Cooper Lesley, Stankiewicz Nikolai, Sneddon Jacqueline, Smith Andrew, Seaton R Andrew
Scottish Antimicrobial Prescribing Group, Healthcare Improvement Scotland, Delta House, 50 West Nile Street, Glasgow, G1 2NP, UK.
Bramcote Dental Practice, Woodcock Street, Castle Cary, Somerset, BA7 7BJ, UK.
Evid Based Dent. 2022 Sep 7. doi: 10.1038/s41432-022-0801-6.
Introduction Guidelines on the length of treatment of dental infections with systemic antibiotics vary across different countries. We aimed to determine if short-duration (3-5 days) courses of systemic antibiotics were as effective as longer-duration courses (≥7 days) for the treatment of dental infections in adults in outpatient settings.Methods We searched Ovid Medline, Ovid Embase, Cochrane, trials registries, Google Scholar and forward and backward citations for studies published between database inception and 30 March 2021. All randomised clinical trials (RCT) and non-randomised trials which compared length of treatment with systemic antibiotics for dental infections in adults in outpatient settings published in English were included.Results One small RCT met our defined inclusion criteria. The trial compared three-day versus seven-day courses of amoxicillin in adults with odontogenic infection requiring tooth extraction. There was no significant difference between groups in terms of participant-reported pain or clinical assessment of wound healing.Discussion While a number of observational studies were supportive of shorter-course therapy, only one small RCT concluded that a three-day course of amoxicillin was clinically non-inferior versus seven days for the treatment of odontogenic infection requiring tooth extraction. Limited conclusions on shorter-course therapy can be drawn from this study as all participants commenced amoxicillin two days before tooth extraction which is not common clinical practice. The variability in guidelines for use of antimicrobials in dental infections suggests that guidelines are based on local or national historical practice and indicates the need for further research to determine the optimum length of treatment. RCTs are required to investigate if short-duration courses of antibiotics are effective and to provide evidence to support consistent guidance for dental professionals.
引言 不同国家关于使用全身性抗生素治疗牙齿感染的疗程指南各不相同。我们旨在确定短期（3 - 5天）全身性抗生素疗程对于门诊环境中成人牙齿感染的治疗是否与长期（≥7天）疗程同样有效。
方法 我们检索了Ovid Medline、Ovid Embase、Cochrane、试验注册库、谷歌学术以及数据库建立至2021年3月30日期间发表的研究的前后文引用文献。纳入所有以英文发表的、比较门诊环境中成人牙齿感染使用全身性抗生素治疗疗程的随机临床试验（RCT）和非随机试验。
结果 一项小型RCT符合我们定义的纳入标准。该试验比较了需要拔牙的牙源性感染成人使用阿莫西林的三日疗程与七日疗程。在参与者报告的疼痛或伤口愈合的临床评估方面，两组之间没有显著差异。
讨论 虽然一些观察性研究支持较短疗程治疗，但只有一项小型RCT得出结论，对于需要拔牙的牙源性感染，阿莫西林三日疗程在临床上并不劣于七日疗程。由于所有参与者在拔牙前两天开始使用阿莫西林，这并非常见的临床做法，因此从这项研究中只能得出关于较短疗程治疗的有限结论。牙齿感染中抗菌药物使用指南的差异表明，这些指南基于当地或国家的历史实践，并表明需要进一步研究以确定最佳治疗疗程。需要进行RCT来研究短期抗生素疗程是否有效，并为牙科专业人员提供支持一致指导的证据。
