primary studies were assessed. Medline (OVID), The Cochrane Library (Wiley) and EMBASE (embase.com), PubMed (non-indexed articles) and Health Technology Assessment (HTA) publications were searched. The primary studies were assessed using GRADE and the systematic reviews by AMSTAR. Results Screening of abstracts yielded 6 systematic reviews and 36 primary studies warranting full text scrutiny. In total,14 primary studies were assessed for risk of bias. Assessment of the included systematic reviews identified two studies with a moderate risk of bias, due to inclusion in the meta-analyses of primary studies with a high risk of bias. Quality assessment of the primary studies disclosed one with a moderate risk of bias and one with a low risk. The former compared a single dose of antibiotic with 24 hour prophylaxis using the same antibiotic; the latter compared oral and intravenous administration of antibiotics. Given the limited number of acceptable studies, no statistical analysis was undertaken, as it was unlikely to contribute any relevant information. Conclusion With respect to antibiotic prophylaxis in orthognathic surgery, most of the studies to date have been poorly conducted and reported. Thus scientific uncertainty remains as to the preferred antibiotic and the optimal duration of administration.
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Affiliation(s)
- Aron Naimi-Akbar
- Department of Oral and Maxillofacial Surgery, Karolinska University Hospital, Huddinge, Sweden
- Department of Dental Medicine, Division of Cariology, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Margareta Hultin
- Department of Dental Medicine, Division of Periodontology, Karolinska Institutet, Stockholm, Sweden
| | - Anna Klinge
- Department of Oral and Maxillofacial Surgery and Oral Medicine, Malmo University, Malmo, Sweden
| | - Björn Klinge
- Department of Dental Medicine, Division of Periodontology, Karolinska Institutet, Stockholm, Sweden
- Department of Periodontology, Malmo University, Malmo, Sweden
- Health Technology Assessment-Odontology (HTA-O), Malmö University, Malmö, Sweden
| | - Sofia Tranæus
- Department of Dental Medicine, Division of Cariology, Karolinska Institutet, Stockholm, Sweden
- Health Technology Assessment-Odontology (HTA-O), Malmö University, Malmö, Sweden
| | - Bodil Lund
- Department of Oral and Maxillofacial Surgery, Karolinska University Hospital, Huddinge, Sweden
- Department of Dental Medicine, Division of Oral Maxillofacial Diagnostics and Surgery, Section of Oral Maxillofacial Surgery, Karolinska Institutet, Stockholm, Sweden
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14
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Abstract
This article focuses on the diagnosis and management of odontogenic infections. Current antibiotic regimens are reviewed and discussed including use of alternative antibiotics with patients known to have a penicillin allergy. Emphasis is made on proper examination of the patient with use of diagnostic aids to provide the correct treatment of choice.
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Affiliation(s)
- Curtis J Holmes
- Department of Dentistry and Oral and Maxillofacial Surgery, The Brooklyn Hospital Center, Brooklyn, NY, USA.
| | - Robert Pellecchia
- Department of Dentistry and Oral and Maxillofacial Surgery, Geisinger Medical Center, Danville, PA, USA
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15
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Martins JR, Chagas OL Jr, Velasques BD, Bobrowski ÂN, Correa MB, Torriani MA. The Use of Antibiotics in Odontogenic Infections: What Is the Best Choice? A Systematic Review. J Oral Maxillofac Surg 2017; 75:2606.e1-2606.e11. [PMID: 28893540 DOI: 10.1016/j.joms.2017.08.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 08/08/2017] [Accepted: 08/09/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE Odontogenic infections are a common problem in dentistry, and their treatment often requires the use of antibiotics besides the removal of the source of infection, which frequently makes it more difficult for clinicians to make a decision regarding the choice of antibiotic. This study aimed to answer the following questions through the Patient, Intervention, Comparison, Outcome (PICO) format: When should antibiotics be used in dental infections (DIs)? Which are the most effective drugs? How long should antibiotics be administered? MATERIALS AND METHODS This was a systematic review using the PubMed, Scopus, and Cochrane databases without restriction as to the period researched. The variables analyzed in each article were the number of odontogenic infections in each study, type of study, surgical intervention performed, antibiotics administered, statistical differences between groups studied, and patients' evolution after treatment. RESULTS The search included 1,109 articles. After the full reading of 46 articles, 16 were included in the final review and 30 were excluded. A sample of 2,197 DI cases was obtained, in which 15 different antibiotics were used, with a 98.2% overall cure rate. CONCLUSIONS The studies showed that antibiotics were prescribed only in situations of regional and/or systemic body manifestations. In the case of DIs, once drainage has been performed and/or the cause of infection has been removed, all antibiotics tested are equally effective with respect to clinical cure, and the choice of antibiotics is not as successful as the local intervention treatment procedure. When the real need for antibiotic therapy is detected, antibiotics should be used for the shortest time possible until the patient's clinical cure is achieved.
