J Am Dent Assoc. 2019 Dec;150(12):e179-e216. doi: 10.1016/j.adaj.2019.09.011.
Patients with pulpal and periapical conditions often seek treatment for pain, intraoral swelling, or both. Even when definitive, conservative dental treatment (DCDT) is an option, antibiotics are often prescribed. The purpose of this review was to summarize available evidence regarding the effect of antibiotics, either alone or as adjuncts to DCDT, to treat immunocompetent adults with pulpal and periapical conditions, as well as additional population-level harms associated with antibiotic use.
The authors updated 2 preexisting systematic reviews to identify newly published randomized controlled trials. They also searched for systematic reviews to inform additional harm outcomes. They conducted searches in MEDLINE, Embase, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature. Pairs of reviewers independently conducted study selection, data extraction, and assessment of risk of bias and certainty in the evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach.
The authors found no new trials via the update of the preexisting reviews. Ultimately, 3 trials and 8 additional reports proved eligible for this review. Trial estimates for all outcomes suggested both a benefit and harm over 7 days (very low to low certainty evidence). The magnitude of additional harms related to antibiotic use for any condition were potentially large (very low to moderate certainty evidence).
Evidence for antibiotics, either alone or as adjuncts to DCDT, showed both a benefit and a harm for outcomes of pain and intraoral swelling and a large potential magnitude of effect in regard to additional harm outcomes. The impact of dental antibiotic prescribing requires further research.
患有牙髓和根尖周疾病的患者常因疼痛、口腔肿胀或两者兼有而寻求治疗。即使可以进行明确的保守性牙科治疗（DCDT），抗生素也经常被开具。本综述的目的是总结有关抗生素（单独使用或作为 DCDT 的辅助治疗）治疗牙髓和根尖周疾病的免疫功能正常的成人的疗效的现有证据，以及与抗生素使用相关的其他人群水平危害。
作者更新了 2 项先前的系统综述，以确定新发表的随机对照试验。他们还搜索了系统综述，以提供额外的危害结果。他们在 MEDLINE、Embase、Cochrane 图书馆和 Cumulative Index to Nursing and Allied Health Literature 中进行了检索。两名评审员独立进行了研究选择、数据提取以及使用 Grading of Recommendations Assessment、Development、and Evaluation 方法评估偏倚风险和证据确定性。
通过对先前综述的更新，作者没有发现新的试验。最终，3 项试验和 8 项额外的报告被证明符合本综述的纳入标准。所有结局的试验估计均表明，在 7 天内既有益处又有危害（极低至低确定性证据）。与任何情况下使用抗生素相关的额外危害的严重程度可能较大（极低至中度确定性证据）。
单独使用抗生素或作为 DCDT 的辅助治疗，对疼痛和口腔肿胀的结局均显示出获益和危害，并且在额外危害结局方面可能具有较大的影响程度。牙科抗生素处方的影响需要进一步研究。
