Decision-making on systemic antibiotics in the management of periodontitis: A retrospective comparison of two concepts.

AIM: To retrospectively compare two approaches for the adjunctive use of systemic antibiotics in non-surgical periodontal therapy: one based on the detection of Aggregatibacter actinomycetemcomitans (Aa) and the other on age and severity of periodontitis (Age & PPD). We also assessed the additional benefit of antibiotics in reducing the need for further surgical therapy in each group. MATERIALS AND METHODS: Patients of the Department of Periodontology, Goethe University Frankfurt, Germany, were screened for microbiological testing between 2008 and 2018. Patients were categorized by their microbiological result (Aa+/-) and demographic/clinical data (Age & PPD+/-). Agreement on antibiotic indication was tested. The clinical evaluation focussed on teeth with probing pocket depths (PPDs) ≥ 6 mm. RESULTS: Analysis of 425 patients revealed 30% categorized as Age & PPD+ and 34% as Aa+. Sixty-three percent had consistent antibiotic recommendations (phi coefficient 0.14, p = .004). Patients in the Age & PPD+ group receiving antibiotics showed the most substantial reduction in the number of teeth with PPD ≥ 6 mm after non-surgical periodontal therapy. CONCLUSIONS: Both strategies resulted in a significant clinical improvement compared with those without antibiotic treatment and restricted antibiotic use similarly, but targeted different patient groups. Younger individuals with severe periodontitis benefited most from antibiotics, reducing the need for additional surgeries. The study was registered in an international trial register (German Clinical Trial Register number DRKS00028768, registration date 27 April 2022, https://drks.de/search/en/trial/DRKS00028768).

Is topical antibiotic use necessary to prevent surgical site infection following oculoplastic surgery?

PURPOSE: To assess whether oculoplastic surgeries can be performed without any topical and systemic antibiotics, in a "100% antibiotic free" fashion. METHOD: We conducted a multicenter retrospective study between November 2017 and December 2022. Patients who underwent an oculoplastic procedure were screened. Patients who received preoperative or postoperative systemic antibiotics were excluded. Intraoperative IV antibiotics were allowed. Patients were divided into two groups: those who were treated with local antibiotics ointments (LATB group) and those who were treated without local antibiotics ointments (LATB free group) postoperatively. The primary outcome was the incidence of surgical site infections (SSI). The relationship between the use of local antibiotics and the occurrence of SSI was assessed using Fisher's exact test. The alpha risk was set to 5% and two-tailed tests were used. RESULTS: Among the 947 procedures included, 617 were included in the LATB group and 330 in the LATB free group. 853 and 80 procedures were classified Altemeier class 1 (clean) and class 2 (clean-contaminated) surgeries, respectively. Overall, 310 (32.73%) procedures were performed without any systemic nor topical antibiotics (100% antibiotic free fashion). SSI occured in four (4/617; 0.65%) and five (5/330; 1.52%) procedures in the LATB and LATB free group respectively, without any statistical difference between the groups (p = 0.290). A subgroup analysis was carried out by excluding the procedures performed under prophylactic intraoperative intravenous antibiotics and did not reveal any statistical difference between the two groups (p = 0.144). All SSI patients were treated with systemic antibiotics with favorable outcomes. Postoperative wound dehiscence was the only risk factor associated with postoperative SSI (p = 0.002). CONCLUSION: This study suggests that performing a "100% antibiotic free" oculoplastic surgery without systemic and topical antibiotics is reasonable in Altemeier class 1 and class 2 procedures.

Systemic Antibiotic Use in Acute Irreversible Pulpitis: Evaluating Clinical Practices and Molecular Insights.

