Guideline on the prudent prescription of antibiotics in the dental office
Authors: Leroy Roos , Bourgeois Jolyce , Verleye Leen , Declerck Dominique , Depuydt Pieter , Eloot Anouk , Carvalho Joana C. , Theugels Wim , Cauwels Rita , Leprince Julian , Toma Selena , Michiels Kathleen , Aryanpour Sam , Vanden Abbeele Astrid , De Bruyne Mieke 
Published: January 2025

LIST OF FIGURES 9 -- LIST OF TABLES 15 -- LIST OF ABBREVIATIONS 19 -- 1 INTRODUCTION 25 -- 1.1 BACKGROUND 25 -- 1.1.1 Why a guideline on the prudent use of antibiotics in the dental office is needed 25 -- 1.1.2 Current use of antibiotics prescribed by dentists 25 -- 1.2 SCOPE 26 -- 1.3 REMIT OF THE GUIDELINE 26 -- 1.3.1 Overall objectives 26 -- 1.3.2 Population for which the guideline is meant 26 -- 1.3.3 Target users of the guideline 27 -- 1.4 STATEMENT OF INTENT 27 -- 1.5 FUNDING AND DECLARATION OF INTEREST 27 -- 2 METHODOLOGY 28 -- 2.1 INTRODUCTION 28 -- 2.2 THE GUIDELINE DEVELOPMENT GROUP 28 -- 2.3 MARKING OUT THE SCOPE OF THE GUIDELINE 28 -- 2.4 DEVELOPMENT OF THE RESEARCH QUESTIONS 30 -- 2.5 LITERATURE REVIEW 30 -- 2.5.1 Scoping searches 30 -- 2.5.2 Dedicated searches per indication 30 -- 2.6 QUALITY ASSESSMENT 30 -- 2.6.1 Guidelines 30 -- 2.6.2 Systematic reviews 31 -- 2.6.3 RCTs 31 -- 2.6.4 Non-randomised primary studies 31 -- 2.7 DATA EXTRACTION 32 -- 2.8 STATISTICAL ANALYSES 32 -- 2.9 GRADING EVIDENCE 32 -- 2.10 FORMULATION OF RECOMMENDATIONS 35 -- 2.11 STAKEHOLDER INVOLVEMENT 38 -- 2.11.1 Professional associations 38 -- 2.11.2 Patient representatives 39 -- 2.11.3 Process 40 -- 2.12 FINAL VALIDATION 40 -- 3 ADVERSE EVENTS ASSOCIATED WITH THE USE OF ANTIBIOTICS 41 -- 3.1 ANTIBACTERIAL RESISTANCE 42 -- 3.1.1 Antibacterial resistance, a natural phenomenon 42 -- 3.1.2 How do bacteria become resistant? 42 -- 3.1.3 How does antibiotic resistance spread? 43 -- 3.1.4 The burden of antibacterial resistance 43 -- 3.1.5 The prudent use of antibiotics, an essential element in the battle against antibacterial resistance 47 -- 3.2 DISRUPTION OF THE HUMAN MICROBIOME 47 -- 3.2.1 The human microbiome 47 -- 3.2.2 Impact of antibiotics on the human microbiome 48 -- 3.2.3 Clostridioides difficile infection following antibiotic use 8 -- 3.3 DRUG HYPERSENSITIVITY REACTIONS 49 -- 3.3.1 Drug hypersensitivity reactions 49 -- 3.3.2 Documentation of antimicrobial allergy 51 -- 3.3.3 Beta-Lactam cross-reactivity 51 -- 3.4 DRUG TOXICITIES 52 -- 4 CLINICAL RECOMMENDATIONS 53 -- 4.1 SYMPTOMATIC IRREVERSIBLE PULPITIS IN THE PRIMARY DENTITION 53 -- 4.1.1 Background 53 -- 4.1.2 Evidence base 54 -- 4.1.3 Are systemic antibiotics beneficial or harmful in children who present with a symptomatic irreversible pulpitis in primary teeth, whether or not in combination with dental treatment and whether or not in combination with analgesics? 54 -- 4.1.4 If antibiotics are beneficial, which type, dosage and duration are the most effective? 54 -- 4.2 ODONTOGENIC ABSCESS IN THE PRIMARY DENTITION 56 -- 4.2.1 Backgrounds 56 -- 4.2.2 Evidence base 56 -- 4.2.3 Are systemic antibiotics beneficial or harmful in children who present with an odontogenic abscess with or without systemic involvement in the primary dentition, whether or not in combination with dental treatment and whether or not in combination with analgesics? 56 -- 4.2.4 If antibiotics are beneficial, which type, dosage and duration are the most effective? 56 -- 4.3 SYMPTOMATIC IRREVERSIBLE PULPITIS IN THE PERMANENT DENTITION 58 -- 4.3.1 Backgrounds 58 -- 4.3.2 Evidence base 58 -- 4.3.3 Are systemic antibiotics beneficial or harmful in patients who present with a single permanent tooth with symptomatic irreversible pulpitis, awaiting dental treatment? 