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16
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17
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Khalil D, Hultin M, Rashid M, Lund B. Oral microflora and selection of resistance after a single dose of amoxicillin. Clin Microbiol Infect 2016; 22:949.e1-949.e4. [DOI: 10.1016/j.cmi.2016.08.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 08/12/2016] [Accepted: 08/18/2016] [Indexed: 10/21/2022]
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18
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Malhotra-Kumar S, Van Heirstraeten L, Coenen S, Lammens C, Adriaenssens N, Kowalczyk A, Godycki-Cwirko M, Bielicka Z, Hupkova H, Lannering C, Mölstad S, Fernandez-Vandellos P, Torres A, Parizel M, Ieven M, Butler CC, Verheij T, Little P, Goossens H. Impact of amoxicillin therapy on resistance selection in patients with community-acquired lower respiratory tract infections: a randomized, placebo-controlled study. J Antimicrob Chemother 2016; 71:3258-3267. [PMID: 27353466 DOI: 10.1093/jac/dkw234] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 05/09/2016] [Accepted: 05/16/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To determine the effect of amoxicillin treatment on resistance selection in patients with community-acquired lower respiratory tract infections in a randomized, placebo-controlled trial. METHODS Patients were prescribed amoxicillin 1 g, three times daily (n = 52) or placebo (n = 50) for 7 days. Oropharyngeal swabs obtained before, within 48 h post-treatment and at 28-35 days were assessed for proportions of amoxicillin-resistant (ARS; amoxicillin MIC ≥2 mg/L) and -non-susceptible (ANS; MIC ≥0.5 mg/L) streptococci. Alterations in amoxicillin MICs and in penicillin-binding-proteins were also investigated. ITT and PP analyses were conducted. RESULTS ARS and ANS proportions increased 11- and 2.5-fold, respectively, within 48 h post-amoxicillin treatment compared with placebo [ARS mean increase (MI) 9.46, 95% CI 5.57-13.35; ANS MI 39.87, 95% CI 30.96-48.78; P < 0.0001 for both]. However, these differences were no longer significant at days 28-35 (ARS MI -3.06, 95% CI -7.34 to 1.21; ANS MI 4.91, 95% CI -4.79 to 14.62; P > 0.1588). ARS/ANS were grouped by pbp mutations. Group 1 strains exhibited significantly lower amoxicillin resistance (mean MIC 2.8 mg/L, 95% CI 2.6-3.1) than group 2 (mean MIC 9.3 mg/L, 95% CI 8.1-10.5; P < 0.0001). Group 2 strains predominated immediately post-treatment (61.07%) and although decreased by days 28-35 (30.71%), proportions remained higher than baseline (18.70%; P = 0.0004). CONCLUSIONS By utilizing oropharyngeal streptococci as model organisms this study provides the first prospective, experimental evidence that resistance selection in patients receiving amoxicillin is modest and short-lived, probably due to 'fitness costs' engendered by high-level resistance-conferring mutations. This evidence further supports European guidelines that recommend amoxicillin when an antibiotic is indicated for community-acquired lower respiratory tract infections.
