Martins João Roig, Chagas Otacílio Luiz, Velasques Bibiana Dalsasso, Bobrowski Ângelo Niemczewski, Correa Marcos Britto, Torriani Marcos Antonio
Author, University Hospital, Federal University of Pelotas, Pelotas, Brazil.
Associate Professor, Oral and Maxillofacial Surgery Residency Program, University Hospital, Federal University of Pelotas, Pelotas, Brazil.
J Oral Maxillofac Surg. 2017 Dec;75(12):2606.e1-2606.e11. doi: 10.1016/j.joms.2017.08.017. Epub 2017 Aug 17.
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?
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.
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.
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.
牙源性感染是牙科领域的常见问题，其治疗通常除了要消除感染源外，还需要使用抗生素，这常常使临床医生在选择抗生素时更加难以做出决定。本研究旨在通过患者、干预措施、对照、结局（PICO）格式回答以下问题：牙科感染（DI）何时应使用抗生素？哪些是最有效的药物？抗生素应使用多长时间？
这是一项系统评价，使用PubMed、Scopus和Cochrane数据库，对研究时间没有限制。每篇文章中分析的变量包括每项研究中牙源性感染的数量、研究类型、进行的手术干预、使用的抗生素、研究组之间的统计学差异以及治疗后患者的病情演变。
检索到1109篇文章。在对46篇文章进行全文阅读后，16篇被纳入最终评价，30篇被排除。获得了2197例DI病例的样本，其中使用了15种不同的抗生素，总体治愈率为98.2%。
研究表明，仅在出现局部和/或全身症状时才使用抗生素。对于DI，一旦进行了引流和/或消除了感染源，所有测试的抗生素在临床治愈方面同样有效，抗生素的选择不如局部干预治疗方法成功。当检测到真正需要抗生素治疗时，应尽可能短时间使用抗生素，直至患者临床治愈。
