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Comparative Efficacy of Different Oral Doses of Clindamycin in Preventing Post-Operative Sequelae of Lower Third Molar Surgery—A Randomized, Triple-Blind Study. Medicina (B Aires) 2022; 58:medicina58050668. [PMID: 35630085 PMCID: PMC9146338 DOI: 10.3390/medicina58050668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/11/2022] [Accepted: 05/16/2022] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives. Antibiotic regimen optimization is a major concern in post extraction sequelae management following third molar surgery, mostly owing to the absence of universal guidelines. Hence, this study aimed to determine the effect of antibiotic prophylaxis using three different doses of clindamycin on the prevention of infection and other complications following mandibular third molar disimpaction. The secondary outcome was testing whether clindamycin exhibits activity in acute or chronic models of pain using the visual analog scale of pain and the necessity for post-operative rescue analgesia. The tertiary outcome was to assess clindamycin penetration into the saliva by measuring its concentration using liquid chromatography/electrospray ionization tandem mass spectrometry. Materials and Methods. A randomized, two-center, triple-blind, controlled clinical trial was conducted, in which the patients were randomly allocated to three groups: I, receiving 150 mg clindamycin every 8 h; II, receiving 300 mg clindamycin every 8 h; and III, receiving 600 mg clindamycin every 12 h. Each group continued the therapy for five days. Results. An overall decrease in the risk of infection and other post-operative complications, such as trismus, edema, dysphagia, and lymphadenopathy, was achieved, with the best results in group I. Conclusion. As no statistical association was observed between clindamycin concentration in saliva and degree of post-operative inflammation, clindamycin concentration, or pain intensity, smaller doses of clindamycin administered over shorter time periods is recommended.
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Arteagoitia I, Sánchez FR, Figueras A, Arroyo-Lamas N. Is clindamycin effective in preventing infectious complications after oral surgery? Systematic review and meta-analysis of randomized controlled trials. Clin Oral Investig 2022; 26:4467-4478. [PMID: 35235059 PMCID: PMC9203405 DOI: 10.1007/s00784-022-04411-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/11/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the effect of clindamycin in the prevention of infection after oral surgery. MATERIAL AND METHODS This systematic review and meta-analysis followed the PRISMA statement, the PICO-framework and included only randomized controlled clinical trials. In all studies clindamycin was administered to prevent infections in patients who underwent oral surgery. Two independent researchers conducted the search, data extraction and risk of bias assessment. Included studies were classified by the type of oral surgery. Besides, data of patients, procedures and outcome variables were collected. Risk ratios (RR) and 95% confidence intervals (CI) were calculated by using Mantel-Haenszel model and the number needed to treat (NNT). Finally, any potential sources of heterogeneity were estimated. RESULTS Seven trials of 540 articles met the inclusion criteria and were included in the qualitative synthesis. Four articles assessing the effect of oral clindamycin in third molar surgery were quantitatively analyzed. The overall RR was 0.66 (95% CI = 0.38-1.16), being non-statistically significant (p = 0.15). There was no heterogeneity between the studies I2 = 0, p = 0.44. The NNT was 29 (95% CI = 12- -57). CONCLUSIONS The effectiveness of clindamycin could not be evaluated except in third molar extraction. Oral clindamycin is ineffective in preventing infection in third molar surgery. CLINICAL RELEVANCE There is a lack of high-quality evidence supporting the prescription of clindamycin to prevent infections after oral surgery, despite being frequently prescribed as an alternative for penicillin-allergic patients. Oral clindamycin has not been shown to be effective after third molar extractions.
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Affiliation(s)
- Iciar Arteagoitia
- Stomatology Department, University of the Basque Country UPV/EHU, 48940, Leioa, Bizkaia, Spain.
- BioCruces Health Research Institute Cruces Plaza, 48903, Barakaldo, Bizkaia, Spain.
