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Optimum length of treatment with systemic antibiotics in adults with dental infections: a systematic review

Evidence-Based Dentistry (2022)Cite this article

Abstract

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.

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Funding

The Scottish Antimicrobial Prescribing Group receives funding from the Scottish Government. No specific funding was provided for this work. Registration number: Prospero CRD42021241767.

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Authors and Affiliations

  1. Scottish Antimicrobial Prescribing Group, Healthcare Improvement Scotland, Delta House, 50 West Nile Street, Glasgow, G1 2NP, UK

    Lesley Cooper & Jacqueline Sneddon

  2. Bramcote Dental Practice, Woodcock Street, Castle Cary, Somerset, BA7 7BJ, UK

    Nikolai Stankiewicz

  3. College of Medical, Veterinary & Life Sciences, Glasgow Dental Hospital & School, University of Glasgow, 378 Sauchiehall Street, Glasgow, G2 3JZ, UK

    Andrew Smith

  4. Scottish Antimicrobial Prescribing Group, Healthcare Improvement Scotland, Delta House, 50 West Nile Street, Glasgow, G1 2NP, UK; Queen Elizabeth University Hospital, Govan Road, Glasgow, NHS Greater Glasgow and Clyde, UK

    R. Andrew Seaton

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  1. Lesley Cooper
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Contributions

L. Cooper, J. Sneddon, R. A. Seaton and A. Smith designed the study. L. Cooper and J. Sneddon drafted the manuscript. L. Cooper and N. Stankiewicz completed the literature search, data collection and quality assessment, analysis and synthesis. J. Sneddon, N Stankiewicz, A. Smith and R. A. Seaton critically reviewed and revised the draft manuscript. All authors gave final approval and agree to be accountable for all aspects of the work.

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Correspondence to Lesley Cooper.

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The authors declare no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

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Cooper, L., Stankiewicz, N., Sneddon, J. et al. Optimum length of treatment with systemic antibiotics in adults with dental infections: a systematic review. Evid Based Dent (2022). https://doi.org/10.1038/s41432-022-0801-6

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