Search

Background: Diabetic foot osteomyelitis (DFO) is a major complication and can lead to significant morbidity and mortality. Systemic antibiotic therapy is often initiated first line to achieve quiescence of infection. To perform a multi-centre case review of systemic antibiotic intervention to treat adults with DFO in England and Wales and compare with national guidelines 'Diabetic foot problems: prevention and management'. Methods: Eight centres from England and Wales retrospectively collated data from a minimum of five adults (aged ≥ 18 years) from electronic case records. All patients were treated with systemic antibiotics following a new diagnosis of DFO (1 June 2021–31 December 2021). Results: 40 patients (35 males and 5 females) were included; the mean age was 62.3 years (standard deviation (SD) 13.0). Patients commenced systemic oral 14 (35%) or intravenous 26 (65%) antibiotic therapy following a new diagnosis of DFO. Twenty-seven (67.5%) patients were medically or surgically managed in the 12-week period with clinical quiescence of infection. Twenty-one patients (52.5%) had no recurrence of DFO infection within 12 weeks; seventeen (42.5%) of these patients had clinical quiescence of infection with systemic antibiotics alone without surgical intervention and nine (22.5%) of these cases had no recurrence of DFO. There were no cases of major amputation or death. All centres showed significant in-centre variability in systemic antibiotic management; variability was reported in the clinical and quantity indicators specifically to antibiotic selection, single versus dual therapy, mode of delivery and duration of treatment. Conclusions: This case review identifies there is existing variation when treating adults with systemic antibiotics for DFO. Further national guidance is required to standardise service delivery and care to improve patient outcomes. [ABSTRACT FROM AUTHOR]

To improve the clinical and microbiological outcomes of non-surgical mechanical periodontal therapy, the adjunctive use of antimicrobials has been utilized in treating moderate-to-severe periodontitis. In our study, the retrospective design included previously collected health-related patient data, obtained from the printed and digital charts of patients who received systemic or local antibiotic adjuncts to SI (subgingival instrumentation). A total of 34 patients (diagnosed with generalized Stage III/IV periodontitis) met the inclusion and exclusion criteria and were evaluated. The samples were tested for the following bacterial strains: Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans), Porphyromonas gingivalis (P. gingivalis), Prevotella intermedia (P. intermedia), Tanererella forsythia (T. forsythia), and Treponema denticola (T. denticola). The inter-group comparisons of the bacterial species did not show statistically significant differences between groups. The present study aimed to evaluate the clinical effects after SI and the adjunctive use of systemically administered (SA) AMX (amoxicillin) + MET (metronidazole) (administered for 7 days), with locally delivered (LDD) piperacillin + tazobactam in step 2 of periodontal therapy. Results: Overall, all parameters were improved in the groups, with a significant difference in inter-group comparison regarding the full-mouth bleeding score (FMBS) (p < 0.05) in favor of the SA group, and the p-value < 0.05 was considered to be statistically significant. Statistically significant PPD (probing pocket depth) reductions and CAL (clinical attachment level) gains were observed in both groups at the 3-month follow-up. In conclusion, within the limitations, the outcomes of this study suggest that SI, with adjunctive local or systemic antibiotic therapy, provided comparable clinical improvements. Systemic AMX + MET protocols were more efficacious with regard to the reduction in FMBS. Follow-up studies with larger patient numbers are needed to further investigate this effect. [ABSTRACT FROM AUTHOR]

Targeting inflammatory pathways is considered a common strategy to control type 2 diabetes (T2D) and periodontitis. This overview was to validate systemic antibiotics as an adjuvant to scaling and root planing (SRP) for the treatments of periodontal patients with T2D. Literature searches were conducted using Web of Science, PubMed, Cochrane, and EMBASE. Randomized trials comparing SRP and systemic antibiotics on glycated hemoglobin (HbA1c) and probing pocket depth (PPD) in adults with T2D and periodontitis were analyzed using network meta-analysis and meta-regression. At 3-month postintervention, meta-analyses of 16 studies revealed that SRP and SRP plus systemic antibiotics (SRPa) had similar significant effects in reducing HbA1c levels of − 0.72% and − 0.96% respectively. While SRP and SRPa also, respectively, reduced PPD of − 0.67 and − 0.89 mm, SRPa showed a better reduction than SRP. At 6-month postintervention, meta-analyses of 7 trials revealed that only SRP was effective in reducing HbA1c levels (−0.29%) but not SRPa. Although both SRP and SRPa still significantly reduced PPD by − 0.56 and − 0.81 mm, respectively, there was no difference between them. The current overview suggested that routine SRP alone is highly recommended for patients with T2D and periodontitis, since systemic antibiotics as an adjuvant provide a rather short-term effect.