This scoping review systematically evaluates the use of systemic antibiotics in treating acute irreversible pulpitis, integrating clinical practice patterns with recent molecular insights. We analyzed clinical evidence on antibiotic prescription trends among dental professionals and examined molecular research advancements in relation to pulpitis. This review is intended to bridge the gap between clinical practice and molecular research, guiding more evidence-based approaches to treating acute irreversible pulpitis. Electronic databases were searched for relevant articles published in English based on the objective of the review. A second search using all identified keywords and index terms was undertaken across all the included databases. In addition, a reference list of identified articles was searched. Studies including original research, systematic reviews, meta-analyses, clinical trials, and observational and retrospective studies, all written in English and published from 2010 onwards, were included, and an analysis of the text words contained in the titles and abstracts of the retrieved papers and of the index terms used to describe the articles was performed. A total of N = 53 articles were selected. Altogether, N = 43 (76.79%) articles were cross-sectional studies, N = 4 (11.11%) were systematic reviews, and N = 3 (5.36%) were guidelines. The most frequent level of evidence was level VI (N = 43 (76.79%). The mean percentage of dentists who prescribed antibiotics to treat acute irreversible pulpitis was 23.89 ± 23.74% (range: 0.05-75.7). Similarly, for specialists, it was 22.41 ± 15.64 (range 2.2-50.4), and the percentage for undergraduates was 17.52 ± 20.59 (range 0-62.6). The significant developments in research models for pulpitis research and the characterisation of biomarkers have led to better management strategies. Concurrently, significant advancements in molecular research provide new understandings of pulpitis, suggesting alternative therapeutic approaches. Although there are guidelines available, increased rates of antibiotic prescription are still prevalent around the globe.

The impact of local and systemic penicillin on antimicrobial properties and growth factor release in platelet-rich fibrin: In vitro study.

OBJECTIVE: This study evaluates the impact of local and systemic administration of penicillin on the antimicrobial properties and growth factors of platelet-rich fibrin (PRF) under in vitro conditions. MATERIALS AND METHODS: The study involved 12 volunteers. Four tubes of venous blood were collected before systemic antibiotic administration. Two tubes were centrifuged at 2700 RPM for 12 min to obtain PRF, while 0.2 ml of penicillin was locally added into other two tubes. After systemic administration, blood samples were again collected and subjected to centrifugation. The release of growth factors (IGF-1, PDGF, FGF-2, and TGFß-1) was determined using the Enzyme-Linked Immunosorbent Assay (ELISA), and an antibiotic sensitivity test was performed for S. aureus and E. coli bacteria. RESULTS: Results showed that local antibiotic addition before PRF centrifugation had a significant antimicrobial effect without affecting growth factor releases. There was no statistically significant difference in antimicrobial properties between PRF prepared with systemic antibiotic administration and PRF prepared without antibiotics. MATERIALS AND METHODS: The study suggests that incorporating localized antibiotics into PRF results in strong antimicrobial effects without compromise of growth factor release. However, the combination of PRF with systemic antibiotics did not significantly enhance its antimicrobial properties compared to PRF prepared without antibiotics. CLINICAL RELEVANCE: Local addition of penicillin into PRF provides strong antimicrobial properties which may help reduce dependence on systemic antibiotic regimens, mitigating antibiotic resistance and minimizing associated side effects.

Comparative Study of Systemic vs. Local Antibiotics with Subgingival Instrumentation in Stage III-IV Periodontitis: A Retrospective Analysis.

To improve the clinical and microbiological outcomes of non-surgical mechanical periodontal therapy, the adjunctive use of antimicrobials has been utilized in treating moderate-to-severe periodontitis. In our study, the retrospective design included previously collected health-related patient data, obtained from the printed and digital charts of patients who received systemic or local antibiotic adjuncts to SI (subgingival instrumentation). A total of 34 patients (diagnosed with generalized Stage III/IV periodontitis) met the inclusion and exclusion criteria and were evaluated. The samples were tested for the following bacterial strains: Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans), Porphyromonas gingivalis (P. gingivalis), Prevotella intermedia (P. intermedia), Tanererella forsythia (T. forsythia), and Treponema denticola (T. denticola). The inter-group comparisons of the bacterial species did not show statistically significant differences between groups. The present study aimed to evaluate the clinical effects after SI and the adjunctive use of systemically administered (SA) AMX (amoxicillin) + MET (metronidazole) (administered for 7 days), with locally delivered (LDD) piperacillin + tazobactam in step 2 of periodontal therapy. Results: Overall, all parameters were improved in the groups, with a significant difference in inter-group comparison regarding the full-mouth bleeding score (FMBS) (p < 0.05) in favor of the SA group, and the p-value < 0.05 was considered to be statistically significant. Statistically significant PPD (probing pocket depth) reductions and CAL (clinical attachment level) gains were observed in both groups at the 3-month follow-up. In conclusion, within the limitations, the outcomes of this study suggest that SI, with adjunctive local or systemic antibiotic therapy, provided comparable clinical improvements. Systemic AMX + MET protocols were more efficacious with regard to the reduction in FMBS. Follow-up studies with larger patient numbers are needed to further investigate this effect.

