title: Antibiotics in Endodontics: a review.
abstract: The overuse of antibiotics and the emergence of antibiotic-resistant bacterial strains is a global concern. This concern is also of importance in terms of the oral microbiota and the use of antibiotics to deal with oral and dental infections. The aim of this paper was to review the current literature on the indications and use of antibiotics and to make recommendations for their prescription in endodontic patients. Odontogenic infections, including endodontic infections, are polymicrobial, and in most cases, the prescription of antibiotics is empirical. This has led to the increasing use of broad-spectrum antibiotics even in cases where antibiotics are not indicated, such as symptomatic irreversible pulpitis, necrotic pulps and localized acute apical abscesses. In case of discrete and localized swelling, the primary aim is to achieve drainage without additional antibiotics. Adjunctive antibiotic treatment may be necessary in the prevention of the spread of infection, in acute apical abscesses with systemic involvement and in progressive and persistent infections. Medically compromised patients are more susceptible to complication arising from odontogenic infections and antimicrobials have a more specific role in their treatment. Therefore, antibiotics should be considered in patients having systemic diseases with compromised immunity or in patients with a localized congenital or acquired altered defence capacity, such as patients with infective endocarditis, prosthetic cardiac valves or recent prosthetic joint replacement. Penicillin VK, possibly combined with metronidazole to cover anaerobic strains, is still effective in most cases. However, amoxicillin (alone or together with clavulanic acid) is recommended because of better absorption and lower risk of side effects. In case of confirmed penicillin allergy, lincosamides such as clindamycin are the drug of choice.
authors.affiliation: Department of Endodontics, School of Dentistry, University of Sevilla, Sevilla, Spain.
authors.forename: J J
authors.identifier: http://orcid.org/0000-0002-0427-9059
authors.initials: JJ
authors.lastname: Segura-Egea
authors.affiliation: Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
authors.forename: K
authors.initials: K
authors.lastname: Gould
authors.affiliation: Private Practice, Alsancak, İzmir, Turkey.
authors.forename: B Hakan
authors.identifier: http://orcid.org/0000-0003-1173-909X
authors.initials: BH
authors.lastname: Şen
authors.affiliation: Department of Endodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Jonasson
authors.affiliation: Department of Conservative Dentistry and Endodontics, University of Cagliari, Cagliari, Sardinia, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Cotti
authors.affiliation: Department of Biomedical and Neuromotor Sciences, DIBINEM, University of Bologna, Bologna, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Mazzoni
authors.affiliation: Department of Endodontology, Dental Faculty of Istanbul Kemerburgaz University, Istanbul, Turkey.
authors.forename: H
authors.initials: H
authors.lastname: Sunay
authors.affiliation: Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.|Research Unit of Oral Health Sciences, Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland.
authors.forename: L
authors.initials: L
authors.lastname: Tjäderhane
authors.affiliation: School of Dentistry, College of Biomedical & Life Sciences, Cardiff University, Cardiff, UK.
authors.forename: P M H
authors.initials: PMH
authors.lastname: Dummer
mesh_terms: D000287:Administration, Topical; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004708:Endodontics; D005060:Europe; D005491:Focal Infection, Dental / Q000188:drug therapy; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control / Q000706:statistics & numerical data; D019239:Practice Patterns, Dentists'; D014076:Tooth Diseases / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Endodontics; antibiotics