This scoping review systematically evaluates the use of systemic antibiotics in treating acute irreversible pulpitis, integrating clinical practice patterns with recent molecular insights. We analyzed clinical evidence on antibiotic prescription trends among dental professionals and examined molecular research advancements in relation to pulpitis. This review is intended to bridge the gap between clinical practice and molecular research, guiding more evidence-based approaches to treating acute irreversible pulpitis. Electronic databases were searched for relevant articles published in English based on the objective of the review. A second search using all identified keywords and index terms was undertaken across all the included databases. In addition, a reference list of identified articles was searched. Studies including original research, systematic reviews, meta-analyses, clinical trials, and observational and retrospective studies, all written in English and published from 2010 onwards, were included, and an analysis of the text words contained in the titles and abstracts of the retrieved papers and of the index terms used to describe the articles was performed. A total of N = 53 articles were selected. Altogether, N = 43 (76.79%) articles were cross-sectional studies, N = 4 (11.11%) were systematic reviews, and N = 3 (5.36%) were guidelines. The most frequent level of evidence was level VI (N = 43 (76.79%). The mean percentage of dentists who prescribed antibiotics to treat acute irreversible pulpitis was 23.89 ± 23.74% (range: 0.05–75.7). Similarly, for specialists, it was 22.41 ± 15.64 (range 2.2–50.4), and the percentage for undergraduates was 17.52 ± 20.59 (range 0–62.6). The significant developments in research models for pulpitis research and the characterisation of biomarkers have led to better management strategies. Concurrently, significant advancements in molecular research provide new understandings of pulpitis, suggesting alternative therapeutic approaches. Although there are guidelines available, increased rates of antibiotic prescription are still prevalent around the globe. [ABSTRACT FROM AUTHOR]

Targeting inflammatory pathways is considered a common strategy to control type 2 diabetes (T2D) and periodontitis. This overview was to validate systemic antibiotics as an adjuvant to scaling and root planing (SRP) for the treatments of periodontal patients with T2D. Literature searches were conducted using Web of Science, PubMed, Cochrane, and EMBASE. Randomized trials comparing SRP and systemic antibiotics on glycated hemoglobin (HbA1c) and probing pocket depth (PPD) in adults with T2D and periodontitis were analyzed using network meta-analysis and meta-regression. At 3-month postintervention, meta-analyses of 16 studies revealed that SRP and SRP plus systemic antibiotics (SRPa) had similar significant effects in reducing HbA1c levels of − 0.72% and − 0.96% respectively. While SRP and SRPa also, respectively, reduced PPD of − 0.67 and − 0.89 mm, SRPa showed a better reduction than SRP. At 6-month postintervention, meta-analyses of 7 trials revealed that only SRP was effective in reducing HbA1c levels (−0.29%) but not SRPa. Although both SRP and SRPa still significantly reduced PPD by − 0.56 and − 0.81 mm, respectively, there was no difference between them. The current overview suggested that routine SRP alone is highly recommended for patients with T2D and periodontitis, since systemic antibiotics as an adjuvant provide a rather short-term effect. [ABSTRACT FROM AUTHOR]

Abstract Background The aim of this systematic review (SR) was to evaluate the clinical efficacy of different adjunctive methods/therapies to the non-surgical treatment (NST) of peri-implantitis. Materials and methods The protocol of the review was registered in PROSPERO database (CRD42022339709) and was designed according to PRISMA statement. Electronic and hand searches were performed to identify randomized clinical trials (RCTs) comparing non-surgical treatment of peri-implantitis alone versus NST plus any adjunctive method/treatment. The primary outcome was probing pocket depth (PPD) reduction. Results Sixteen RCTs were included. Only 2 out of 1189 implants were lost and follow-up ranged from 3 to 12 months. PPD reduction across the studies varied from 0.17 to 3.1 mm, while defect resolution from 5.3% to 57.1%. Systemic antimicrobials were associated to higher PPD reduction (1.56 mm; [95% CI 0.24 to 2.89]; p = 0.02) with high heterogeneity, and treatment success (OR = 3.23; [95% CI 1.17 to 8.94]; p = 0.02), compared to NST alone. No differences were found with adjunctive local antimicrobials and lasers for PPD and bleeding on probing (BoP) reduction. Conclusions Non-surgical treatment with or without adjunctive methods may reduce PPD and BoP even if complete resolution of the pocket is unpredictable. Among possible adjunctive methods, only systemic antibiotics seems to provide further benefits, but their usage should be considered with caution.