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Affiliation(s)
- Surbhi Malhotra-Kumar
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Liesbet Van Heirstraeten
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Samuel Coenen
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium.,Centre for General Practice, Department of Primary and Interdisciplinary care (ELIZA), University of Antwerp, Antwerp, Belgium
| | - Christine Lammens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Niels Adriaenssens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium.,Centre for General Practice, Department of Primary and Interdisciplinary care (ELIZA), University of Antwerp, Antwerp, Belgium
| | - Anna Kowalczyk
- Department of Family and Community Medicine, Medical University of Lodz, Lodz, Poland
| | - Maciek Godycki-Cwirko
- Department of Family and Community Medicine, Medical University of Lodz, Lodz, Poland
| | - Zuzana Bielicka
- Clinical Research Associates and Consultants, Bratislava, Slovakia
| | - Helena Hupkova
- Institute of Microbiology, Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovakia
| | | | - Sigvard Mölstad
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | | | | | - Maxim Parizel
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Margareta Ieven
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Chris C Butler
- Cardiff University, Cardiff, UK.,Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK
| | - Theo Verheij
- University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
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19
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Lund B, Hultin M, Tranaeus S, Naimi-Akbar A, Klinge B. Complex systematic review - Perioperative antibiotics in conjunction with dental implant placement. Clin Oral Implants Res 2015; 26 Suppl 11:1-14. [PMID: 26080862 DOI: 10.1111/clr.12637] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2015] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The aim of this study was to revisit the available scientific literature regarding perioperative antibiotics in conjunction with implant placement by combining the recommended methods for systematic reviews and complex systematic reviews. MATERIAL AND METHODS A search of Medline (OVID), The Cochrane Library (Wiley), EMBASE, PubMed and Health technology assessment (HTA) organizations was performed, in addition to a complementary hand-search. Selected systematic reviews and primary studies were assessed using GRADE and AMSTAR, respectively. A meta-analysis was performed. RESULTS The literature search identified 846 papers of which 10 primary studies and seven systematic reviews were included. Quality assessment of the systematic reviews revealed two studies of moderate risk of bias and five with high risk of bias. The two systematic reviews of moderate risk of bias stated divergent numbers needed to treat (NNT) to prevent one patient from implant failure. Four of the primary studies comparing antibiotic prophylaxis with placebo were estimated to be of low, or moderate, risk of bias and subjected to meta-analysis. The NNT was 50 (pooled RR 0.39, 95% CI 0.18, 0.84; P = 0.02). None of these four studies individually show a statistical significant benefit of antibiotic prophylaxis. Furthermore, narrative analysis of the studies eligible for meta-analysis reveals clinical heterogeneity regarding intervention and smoking. CONCLUSION Antibiotic prophylaxis in conjunction with implant placement reduced the risk for implant loss by 2%. However, the sub-analysis of the primary studies suggests that there is no benefit of antibiotic prophylaxis in uncomplicated implant surgery in healthy patient.
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Affiliation(s)
- Bodil Lund
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,Department of Oral and Maxillofacial Surgery, Karolinska University Hospital, Huddinge, Sweden
| | - Margareta Hultin
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Sofia Tranaeus
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,Swedish Council on Health Technology Assessment, Stockholm, Sweden.,Department of Periodontology, Faculty of Odontology, Malmo University, Malmo, Sweden
| | - Aron Naimi-Akbar
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,Department of Oral and Maxillofacial Surgery, Karolinska University Hospital, Huddinge, Sweden
| | - Björn Klinge
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,Department of Periodontology, Faculty of Odontology, Malmo University, Malmo, Sweden
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Larsson Wexell C, Ryberg H, Sjöberg Andersson WA, Blomqvist S, Colin P, Van Bocxlaer J, Dahlén G. Antimicrobial Effect of a Single Dose of Amoxicillin on the Oral Microbiota. Clin Implant Dent Relat Res 2015; 18:699-706. [PMID: 26047213 DOI: 10.1111/cid.12357] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Amoxicillin is commonly used in oral surgery for antimicrobial prophylaxis against surgical-site infection and bacteremia because of its effect on oral streptococci. The aim of this study was to determine whether amoxicillin reaches the break-point concentrations in saliva and has any effect on the salivary microbiota, colonizing bacteria on mucosal membranes and on the gingival crevice after a single dose of amoxicillin. MATERIAL AND METHODS Twenty subjects received 2 g of amoxicillin, per os. The facultative and strictly anaerobic microflora, as well as the streptococcal microflora specifically, were followed from baseline and after 1, 4, and 24 hours. Samples were taken for microbial analysis from saliva, the dorsum of the tongue, and the gingival crevice, and were inoculated and cultured. Plasma samples and saliva samples were analyzed for amoxicillin concentrations (free and protein bound) using liquid chromatography and mass-spectrometry. RESULTS Amoxicillin was detected in concentrations over the break-point (>2 μg/mL) of amoxicillin in plasma after 1 and 4 hours but not after 24 hours. The dose had a significant effect on the streptococci in the gingival crevice. CONCLUSION A single dose given as prophylaxis to prevent a surgical-site infection results in a significant reducing effect on the oral streptococcal microflora in the gingival crevice and may have an impact on bacteria spreading into tissues and the bacteremia of streptococci.
