Abbott A A, Koren L Z, Morse D R, Sinai I H, Doo R S, Furst M L
Department of Endodontology, Temple University School of Dentistry, Philadelphia, Pa.
Oral Surg Oral Med Oral Pathol. 1988 Dec;66(6):722-33. doi: 10.1016/0030-4220(88)90324-6.
A recent study from a private endodontic practice compared "prophylactic" antibiotic (high-dose, 1-day) regimens of penicillin V and erythromycin (base or stearate) for patients who had asymptomatic teeth with pulpal necrosis and associated periapical radiolucent lesions (PN/PL). A 2.2% flare-up incidence was found, with no statistically significant differences for penicillin (0.0%), base (2.9%), and stearate (3.8%). No hypersensitivity responses occurred, and gastrointestinal side effects were found primarily with the erythromycins (12.4%). To ascertain whether or not similar results would occur with student operators in a dental school clinic population, the current study was undertaken. One-hundred ninety-five patients with quiescent PN/PL were randomly given either penicillin V or erythromycin (base or stearate). A 2.6% flare-up incidence was found, with no statistically significant differences for penicillin (3.1%), base (1.5%), and stearate (3.1%). No hypersensitivity responses occurred, and GI side effects were found primarily with the erythromycins (17.7%). As can be seen, the results were very similar to those of the recent endodontic practice study. Hence, it can be concluded that the results of the previous endodontic practice study were not unique to any one clinician or method. A comparison was also made between the "prophylactic" penicillin group of the current study and the placebo control group of our previous dental school clinic, student operator study (in which the methods, population, and regimen were almost identical to those of the current study). The results showed that the "prophylactic" penicillin group had significant fewer flare-ups and non-flare-up-associated swelling and pain than did the placebo group. In view of these findings and those from studies from the literature in which "prophylactic" antibiotics were not used, it is our opinion that the antibiotic regimens used in the current study should be a component of clinical endodontic therapy for quiescent PN/PL.
一项来自私人牙髓病诊疗机构的近期研究，比较了青霉素V和红霉素（碱或硬脂酸盐）针对患有无症状牙髓坏死及相关根尖周透射性病变（PN/PL）牙齿患者的“预防性”抗生素（高剂量，1日疗法）方案。研究发现 flare-up发生率为2.2%，青霉素组（0.0%）、红霉素碱组（2.9%）和红霉素硬脂酸盐组（3.8%）之间无统计学显著差异。未发生超敏反应，胃肠道副作用主要出现在红霉素组（12.4%）。为确定在牙科学校诊所人群中由学生操作者治疗时是否会出现类似结果，开展了本研究。195例静止期PN/PL患者被随机给予青霉素V或红霉素（碱或硬脂酸盐）。发现flare-up发生率为2.6%，青霉素组（3.1%）、红霉素碱组（1.5%）和红霉素硬脂酸盐组（3.1%）之间无统计学显著差异。未发生超敏反应，胃肠道副作用主要出现在红霉素组（17.7%）。可以看出，结果与近期牙髓病诊疗研究的结果非常相似。因此，可以得出结论，先前牙髓病诊疗研究的结果并非特定于任何一位临床医生或方法。本研究的“预防性”青霉素组与我们先前牙科学校诊所学生操作者研究的安慰剂对照组（其方法、人群和方案与本研究几乎相同）也进行了比较。结果显示，“预防性”青霉素组的flare-up以及与非flare-up相关的肿胀和疼痛明显少于安慰剂组。鉴于这些发现以及文献中未使用“预防性”抗生素的研究结果，我们认为本研究中使用的抗生素方案应成为静止期PN/PL临床牙髓治疗的一个组成部分。
