Department of Endodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey.
Division of Endodontics, School of Dental Medicine, University at Buffalo, New York, USA.
Int Endod J. 2020 Dec;53(12):1715-1727. doi: 10.1111/iej.13390. Epub 2020 Sep 18.
To investigate the antibiotic prescribing patterns for endodontic infections based on the reports of Turkish dentists.
A survey consisting of 20 questions on general information and 13 questions on antibiotic prescribing patterns for endodontic cases was delivered to the e-mail addresses of general dentists and specialists via the database of the Turkish Dental Association. Collected data were analysed using Mc-Nemar-Bowker Test and multivariate ordinal logistic regression tests at the significance level of 0.05.
A total of 1007 responses were obtained from 17 827 dentists. The majority of the participants were general dental practitioners (GDP, 80%) whilst 8% were Endodontists. Gender, clinical experience, affiliations and speciality were significant risk factors for antibiotic prescription (P < 0.05). GDPs prescribed antibiotics twice as much as all specialists and members of public hospitals prescribed antibiotics three times more than specialists and clinical academics (P < 0.05). Amoxicillin with clavulanic acid was the most prescribed antibiotic (90%), followed by Ornidazole (25%). Clindamycin was the drug of choice for the patients with penicillin allergy (59%). Infection and fever control (76%), prophylaxis (44%) and avoiding swelling and trismus during endodontic treatment (26%) were the most common reasons for antibiotic prescriptions. Completing a course of prescribed antibiotics was recommended by most (75%). Infective endocarditis, immunosuppression, artificial heart valve and mitral valve prolapse were the main causes of prophylaxis in descending order. Uncontrolled and extensive use of antibiotics by patients (62%) was mentioned as the most effective reason for antibiotic resistance. Up to 10% of participants prescribed antibiotics for symptomatic irreversible pulpitis, asymptomatic apical periodontitis with or without endodontic treatment (8, 12 and 11%, respectively). Up to 20% of dentists prescribed antibiotics for symptomatic apical periodontitis when the pulp was vital or necrotic (13 and 23%, respectively). Almost one third of the participants prescribed antibiotics for symptomatic apical periodontitis of previously treated teeth with or without radiographic lesions whilst 34% prescribed antibiotics for acute apical abscess with localized swelling without systemic involvement.
The majority of dentists reported they prescribed antibiotics inappropriately. It is necessary to improve the knowledge of dentists about antibiotics and their indications in endodontics.
根据土耳其牙医的报告，调查牙髓感染的抗生素使用模式。
通过土耳其牙科协会的数据库，向普通牙医和专家的电子邮件地址发送了一份包含 20 个一般信息问题和 13 个牙髓感染抗生素使用模式问题的调查问卷。使用 McNemar-Bowker 检验和多变量有序逻辑回归检验对收集到的数据进行分析，检验水平为 0.05。
从 17827 名牙医中获得了 1007 份回复。大多数参与者是普通牙科医生（GDP，80%），而 8%是牙髓病专家。性别、临床经验、专业背景和机构是抗生素处方的显著危险因素（P<0.05）。GDP 开具抗生素的频率是所有专家的两倍，公立医院的专家和临床学术人员开具抗生素的频率是专家的三倍（P<0.05）。阿莫西林克拉维酸是最常被开具的抗生素（90%），其次是奥硝唑（25%）。对于青霉素过敏的患者，首选药物是克林霉素（59%）。控制感染和发热（76%）、预防（44%）和避免牙髓治疗期间肿胀和牙关紧闭（26%）是开具抗生素的最常见原因。大多数（75%）牙医推荐完成规定的抗生素疗程。感染性心内膜炎、免疫抑制、人工心脏瓣膜和二尖瓣脱垂是预防的主要原因，按降序排列。控制和广泛使用抗生素导致细菌耐药性增加是患者（62%）提到的最有效原因。多达 10%的参与者为有症状的不可复性牙髓炎、无症状的根尖周炎伴或不伴牙髓治疗（分别为 8%、12%和 11%）开具了抗生素。多达 20%的牙医在牙髓活力或坏死时为有症状的根尖周炎开具了抗生素（分别为 13%和 23%）。近三分之一的参与者为先前治疗过的牙齿有症状的根尖周炎开具了抗生素，无论是否有放射学病变，而 34%的参与者为有局部肿胀但无全身受累的急性根尖脓肿开具了抗生素。
大多数牙医报告说他们不恰当地开具了抗生素。有必要提高牙医对抗生素及其在牙髓病学中的适应证的认识。
