Indications for the use of metronidazole in the treatment of non-periodontal dental infections: a systematic review.
JAC Antimicrob Resist
; 4(4): dlac072, 2022 Aug.
Article
em En
| MEDLINE
| ID: mdl-35959239
ABSTRACT
Background:
Dental practitioners are the largest prescribers of metronidazole. Antibiotics should only be prescribed when systemic involvement is clear and should be limited to monotherapy with ß-lactams in the first instance.Objectives:
To determine whether metronidazole used as monotherapy or in addition to a ß-lactam antibiotic offers any additional benefit over ß-lactam monotherapy in non-periodontal dental infections.Methods:
Searches of Ovid Medline, Ovid Embase, Cochrane library and trials registries, forward and backward citations, for studies published between database inception and 2 August 2021. All randomized clinical trials (RCTs) and non-randomized trials comparing either systemic metronidazole monotherapy or metronidazole combined with a ß-lactam with ß-lactam monotherapy for the treatment of non-periodontal dental infections in adults or children in outpatient settings were included.Results:
Four publications reporting three RCTs comparing metronidazole with a ß-lactam antibiotic were recovered. Studies were conducted in the 1970s-80s and aimed to demonstrate metronidazole was as effective as penicillin for the treatment of acute pericoronitis or acute apical infections with systemic involvement. Meta-analysis of results was not possible due to differences in measurement of infection signs. All studies concluded that metronidazole and penicillin are equally effective for the treatment of non-periodontal dental infections with systemic involvement.Conclusions:
Metronidazole does not provide superior clinical outcomes (alone or in combination with a ß-lactam) when compared with a ß-lactam antibiotic alone for the treatment of non-periodontal dental infections in general dental practice. Guidelines should reinforce the importance of surgical interventions and if appropriate the use of a single agent narrow-spectrum ß-lactam.
Texto completo:
1
Base de dados:
MEDLINE
Tipo de estudo:
Clinical_trials
/
Guideline
/
Systematic_reviews
Idioma:
En
Revista:
JAC Antimicrob Resist
Ano de publicação:
2022
Tipo de documento:
Article
País de afiliação:
Reino Unido