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Affiliation(s)
- Cecilia Larsson Wexell
- Department of Oral and Maxillofacial Surgery, Södra Älvsborg Hospital, Borås, Sweden.,Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Henrik Ryberg
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Chemistry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Wivi-Anne Sjöberg Andersson
- Wivi-Anne Sjöberg-Andersson, Clinic of Oral Medicine and Special Care Dentistry, Östra Sjukhuset, Gothenburg, Sweden
| | - Susanne Blomqvist
- Department of Oral Microbiology and Immunology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Pieter Colin
- Laboratory of Medical Biochemistry and Clinical Analysis, Faculty of Pharmaceutical Sciences, Ghent University, Belgium.,Department of Anesthesiology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Jan Van Bocxlaer
- Laboratory of Medical Biochemistry and Clinical Analysis, Faculty of Pharmaceutical Sciences, Ghent University, Belgium
| | - Gunnar Dahlén
- Department of Oral Microbiology and Immunology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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21
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Löffler C, Böhmer F, Hornung A, Lang H, Burmeister U, Podbielski A, Wollny A, Kundt G, Altiner A. Dental care resistance prevention and antibiotic prescribing modification-the cluster-randomised controlled DREAM trial. Implement Sci 2014; 9:27. [PMID: 24559212 PMCID: PMC3936853 DOI: 10.1186/1748-5908-9-27] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 02/18/2014] [Indexed: 01/26/2023] Open
Abstract
Background Bacterial resistance development is one of the most urgent problems in healthcare worldwide. In Europe, dentistry accounts for a comparatively high amount of antibiotic prescriptions. In light of increasing levels of bacterial resistance, this development is alarming. So far, very few interventional studies have been performed, and further research is urgently needed. By means of a complex educational intervention, the DREAM trial aims at optimising antibiotic prescribing behaviour of general dentists in Germany. Method This is a cluster-randomised controlled trial, where each cluster consists of one dental practice and all of its patients in a defined period. Participants are general dentists practicing in the German region of Mecklenburg-Western Pomerania. Randomisation takes place after baseline data collection (6 months) and will be stratified by the antibiotic prescribing rates of the participating dental practices. Dentists randomised into the intervention group will participate in a complex small group educational seminar that aims at: increasing knowledge on bacterial resistance, pharmacology, and prophylaxis of infectious endocarditis; increasing awareness of dentist-patient communication using video-taped vignettes of dentist-patient communication on antibiotic treatment; improving collaboration between general dentists, general practitioners, and practice-based cardiologists on the necessity of antibiotic prophylaxis; enhancing awareness of the dentists’ own prescribing habits by providing antibiotic prescribing feedback; and increasing patient knowledge on antibiotic treatment by providing patient-centred information material on antibiotic prophylaxis of endocarditis. The dentists randomised into the control group will not receive any educational programme and provide care as usual. Primary outcome is the overall antibiotic prescribing rate measured at T1 (period of six months after intervention). In a subgroup of adult patients affected by odontogenic infections, microbiological analyses for antibiotic resistance of oral streptococci are performed. Discussion Major aim of the study is to improve the process of decision making with regard to antibiotic prescribing. The approach is simple to implement and might be used rapidly in graduate and post-graduate medical education. We expect the results of this trial to have a major impact on antibiotic prescription strategies and practices in Germany. Trial registration Current Controlled Trials ISRCTN09576376
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Affiliation(s)
- Christin Löffler
- Institute of General Practice, Rostock University Medical Center, Postfach 100888, 18055 Rostock, Germany.