Background: In India, states have licensed the manufacture of large numbers of fixed-dose combination (FDC) drugs without the required prior approval of the central regulator. This paper describes two major regulatory initiatives to address the problem, which began in 2007 and 2013, and examines whether they have been sufficient to remove centrally unapproved systemic antibiotic FDCs from the market. Methods: Information was extracted from documents published by the central regulator and the ministry of health, including the National List of Essential Medicines (NLEM), and court judgments, and analysed alongside sales volume data for 2008–2020 using PharmaTrac market dataset. Results: The regulatory initiatives permitted 68 formulations to be given de facto approvals ('No Objection Certificates') outside the statutory regime, banned 46 FDCs and restricted one FDC. Market data show that FDCs as a proportion of total antibiotic sales increased from 32.9 in 2008 to 37.3% in 2020. The total number of antibiotic FDC formulations on the market fell from 574 (2008) to 395 (2020). Formulations with a record of prior central approval increased from 86 (2008) to 94 (2020) and their share of the antibiotic FDC sales increased from 32.0 to 55.3%. In 2020, an additional 23 formulations had been permitted de facto approval, accounting for 10.6% of the antibiotic FDC sales. Even in 2020, most marketed formulations (70.4%, 278/395) were unapproved or banned, and comprised a 15.9% share of the antibiotic FDC sales. The share of NLEM-listed antibiotic FDC sales increased from 21.2 (2008) to 26.7% (2020). Conclusion: The initiatives had limited impact. Regulatory enforcement has been slow and weak, with many unapproved, and even banned, FDCs remaining on the market. [ABSTRACT FROM AUTHOR]

To improve the clinical and microbiological outcomes of non-surgical mechanical periodontal therapy, the adjunctive use of antimicrobials has been utilized in treating moderate-to-severe periodontitis. In our study, the retrospective design included previously collected health-related patient data, obtained from the printed and digital charts of patients who received systemic or local antibiotic adjuncts to SI (subgingival instrumentation). A total of 34 patients (diagnosed with generalized Stage III/IV periodontitis) met the inclusion and exclusion criteria and were evaluated. The samples were tested for the following bacterial strains: Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans), Porphyromonas gingivalis (P. gingivalis), Prevotella intermedia (P. intermedia), Tanererella forsythia (T. forsythia), and Treponema denticola (T. denticola). The inter-group comparisons of the bacterial species did not show statistically significant differences between groups. The present study aimed to evaluate the clinical effects after SI and the adjunctive use of systemically administered (SA) AMX (amoxicillin) + MET (metronidazole) (administered for 7 days), with locally delivered (LDD) piperacillin + tazobactam in step 2 of periodontal therapy. Results: Overall, all parameters were improved in the groups, with a significant difference in inter-group comparison regarding the full-mouth bleeding score (FMBS) (p < 0.05) in favor of the SA group, and the p-value < 0.05 was considered to be statistically significant. Statistically significant PPD (probing pocket depth) reductions and CAL (clinical attachment level) gains were observed in both groups at the 3-month follow-up. In conclusion, within the limitations, the outcomes of this study suggest that SI, with adjunctive local or systemic antibiotic therapy, provided comparable clinical improvements. Systemic AMX + MET protocols were more efficacious with regard to the reduction in FMBS. Follow-up studies with larger patient numbers are needed to further investigate this effect.

Background: The aim of this systematic review (SR) was to evaluate the clinical efficacy of different adjunctive methods/therapies to the non-surgical treatment (NST) of peri-implantitis. Materials and methods: The protocol of the review was registered in PROSPERO database (CRD42022339709) and was designed according to PRISMA statement. Electronic and hand searches were performed to identify randomized clinical trials (RCTs) comparing non-surgical treatment of peri-implantitis alone versus NST plus any adjunctive method/treatment. The primary outcome was probing pocket depth (PPD) reduction. Results: Sixteen RCTs were included. Only 2 out of 1189 implants were lost and follow-up ranged from 3 to 12 months. PPD reduction across the studies varied from 0.17 to 3.1 mm, while defect resolution from 5.3% to 57.1%. Systemic antimicrobials were associated to higher PPD reduction (1.56 mm; [95% CI 0.24 to 2.89]; p = 0.02) with high heterogeneity, and treatment success (OR = 3.23; [95% CI 1.17 to 8.94]; p = 0.02), compared to NST alone. No differences were found with adjunctive local antimicrobials and lasers for PPD and bleeding on probing (BoP) reduction. Conclusions: Non-surgical treatment with or without adjunctive methods may reduce PPD and BoP even if complete resolution of the pocket is unpredictable. Among possible adjunctive methods, only systemic antibiotics seems to provide further benefits, but their usage should be considered with caution. [ABSTRACT FROM AUTHOR]

