RESUMEN
Current patterns of preventive antibiotic prescribing are encouraging the spread of antimicrobial resistance. Recently, the Spanish Society of Implants (SEI) developed the first clinical practice guidelines published to date, providing clear guidelines on how to prescribe responsible and informed preventive antibiotic therapy (PAT) based on the available scientific evidence on dental implant treatments (DIs). The present document aims to summarise and disseminate the recommendations established by this expert panel. These were based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies were analysed using the Scottish Intercollegiate Guidelines Network (SIGN) checklist templates and ranked according to their level of evidence. They were then assigned a level of recommendation using the Grading of Recommendations, Assessment, Development and Evaluation system (GRADE). Guidelines were established on the type of PAT, antibiotic and dosage of administration in the placement of DIs without anatomical constraints, in bone augmentation with the placement of DIs in one or two stages, placement of immediate DIs, sinus elevations, implant prosthetic phase, as well as recommendations in patients allergic to penicillin. Therefore, the PAT must be adapted to the type of implant procedure to be performed.
RESUMEN
The prescription of preventive antibiotics in dental implant treatments reduces the incidence of early failures. This study has focused mainly on the influence of amoxicillin, which is contraindicated in penicillin-allergic patients. The present systematic review aimed to determine whether penicillin-allergic patients have a higher risk of implant failure compared to non-allergic patients. An electronic search was performed on Medline and Web of Science using the following MeSH terms: (penicillin allergy OR clindamycin OR erythromycin OR azithromycin OR metronidazole) AND (dental implant OR dental implant failure OR dental implant complications). The criteria employed were those described in the PRISMA® Declaration. Only five articles were included that analyzed the failure rates of implants placed in penicillin-allergic patients who were prescribed clindamycin compared to non-allergic patients who were prescribed amoxicillin. With the limitations of this study, it is not possible to state that penicillin allergy per se constitutes a risk factor for early dental implant failure as most of the studies included self-reported allergic patients. Clindamycin has been associated with a significantly elevated risk of failure and an up to six times increased risk of infection. Immediate implants also have a 5.7 to 10 times higher risk of failure.
RESUMEN
A substantial portion of "potentially inappropriate" systemic antibiotics in nursing homes are prescribed with the intention of preventing the development of bacterial infections. In the past, such practices were generally considered acceptable; however, they now are being increasingly scrutinized due to concerns about limited benefits and the potential for adverse effects, including contributing to antimicrobial resistance. As a result of these issues and because of the frequency of these practices, unnecessary prophylactic antibiotic use is an appropriate target for antibiotic stewardship practices. However, a challenge toward this end is the limited number of definitive studies involving nursing home residents, with most existing recommendations being based on expert opinion. This report reviews the common situations when systemic administration of antibiotics is used for prophylactic purposes and provides operational definitions and recommendations for providers. The preventive practices discussed include (1) long-term antibiotic use to prevent recurrent urinary infections, (2) antibiotic treatment of acute bronchitis to prevent bacterial pneumonia, (3) antibiotic treatment of acute sinusitis to prevent bacterial superinfection, (4) daily or intermittent therapy of persons with chronic obstructive pulmonary disease to prevent exacerbations or hospitalization, (5) antibiotic treatment to prevent skin or soft tissue infections in a person with recurrent cellulitis, (6) antibiotic treatment at the time of dental work to prevent endocarditis, and (7) antibiotic treatment at the time of dental work to prevent bacterial infection of artificial joints. In each of these situations, medical providers are encouraged to consult the most recent guidelines and to weigh risks and benefits before writing a "prophylactic" prescription. In addition, researchers are encouraged to examine the preventive use of antibiotics in nursing home populations, given the paucity of research conducted in this area.