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22
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Nemoto H, Nomura R, Ooshima T, Nakano K. Distribution of amoxicillin-resistant oral streptococci in dental plaque specimens obtained from Japanese children and adolescents at risk for infective endocarditis. J Cardiol 2013; 62:296-300. [PMID: 23810065 DOI: 10.1016/j.jjcc.2013.05.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 05/06/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND Infective endocarditis (IE) is known to be a life-threatening disease and prevention of its onset is important. Oral amoxicillin (AMPC) is generally prescribed to patients at risk for IE prior to undergoing risky procedures, such as invasive dental treatments. We previously found that approximately 5% of systemically healthy Japanese subjects harbor strains highly resistant to AMPC. In the present study, the prevalence of strains in patients at risk for IE was investigated. METHODS AND RESULTS Thirty-four Japanese children and adolescents designated at risk for IE by their cardiovascular surgeons participated. Dental plaque specimens were obtained at recall examinations for dental checkups and placed in sterile phosphate-buffered saline, then diluted and streaked onto selective media for oral streptococci and also media containing AMPC. Nine strains with a minimum inhibitory concentration of AMPC of 16μg/mL or more were isolated from 7 of the subjects (20.6%), each of which was also resistant to other antibiotics analyzed except for new quinolone drugs. The 16S rRNA sequence of each strain demonstrated that all were oral streptococcal species. In addition, dental plaque specimens collected from 5 subjects after an additional interval of 3-4 months showed that 2 harbored the same clones at different time points. CONCLUSIONS These findings suggest a higher prevalence of AMPC-resistant strains in children and adolescents at risk for IE as compared to systemically healthy subjects. Thus, alternative antibiotics should be considered for such subjects when performing prophylaxis procedures.
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Jundt JS, Gutta R. Characteristics and cost impact of severe odontogenic infections. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114:558-66. [PMID: 22819453 DOI: 10.1016/j.oooo.2011.10.044] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Revised: 10/16/2011] [Accepted: 10/23/2011] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The objective of this study was to retrospectively analyze the clinical presentation, surgical management, and cost implications of inpatients treated for odontogenic infections at a public tertiary care hospital. STUDY DESIGN Specific analysis from 3 years of chart review included length of stay, cost of hospitalization, site of infection, number of infected spaces, microbiology profile, antibiotics administered, intensive care unit (ICU) stay, number of days intubated, comorbidities, number of operating room visits, imaging studies, and whether the patients received preadmission treatment. RESULTS Multiple fascial spaces were involved in most of the infections. The average length of stay was 4.57 days and average time in the ICU was 3.1 days. Ninety percent of the patients had a coexisting medical comorbidity. The overall hospital costs totaled $749,382 averaging $17,842 per person. CONCLUSIONS This study reveals a staggering cost burden on a public health care facility as a result of odontogenic infections.
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Affiliation(s)
- Jonathon S Jundt
- Department of Oral & Maxillofacial Surgery, University of Texas, Dental Branch at Houston, Houston, Texas, USA
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Abstract
In the everyday practice of oral and maxillofacial surgeons, empiric antibiotics are prescribed in the face of uncertainty. Is there a highly resistant organism present? Are the old-line antibiotics no longer effective? Should a broad-spectrum antibiotic be used just to cover all the bases in this case? The surprising result of this systematic review is that when combined with appropriate surgery, the usual antibiotics are all effective. Safety and cost become the differentiating factors in this clinical decision.
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