Abstract Purpose To review the literature on endogenous subretinal abscess (SRA). Methods We searched in the literature for the terms ‘subretinal abscess’, ‘chorio-retinal abscess’ and ‘choroidal abscess’. Results A total of 122 patients were identified, of whom 20 patients (22 eyes) had no identified systemic infective foci (group 1) and 102 (120 eyes) had systemic infective foci (group 2). The mean age for group 1 was 44.6 years (range 2 weeks-82 years) and for group 2 was 43.2 years (range 1–89 years). The responsible pathogen was identified in 90% and 95% of cases, respectively. In group 1 the most frequent causative agents were Aspergillus and Nocardia, while in group 2 were Nocardia, Mycobacterium Tuberculosis and Klebsiella. In both groups the most common symptoms were reduced vision (70% and 72.5%, respectively), pain (65% and 29.4%, respectively) and redness (35% and 17.6%, respectively). For group 1 there was no difference between mean initial and final visual acuity (1.7 logMAR, range 0–3 logMAR), while for group 2 mean initial and final visual acuities were 0.8 logMAR and 0.6 logMAR, respectively. Final visual acuity was significantly better in group 2 (p = 0.003). Anterior segment inflammation was seen in 77.3% of cases of group 1 and 66.7% of cases of group 2. In both groups the abscess most common locations were posterior pole (45.4% and 32.5%, respectively) and temporal periphery (13.6% and 13.3%, respectively). Clinical features included hemorrhages (76.5% and 76.3%, respectively) and subretinal fluid (75% in both groups). Diabetes mellitus (20% and 25.5%) and immunosuppressive drug intake (35% and 23.5%) were the main predisposing factors for SRA. Combination of systemic and intravitreal antibiotics/antifungals and vitrectomy was the main therapeutic strategy for both groups. Systemic treatment alone was used mainly for cases of tubercular etiology. The timing of vitrectomy differed between the two groups, as it more commonly followed the use of systemic and intravitreal antibiotics in the forms associated with systemic infective foci. Additional abscess drainage or intralesional antibiotics were performed in 23.8% of cases. Conclusion At present no guideline exists for the treatment of subretinal abscess. Systemic broad-spectrum antibiotic treatment is of primary importance and should be used in all cases unless contraindicated. Combination of systemic and local treatment is the most frequently adopted strategy.

This review aimed to evaluate the effectiveness of systemic antibiotics as adjunctive treatment to subgingival debridement in patients with periodontitis. Randomized controlled trials were included that assessed the effectiveness of systemic antibiotics in improving periodontal status, indicated by clinical attachment gain level, probable pocket depth reduction, and bleeding on probing reduction of patients with any form of periodontitis at any follow-up time. Network meta-analyses with a frequentist model using random effects was employed to synthesize the data. The relative effects were reported as mean difference with a 95% confidence interval. Subsequently, all treatments were ranked based on their P-scores. A total of 30 randomized controlled trials were included in this network meta-analyses. Minimally important clinical differences were observed following the adjunctive use of satranidazole, metronidazole, and clindamycin for clinical attachment gain level and probable pocket depth reduction. For bleeding on probing reduction, minimally important clinical differences were observed following the adjunctive use of metronidazole and a combination of amoxycillin and metronidazole. However, the network estimates were supported by evidence with certainty ranging from very low to high. Therefore, the findings of this network meta-analyses should be interpreted with caution. Moreover, the use of these antibiotics adjunct to subgingival debridement should be weighed against possible harm to avoid overuse and inappropriate use of these antibiotics in patients with periodontitis. [ABSTRACT FROM AUTHOR]