| | - Fabio Rodríguez Sánchez
- Department of Preventive Medicine and Public Health, University of the Basque Country, UPV/EHU, 48940, Leioa, Bizkaia, Spain
- Department of Oral Health Sciences, Section Periodontology, Catholic University of Leuven & University Hospitals Leuven, Leuven, Belgium
| | - Amaia Figueras
- University of the Basque Country UPV/EHU, Bizkaia, 48940, Leioa, Spain
| | - Nagore Arroyo-Lamas
- Medicine and Surgery Program, PhD School, University of the Basque Country UPV/EHU, 48940, Leioa, Bizkaia, Spain
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Angarita-Díaz MDP, Bernal-Cepeda L, Bastidas-Legarda L, Forero-Escobar D, Ricaurte-Avendaño A, Mora-Reina J, Vergara-Mercado M, Herrera-Herrera A, Rodriguez-Paz M, Cáceres- Matta S, Fortich-Mesa N, Ochoa-Acosta EM. Impact of a virtual learning environment on the conscious prescription of antibiotics among Colombian dentists. PLoS One 2022; 17:e0262731. [PMID: 35089952 PMCID: PMC8797226 DOI: 10.1371/journal.pone.0262731] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 01/04/2022] [Indexed: 12/17/2022] Open
Abstract
Appropriate antibiotic prescription contributes to reducing bacterial resistance; therefore, it is critical to provide training regarding this challenge. The objective of this study was to develop a virtual learning environment for antibiotic prescription and to determine its impact on dentists' awareness, attitudes, and intention to practice. First, the learning content on multimedia resources was developed and distributed into three challenges that participants had to overcome. Then, a quasi-experimental study was performed in which the virtual learning environment was implemented on dentists from seven Colombian cities. The median of correct answers and the levels of awareness, attitudes, and intention to practice were compared before, immediately after, and 6-months post-intervention. Wilcoxon signed-rank and McNemar's tests were used to determine the differences. A total of 206 participants who finished the virtual learning environment activities exhibited a favorable and statistically significant impact on the median of correct answers of awareness (p < 0.001), attitudes (p < 0.001), and intention to practice (p = 0.042). A significant increase occurred in the number of participants with a high level of awareness (p < 0.001) and a non-significant increase in participants with high levels of attitudes (p = 0.230) and intention to practice (p = 0.286). At 6 months, the positive effect on the median of correct answers on awareness and intention to practice persisted (p < 0.001); however, this was not evident for attitudes (p = 0.105). Moreover, there was a significant decrease in the number of participants who showed low levels of awareness (p = 0.019) and a slight increase in those with high levels of the same component (p = 0.161). The use of a virtual learning environment designed for dentists contributed to a rapid improvement in awareness and intention to practice antibiotic prescription; however, their attitudes and information retention need reinforcement.
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Affiliation(s)
| | | | - Leidy Bastidas-Legarda
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Diana Forero-Escobar
- Facultad de Odontología, Universidad Cooperativa de Colombia, Villavicencio, Colombia
| | | | - Julián Mora-Reina
- Facultad de Odontología, Universidad Cooperativa de Colombia, Villavicencio, Colombia
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Dormoy J, Vuillemin MO, Rossi S, Boivin JM, Guillet J. Perceptions of Antibiotic Use and Resistance: Are Antibiotics the Dentists' Anxiolytics? Antibiotics (Basel) 2021; 10:735. [PMID: 34204526 PMCID: PMC8235224 DOI: 10.3390/antibiotics10060735] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Antibiotic resistance is a global health crisis. The aim of this study was to explore dentists' perceptions of antibiotic resistance. METHODS A qualitative method was used. Seventeen dentists practising in the Nancy (Lorraine, France) region were surveyed. They were general practitioners or specialised in oral surgery, implantology, or periodontology. The practitioners took part in semi-structured interviews between September 2019 and July 2020. All of the interviews were transcribed in full and analysed thematically. RESULTS Four major themes have been selected: attitudes of the dentists in regard to the guidelines, clinical factors that influence prescriptions, non-clinical factors that influence prescriptions, and the perception of antibiotic resistance. The dentists stated that they were very concerned regarding the public health issue of antibiotic resistance. However, they often prescribe according to their own interests and habits rather than according to the relevant guidelines. CONCLUSIONS Although dentists are generally well aware of antibiotic resistance, they often do not adequately appreciate the link between their prescribing habits and the phenomenon of antibiotic resistance. Regular updating of practitioners' knowledge in this regard is necessary, but patients and the general public should also be made more aware of the issue.
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Affiliation(s)
- Julie Dormoy
- Département de Chirurgie Orale, Faculté d’Odontologie de Lorraine, Université de Lorraine, 54000 Nancy, France; (J.D.); (M.-O.V.)
| | - Marc-Olivier Vuillemin
- Département de Chirurgie Orale, Faculté d’Odontologie de Lorraine, Université de Lorraine, 54000 Nancy, France; (J.D.); (M.-O.V.)
| | - Silvia Rossi
- Apemac EA4360, Université de Lorraine, 54000 Nancy, France;
- École de Santé Publique, Université de Lorraine, 54000 Nancy, France
| | - Jean-Marc Boivin
- Centre d’Investigation Clinique Plurithématique CIC-P Inserm, CHRU de Nancy, 54000 Nancy, France;
- Département de Médecine Générale, Faculté de Médecine, Université de Lorraine, 54000 Nancy, France
- AntibioEst, 54000 Nancy, France
| | - Julie Guillet
- Département de Chirurgie Orale, Faculté d’Odontologie de Lorraine, Université de Lorraine, 54000 Nancy, France; (J.D.); (M.-O.V.)