Variation in Systemic Antibiotic Treatment for Diabetic Foot Osteomyelitis in England and Wales: A Multi-Centre Case Review.

Background: Diabetic foot osteomyelitis (DFO) is a major complication and can lead to significant morbidity and mortality. Systemic antibiotic therapy is often initiated first line to achieve quiescence of infection. To perform a multi-centre case review of systemic antibiotic intervention to treat adults with DFO in England and Wales and compare with national guidelines 'Diabetic foot problems: prevention and management'. Methods: Eight centres from England and Wales retrospectively collated data from a minimum of five adults (aged ≥ 18 years) from electronic case records. All patients were treated with systemic antibiotics following a new diagnosis of DFO (1 June 2021-31 December 2021). Results: 40 patients (35 males and 5 females) were included; the mean age was 62.3 years (standard deviation (SD) 13.0). Patients commenced systemic oral 14 (35%) or intravenous 26 (65%) antibiotic therapy following a new diagnosis of DFO. Twenty-seven (67.5%) patients were medically or surgically managed in the 12-week period with clinical quiescence of infection. Twenty-one patients (52.5%) had no recurrence of DFO infection within 12 weeks; seventeen (42.5%) of these patients had clinical quiescence of infection with systemic antibiotics alone without surgical intervention and nine (22.5%) of these cases had no recurrence of DFO. There were no cases of major amputation or death. All centres showed significant in-centre variability in systemic antibiotic management; variability was reported in the clinical and quantity indicators specifically to antibiotic selection, single versus dual therapy, mode of delivery and duration of treatment. Conclusions: This case review identifies there is existing variation when treating adults with systemic antibiotics for DFO. Further national guidance is required to standardise service delivery and care to improve patient outcomes.

Retrospective study in 1020 cases on the rate of surgical site infections after lacrimal surgery without prophylactic systemic antibiotics.

BACKGROUND/AIMS: Data regarding the effectiveness of prophylactic systemic antibiotics (PSA) in lacrimal surgery is scarce. Therefore, we determined the postoperative surgical site infection (SSI) rate in lacrimal surgery without PSA. METHODS: We retrospectively analysed files of patients who underwent external (extDCR) or endoscopic endonasal dacryocystorhinostomy (endoDCR). We excluded patients with incomplete data (n = 68), acute a priori infection with the need for antibiotics (n = 15) and PSA post-operatively for other reasons (n = 28). Indications for surgery were canalicular stenosis (n = 51, 18.6% endoDCR vs n = 131, 19.5% extDCR), nasolacrimal duct obstruction (n = 118, 43.2% endoDCR vs n = 480, 64.3% extDCR) and mucocele/chronic dacryocystitis (n = 52, 19.0% endoDCR vs n = 187, 25.0% extDCR). RESULTS: In this study, 1020 DCR surgeries were performed in 899 patients. Postoperative SSI was diagnosed in eight patients (0.8%); exclusively after extDCR (1.1% of all extDCR). No SSIs were found in endoDCR cases. The prevalence between SSI in extDCR versus endoDCR did not prove significant (n = 8/747 0.8% vs n = 0/273 0%, p = 0.13). All patients diagnosed with SSI were successfully treated with systemic oral antibiotics. CONCLUSION: The prevalence of SSI after DCR is low and was effectively treated with oral antibiotics. In our study, SSI occurred rarely after extDCR and was not observed after endoDCR. We conclude that lacrimal surgery is safe without the routine administration of PSA.

Systemic antibiotics adjuvants to scaling and root planing in type 2 diabetic and periodontitis individuals: Systematic review with network meta-analysis.