Abstract Background Microbial biofilm accumulation is the main cause of peri-implantitis. The majority of surgical peri-implantitis treatment protocols suggests adjunctive use of systemic antibiotics to target specific putative bacteria. The aim of this systematic review was to critically evaluate the adjunctive use of systemically administered antibiotics in surgical treatment of peri-implantitis by reviewing previously published systematic reviews and primary studies. Methods A systematic literature search was conducted in four electronic databases (MEDLINE, The Cochrane Library, EMBASE, and Web of Science) for randomised controlled trials, cohort studies, case–control studies, and systematic reviews reporting surgical treatment of peri-implantitis with and without adjunctive systemically administered antibiotic therapy. The included systematic reviews and primary studies were qualitatively assessed using AMSTAR and GRADE, respectively. No restrictions were set for date of publication, journal, or language. Results The literature search identified 681 papers. Only seven systematic reviews and two primary studies met the inclusion criteria. Four out of seven included systematic reviews concluded that no evidence exists for use of systemic antibiotics to improve the clinical outcomes in surgical treatment of peri-implantitis. One review did not estimate the level of evidence, one did not clearly state any beneficial effect, whereas one reported a limited adjunctive effect. Further, the two included primary studies did not show a long-term significant benefit of adjunctive use of systemically administrated antibiotics. However, one study reported a short-term adjunctive effect in patients with modified surface implants. Due to heterogeneity in study design, low number of included primary studies, and grade of bias, no meta-analysis was performed. Conclusion The use of systemically administered antibiotics as an adjunct to surgical interventions of peri-implantitis cannot be justified as a part of a standard treatment protocol. A pervasive problem is the lack of uniform diagnosis criteria for peri-implantitis, deficient information about patient characteristics, absence of high quality long-term randomised controlled trials, and authors’ declaration on conflict of interest.

Purpose: To review the literature on endogenous subretinal abscess (SRA). Methods: We searched in the literature for the terms 'subretinal abscess', 'chorio-retinal abscess' and 'choroidal abscess'. Results: A total of 122 patients were identified, of whom 20 patients (22 eyes) had no identified systemic infective foci (group 1) and 102 (120 eyes) had systemic infective foci (group 2). The mean age for group 1 was 44.6 years (range 2 weeks-82 years) and for group 2 was 43.2 years (range 1–89 years). The responsible pathogen was identified in 90% and 95% of cases, respectively. In group 1 the most frequent causative agents were Aspergillus and Nocardia, while in group 2 were Nocardia, Mycobacterium Tuberculosis and Klebsiella. In both groups the most common symptoms were reduced vision (70% and 72.5%, respectively), pain (65% and 29.4%, respectively) and redness (35% and 17.6%, respectively). For group 1 there was no difference between mean initial and final visual acuity (1.7 logMAR, range 0–3 logMAR), while for group 2 mean initial and final visual acuities were 0.8 logMAR and 0.6 logMAR, respectively. Final visual acuity was significantly better in group 2 (p = 0.003). Anterior segment inflammation was seen in 77.3% of cases of group 1 and 66.7% of cases of group 2. In both groups the abscess most common locations were posterior pole (45.4% and 32.5%, respectively) and temporal periphery (13.6% and 13.3%, respectively). Clinical features included hemorrhages (76.5% and 76.3%, respectively) and subretinal fluid (75% in both groups). Diabetes mellitus (20% and 25.5%) and immunosuppressive drug intake (35% and 23.5%) were the main predisposing factors for SRA. Combination of systemic and intravitreal antibiotics/antifungals and vitrectomy was the main therapeutic strategy for both groups. Systemic treatment alone was used mainly for cases of tubercular etiology. The timing of vitrectomy differed between the two groups, as it more commonly followed the use of systemic and intravitreal antibiotics in the forms associated with systemic infective foci. Additional abscess drainage or intralesional antibiotics were performed in 23.8% of cases. Conclusion: At present no guideline exists for the treatment of subretinal abscess. Systemic broad-spectrum antibiotic treatment is of primary importance and should be used in all cases unless contraindicated. Combination of systemic and local treatment is the most frequently adopted strategy. [ABSTRACT FROM AUTHOR]