59 -- 4.3.4 If antibiotics are beneficial, which type, dosage and duration are the most effective? 60 -- 4.4 SYMPTOMATIC APICAL PERIODONTITIS AND ACUTE APICAL ABSCESS IN THE PERMANENT DENTITION 61 -- 4.4.1 Backgrounds 61 -- 4.4.2 Evidence base 61 -- 4.4.3 Are systemic antibiotics beneficial or harmful in patients with symptomatic apical periodontitis or acute apical abscess in permanent teeth, in the absence of dental treatment? 65 -- 4.4.4 If antibiotics are beneficial, which type, dosage and duration are the most effective? 65 -- 4.5 REPLANTATION OF AVULSED PERMANENT TEETH 69 -- 4.5.1 Backgrounds 69 -- 4.5.2 Evidence Base 69 -- 4.5.3 Are systemic antibiotics beneficial or harmful in patients who have an avulsed permanent tooth replanted? 70 -- 4.5.4 If antibiotics are beneficial, which type, dosage and duration are the most effective? 73 -- 4.6 NON-SURGICAL TREATMENT OF AGGRESSIVE PERIODONTITIS 74 -- 4.6.1 Backgrounds 74 -- 4.6.2 Evidence base 76 -- 4.6.3 Is the administration of systemic antibiotics in conjunction with non-surgical periodontal treatment beneficial or harmful in patients with aggressive periodontitis? 79 -- 4.6.4 If antibiotics are beneficial, which type, dosage and duration are the most effective? 85 -- 4.7 PERIODONTAL ABSCESS IN THE PERMANENT DENTITION 89 -- 4.7.1 Backgrounds 89 -- 4.7.2 Evidence base 90 -- 4.7.3 Is the administration of systemic antibiotics beneficial or harmful in patients who have a periodontal abscess or pericoronitis? 90 -- 4.7.4 If antibiotics are beneficial, which type, dosage and duration are the most effective? 90 -- 4.8 DENTAL IMPLANT PLACEMENT 93 -- 4.8.1 Backgrounds 93 -- 4.8.2 Evidence base 93 -- 4.8.3 Are systemic prophylactic antibiotics beneficial or harmful in patients undergoing dental implant placement? 94 -- 4.8.4 If antibiotics are beneficial, which type, dosage and duration are the most effective? 97 -- 4.9 EXTRACTION OF PERMANENT TEETH 99 -- 4.9.1 Backgrounds 99 -- 4.9.2 Evidence base 99 -- 4.9.3 Is the prophylactic administration of systemic antibiotics beneficial or harmful in patients undergoing permanent tooth extraction? 100 -- 4.9.4 If antibiotics are beneficial, which type, dosage and duration are the most effective? 102 -- 4.10 ANTIBIOTIC PROPHYLAXIS IN PATIENTS AT (HIGH) RISK OF INFECTIVE ENDOCARDITIS UNDERGOING DENTAL PROCEDURES 104 -- 4.10.1 Background 104 -- 4.10.2 Evidence base 106 -- 4.10.3 Are prophylactic antibiotics beneficial or harmful in patients at (high) risk of infective endocarditis undergoing invasive dental procedures? 106 -- 4.10.4 If antibiotics are beneficial, which type, dosage and duration are the most effective? 109 -- 4.11 ANTIBIOTIC PROPHYLAXIS IN PATIENTS WITH ORTHOPAEDIC JOINT IMPLANTS UNDERGOING DENTAL PROCEDURES 112 -- 4.11.1 Backgrounds 112 -- 4.11.2 Evidence base 112 -- 4.11.3 Are prophylactic antibiotics effective in preventing periprosthetic joint infections in patients with orthopaedic joint implants undergoing dental procedures? 112 -- 4.11.4 If antibiotics are beneficial, which type, dosage and duration are the most effective? 113 -- 5 ONGOING STUDIES & RESEARCH RECOMMENDATIONS 115 -- 5.1 ONGOING TRIALS 115 -- 5.2 RESEARCH RECOMMENDATIONS 118 -- 5.2.1 Methods 118 -- 5.2.2 Results 119 -- 6 DISSEMINATION, IMPLEMENTATION AND IMPACT ON RESOURCES 127 -- 6.1 DISSEMINATION 127 -- 6.2 IMPLEMENTATION 127 -- 6.3 AUDIT 128 -- 6.4 POTENTIAL IMPACT OF THE RECOMMENDATIONS ON RESOURCES 128 -- 7 UPDATE OF THE GUIDELINE 128 -- APPENDICES 129