Cooper Lesley, Stankiewicz Nikolai, Sneddon Jacqueline, Seaton R Andrew, Smith Andrew
Scottish Antimicrobial Prescribing Group, Healthcare Improvement Scotland, Delta House, 50 West Nile Street, Glasgow, G1 2NP, UK.
Damira Dental Studios, Head Office, First Floor, The High Barn Pinner Hill Farm, Pinner Hill, HA5 3YQ, UK.
JAC Antimicrob Resist. 2022 Aug 9;4(4):dlac072. doi: 10.1093/jacamr/dlac072. eCollection 2022 Aug.
Dental practitioners are the largest prescribers of metronidazole. Antibiotics should only be prescribed when systemic involvement is clear and should be limited to monotherapy with β-lactams in the first instance.
To determine whether metronidazole used as monotherapy or in addition to a β-lactam antibiotic offers any additional benefit over β-lactam monotherapy in non-periodontal dental infections.
Searches of Ovid Medline, Ovid Embase, Cochrane library and trials registries, forward and backward citations, for studies published between database inception and 2 August 2021. All randomized clinical trials (RCTs) and non-randomized trials comparing either systemic metronidazole monotherapy or metronidazole combined with a β-lactam with β-lactam monotherapy for the treatment of non-periodontal dental infections in adults or children in outpatient settings were included.
Four publications reporting three RCTs comparing metronidazole with a β-lactam antibiotic were recovered. Studies were conducted in the 1970s-80s and aimed to demonstrate metronidazole was as effective as penicillin for the treatment of acute pericoronitis or acute apical infections with systemic involvement. Meta-analysis of results was not possible due to differences in measurement of infection signs. All studies concluded that metronidazole and penicillin are equally effective for the treatment of non-periodontal dental infections with systemic involvement.
Metronidazole does not provide superior clinical outcomes (alone or in combination with a β-lactam) when compared with a β-lactam antibiotic alone for the treatment of non-periodontal dental infections in general dental practice. Guidelines should reinforce the importance of surgical interventions and if appropriate the use of a single agent narrow-spectrum β-lactam.
牙科医生是甲硝唑的最大处方者。抗生素仅应在全身感染明确时使用，且首先应限于β-内酰胺类单药治疗。
确定在非牙周性牙齿感染中，甲硝唑单药治疗或与β-内酰胺类抗生素联合使用相比β-内酰胺类单药治疗是否具有任何额外益处。
检索Ovid Medline、Ovid Embase、Cochrane图书馆和试验注册库，进行前后文引用检索，查找数据库建立至2021年8月2日期间发表的研究。纳入所有比较全身应用甲硝唑单药治疗或甲硝唑联合β-内酰胺类与β-内酰胺类单药治疗成人或儿童门诊非牙周性牙齿感染的随机临床试验（RCT）和非随机试验。
检索到4篇报告3项比较甲硝唑与β-内酰胺类抗生素的RCT的文献。这些研究在20世纪70年代至80年代进行，旨在证明甲硝唑在治疗伴有全身感染的急性冠周炎或急性根尖感染方面与青霉素同样有效。由于感染体征测量方法的差异，无法对结果进行荟萃分析。所有研究均得出结论，甲硝唑和青霉素在治疗伴有全身感染的非牙周性牙齿感染方面同样有效。
在一般牙科实践中，对于非牙周性牙齿感染的治疗，与单独使用β-内酰胺类抗生素相比，甲硝唑（单独或与β-内酰胺类联合使用）并未提供更好的临床结局。指南应强化手术干预的重要性，并在适当情况下使用单一窄谱β-内酰胺类药物。