Targeting inflammatory pathways is considered a common strategy to control type 2 diabetes (T2D) and periodontitis. This overview was to validate systemic antibiotics as an adjuvant to scaling and root planing (SRP) for the treatments of periodontal patients with T2D. Literature searches were conducted using Web of Science, PubMed, Cochrane, and EMBASE. Randomized trials comparing SRP and systemic antibiotics on glycated hemoglobin (HbA1c) and probing pocket depth (PPD) in adults with T2D and periodontitis were analyzed using network meta-analysis and meta-regression. At 3-month postintervention, meta-analyses of 16 studies revealed that SRP and SRP plus systemic antibiotics (SRPa) had similar significant effects in reducing HbA1c levels of - 0.72% and - 0.96% respectively. While SRP and SRPa also, respectively, reduced PPD of - 0.67 and - 0.89 mm, SRPa showed a better reduction than SRP. At 6-month postintervention, meta-analyses of 7 trials revealed that only SRP was effective in reducing HbA1c levels (-0.29%) but not SRPa. Although both SRP and SRPa still significantly reduced PPD by - 0.56 and - 0.81 mm, respectively, there was no difference between them. The current overview suggested that routine SRP alone is highly recommended for patients with T2D and periodontitis, since systemic antibiotics as an adjuvant provide a rather short-term effect.

Uso de antibióticos sistêmicos adjuntos à raspagem e alisamento radicular no tratamento da periodontite crônica e periodontite agressiva: uma revisão integrativa da literatura / Use of systemic antibiotics as an adjunct to scaling and root planing in the treatment of chronic periodontitis and agressive periodontitis: an integrative review

A periodontite é uma doença inflamatória crônica que atinge os tecidos de suporte dos dentes. O tratamento padrão consiste na redução do biofilme subgengival através da raspagem e alisamento corono-radicular associada às medidas de higiene oral. Entretanto, em indivíduos com periodontite agressiva ou periodontite crônica severa, pode ser necessário associar antibióticos ao tratamento periodontal não-cirúrgico para que ocorra uma melhora significativa dos parâmetros clínicos periodontais, tais como profundidade de sondagem e nível de inserção clínica. O objetivo desta revisão integrativa da literatura foi avaliar as estratégias terapêuticas antimicrobianas indicadas no tratamento das periodontites crônica severa e agressiva. A busca bibliográfica foi realizada nas bases de dados Pubmed e Scopus. Os descritores utilizados foram: “Chronic Periodontitis” AND “Agressive periodontitis” AND “periodontal debridement” OR “Dental Scaling” AND “Root Planing” AND “Anti-bacterial Agents” OR “Anti-infective Agents”.Foram incluídos ensaios clínicos em humanos, randomizados, controlados, duplo ou triplo cegos, em inglês, publicados entre janeiro de 2010 e março de 2015. Os resultados demonstraram que apesar do uso adjunto de antimicrobianos à raspagem e alisamento radicular, principalmente a associação de Amoxicilina com Metronidazol, ser eficiente na melhora das condições periodontais, há uma grande heterogeneidade em relação às doses e o tempo de seguimento dos antibióticos indicados em Periodontia. Também há dúvidas sobre o momento certo de iniciar a terapia medicamentosa. Dessa forma, há a necessidade de elaboração de protocolo (s) clínico (s) para o uso de antibióticos sistêmicos adjuntos ao tratamento periodontal

Periodontitis is a chronic inflammatory disease that affects the supporting tissues of the teeth. The periodontal treatment consists of modifying the subgingival biofilm by scaling and root planing associated with changes in oral habits. These procedures are sufficient in order to reach an adequate control of the disease in most patients. However, in patients with advanced periodontitis or chronic periodontitis, it is necessary to combine antibiotics to non-surgical periodontal treatment to improve clinical periodontal parameters such as probing depth and clinical attachment level. Thus, the objective of the research was to evaluate the anti-infective therapeutic strategies for the treatment of advanced chronic periodontitis and aggressive periodontitis. It is an integrative literature review. The articles were obtained from PubMed and Scopus databases. The keywords used in the search were “Chronic Periodontitis “AND” Aggressive periodontitis “AND” periodontal debridement “OR” Dental Scaling” AND “Root planing” AND” Anti -bacterial Agents” OR” Anti-infective Agents”. Controlled, randomized, double or triple blind clinical trials in humans, published between January 2010 and March 2015, were included. The results show that the adjunctive use of antibiotics to scaling and root planning, mostly the combination of amoxicillin plus metronidazole, was very effective in improving periodontal conditions, however it lacks optimum dose definition, duration of therapy and the best moment of antibiotic administration.In conclusion, a clinical protocol for the use of systemic antibiotics as an adjunct to periodontal treatment should be developed.