Bartsch Sibylle, Scholz Konstantin J, Al-Ahmad Ali, Cieplik Fabian
Center for Dental Medicine, Department of Operative Dentistry and Periodontology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.
Adv Exp Med Biol. 2025;1472:261-275. doi: 10.1007/978-3-031-79146-8_16.
Antimicrobial resistance (AMR) is a major public health concern, especially with regard to bacterial resistance to antibiotics. Dentists are responsible for approximately 10% of all antibiotic prescriptions. In addition, there seems to be a lack of awareness of potential resistance toward antiseptics and biocides such as chlorhexidine digluconate (CHX) or cetylpyridinium chloride (CPC), which are commonly used in dental practice but also included in over-the-counter products. In comparison to the gut microbiome, only a small number of studies have investigated the impact of antibiotics on the oral microbiome. Amoxicillin is a commonly prescribed antibiotic in dentistry, often used in combination with metronidazole. Several studies have addressed its impact on the oral microbiome. Similarly, the effects of ciprofloxacin, clindamycin, cephazolin, and benzylpenicillin have also been examined in various studies. However, due to variations in study designs, it is difficult to compare the effects of antibiotics on the oral microbiota, and conclusions can only be drawn at the phyla level. In contrast, studies on CPC and CHX have also focused on the genus level. The oral resistome mainly contains genes involved in resistance to macrolides, MLS (macrolide, lincosamide, and streptogramin B), lincosamide and streptogramin A, fluoroquinolone, tetracycline, or penicillin. The oral cavity therefore serves as a reservoir for antibiotic resistance genes (ARGs), which are of crucial importance both for inflammations in the oral cavity and for the treatment of the entire human organism. Therefore, dentists must weigh up the benefits and risks of using antibiotics very carefully.
抗菌药物耐药性（AMR）是一个主要的公共卫生问题，尤其是细菌对抗生素的耐药性。牙医开出的抗生素处方约占所有处方的10%。此外，对于牙科实践中常用且非处方产品中也含有的洗必泰葡萄糖酸盐（CHX）或氯化十六烷基吡啶（CPC）等防腐剂和杀菌剂的潜在耐药性，似乎缺乏认识。与肠道微生物群相比，只有少数研究调查了抗生素对口腔微生物群的影响。阿莫西林是牙科常用的抗生素，常与甲硝唑联合使用。多项研究探讨了其对口腔微生物群的影响。同样，环丙沙星、克林霉素、头孢唑林和苄青霉素的作用也在各种研究中得到了检验。然而，由于研究设计的差异，很难比较抗生素对口腔微生物群的影响，只能在门水平得出结论。相比之下，关于CPC和CHX的研究也集中在属水平。口腔耐药基因组主要包含与对大环内酯类、MLS（大环内酯类、林可酰胺类和链阳霉素B）、林可酰胺类和链阳霉素A、氟喹诺酮类、四环素类或青霉素类耐药相关的基因。因此，口腔是抗生素耐药基因（ARGs）的储存库，这些基因对口腔炎症和整个人体的治疗都至关重要。因此，牙医必须非常谨慎地权衡使用抗生素的利弊。