- AntibioEst, 54000 Nancy, France
- Service d’Odontologie, CHRU de Nancy, 54000 Nancy, France
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Aragoneses J, Suárez A, Rodríguez C, Algar J, Aragoneses JM. Knowledge, Attitudes, and Practices among Dental Practitioners Regarding Antibiotic Prescriptions for Pregnant and Breastfeeding Women in the Dominican Republic. Antibiotics (Basel) 2021; 10:668. [PMID: 34205115 PMCID: PMC8229999 DOI: 10.3390/antibiotics10060668] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/20/2021] [Accepted: 06/02/2021] [Indexed: 02/05/2023] Open
Abstract
In this study, we aimed to explore the trends among dentists in the Dominican Republic of providing antibiotic prescriptions to pregnant/breastfeeding dental patients. A survey was conducted among 98 dentists, using a self-administered questionnaire, about their knowledge and attitudes regarding antibiotic usage in pregnant/lactating women and the translation of these into practice. The majority of the survey population were female dentists (63.3%) aged 45-54 years. A chi-square test showed statistically significant differences in the knowledge sources between older and younger dentists, with a minority having chosen scientific literature as a source (p-value of 0.04). There were statistically significant associations between gender and certain attitudes and practice-based questions, with p-values of 0.04 and 0.01, respectively. The Spearman's correlation test showed a statistically significant correlation between knowledge and attitude (p-value 0.001), whereas no correlation was found with practice (p-value 0.23). A multiple response analysis showed that the majority of the respondents chose the second and third trimester for antibiotic prescriptions for acute conditions such as cellulitis, periodontal abscess, and pericoronitis. Most dentists had sufficient knowledge about antibiotic usage in pregnant/lactating women, but it did not translate into practice, and a certain proportion of the participants followed incongruent drug prescription. These findings can be used to focus on judicious antibiotic usage by dentists in the Dominican Republic.
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Affiliation(s)
- Javier Aragoneses
- Department of Medicine and Medical Specialties, Faculty of Health Sciences, University of Alcalá, 28801 Madrid, Spain;
| | - Ana Suárez
- Department of Preclinical Dentistry, School of Biomedical Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - Cinthia Rodríguez
- Department of Dentistry, Universidad Federico Henriquez y Carvajal, 10106 Santo Domingo, Dominican Republic;
| | - Juan Algar
- Department of Clinical Dentistry, School of Biomedical Sciences, Universidad Europea de Madrid, 28005 Madrid, Spain;
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Walsh LJ, Ford PJ, McGuire T, van Driel M, Hollingworth SA. Trends in Australian dental prescribing of antibiotics: 2005-2016. Aust Dent J 2021; 66 Suppl 1:S37-S41. [PMID: 33893647 DOI: 10.1111/adj.12846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Prescribing of antibiotics by dentists for surgical prophylaxis or as an adjunct to managing dental infections is a substantial part of the overall landscape for prescribed antibiotics in health care settings. METHODS We explored trends in the antibiotic prescribing patterns of Australian dentists over the 12-year period, 2005-2016. We obtained data on dispensed prescriptions of antibiotics from registered dentists subsidized on the Pharmaceutical Benefits Scheme. RESULTS Australian dentists were responsible for almost 7 million dispensed prescriptions of antibiotics over 12 years; an average of 24 prescriptions per year per dentist. The most commonly prescribed antibiotic was amoxicillin, followed by amoxicillin + clavulanic acid and metronidazole. These top three antibiotics constituted more than 80% of all antibiotics prescribed and their use increased dramatically over time. There was a large increase in the prescribing of broad-spectrum antibiotics over time, most of which occurred from 2011 to 2016. CONCLUSIONS Excessive prescribing of broad-spectrum antibiotics runs contrary to national antimicrobial stewardship (AMS) initiatives and guidelines. Multifaceted educational strategies are essential to align prescribing with current best practice. High-level evidence to inform clear guidelines on antibiotic prescribing in dental infections, with audit and feedback, should reduce the inappropriate use of antibiotics in dentistry.
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Affiliation(s)
- L J Walsh
- School of Dentistry, The University of Queensland, Brisbane, Qld, Australia
| | - P J Ford
- School of Dentistry, The University of Queensland, Brisbane, Qld, Australia
| | - T McGuire
- School of Pharmacy, The University of Queensland, Brisbane, Qld, Australia.,Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Qld, Australia.,Mater Pharmacy, Mater Health, South East Queensland, Brisbane, Qld, Australia
| | - M van Driel
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia
| | - S A Hollingworth
- School of Pharmacy, The University of Queensland, Brisbane, Qld, Australia
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