Systemic amoxicillin–metronidazole was proven to be effective in managing periodontitis in systemically healthy patients. It was demonstrated that systemic antibiotic therapy can effectively improve clinical periodontal parameters and reduce periodontopathogenic organisms in the subgingival biofilm. However, the evidence for prescribing this drug combination to patients with diabetes remains insufficient. This systematic review was designed to evaluate the effectiveness of a systemic amoxicillin–metronidazole combination as an adjunct to nonsurgical periodontal therapy in patients with diabetes presenting with chronic periodontitis. The PubMed, Scopus, and Web of Science databases were electronically searched for randomized clinical trials in January 2022. Randomized clinical trials evaluating systemic amoxicillin–metronidazole therapy as an adjunct to nonsurgical periodontal therapy in patients with type 2 diabetes presenting with periodontitis were selected for screening. The qualities of the studies were assessed using the Cochrane Collaboration's Tool for Assessing Risk of Bias Version 2.0 (ROB-2), and a GRADE assessment was applied to estimate the overall certainty of the evidence. Using predefined eligibility criteria, four clinical trials examining 209 patients were selected from the 611 articles identified in the search. Two studies reported a better reduction in clinical parameters when SRP was combined with systemic amoxicillin–metronidazole. Systemic amoxicillin–metronidazole was found to be as effective as clindamycin. Surgical therapy with systemic amoxicillin–metronidazole was more effective than nonsurgical therapy with systemic amoxicillin–metronidazole, even though both resulted in reduced clinical parameters. Combined amoxicillin–metronidazole was observed to reduce periodontal probing depth (PPD), clinical attachment level (CAL), and bleeding on probing (BOP) compared to no treatment or NSPT alone. However, the effect was not greater when compared to NSPT with clindamycin or surgical therapy with amoxicillin–metronidazole. Further randomized trials are required before clinical guidelines can be established for the use of systemic amoxicillin–metronidazole. Future randomized controlled clinical trials with long-term follow-ups are required to assess the efficacy of systemic antibiotic therapy in managing periodontitis in patients with diabetes. [ABSTRACT FROM AUTHOR]

Background: Osteomyelitis of the foot is a major complication of diabetes that can be limb and life threatening. Systemic antibiotic pharmacotherapy is often used first line to eradicate infection and allow restoration of devitalised bone. The aim is to conduct a systematic review of the effectiveness of systemic antibiotics on osteomyelitis of the foot in adults with diabetes mellitus. Methods: A systematic review of all interventional studies treating osteomyelitis with systemic antibiotics in participants with diabetes mellitus and an ulcer of the foot below the malleoli will be conducted. Studies not available in English and in people below the age of 18 will be excluded. Study selection will follow the Patient Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA-P guidelines). The quality of the studies will be assessed using the Cochrane risk-of-bias tool (RoB 2) for all randomised controlled trials and the Newcastle–Ottawa Scale (NOS) will be used for non-randomised controlled trials. Electronic databases will be searched with no timeline restrictions. Data Extraction: All identified references will be imported to the Rayyan Application. Studies for eligibility will be screened by two reviewers. One reviewer will perform the data extraction and quality appraisal will be conducted by two authors. If sufficient data is available, the quality will be analysed and a meta-analysis will be performed. Data synthesis will be conducted, and meta-analysis undertaken using RevMan 5.4.1 Meta-analysis software. Non-parametric data may be compared between selective intervention and outcomes. Discussion: The results of this systematic review will identify the effectiveness of systemic antibiotic therapy on osteomyelitis of the foot in people with diabetes based on the set outcome measure criteria. The findings will establish if there are existing consistent standards or variation in practice when treating diabetic foot osteomyelitis (DFO). The study may establish if guidelines are required to standardise practice when treating DFO with systemic antibiotic therapy. This systematic review protocol will synthesise the existing evidence on the effectiveness of systemic antibiotic therapy for treating DFO. Trial registration: International Prospective Register for Systematic Reviews (PROSPERO) number CRD42021245424. [ABSTRACT FROM AUTHOR]

Objective: To compare efficacy of systemic antibiotics alone and combination of systemic antibiotics with gentamicin cream in diabetic foot infections. Methods: Prospective Observational Study was conducted at Department of Surgery, Pakistan Ordinance Factories (POF) Hospital, Wah Cantt for duration of two years (January 2018-December 2019). A sample size of 140 diabetic foot infection patients (70 patients in each group) was calculated using WHO calculator. DFI patients were selected through non probability (consecutive) sampling technique. All patients signed consent forms before participation into study. Patients were randomly divided into two group (computer generated random number table); Group-A patients were given systemic antibiotics alone while Group-B was given combination of gentamicin cream and systemic antibiotics. SPSS version 24 was utilized for analysis purpose. Chi-square test was applied in our study. Results with p-value ≤0.05 found significant. Results: Total 140 patients were included in study. There were 87(62.1%) male and 53(37.9%) females in our data. Mean age of patients was 46 years ±11.3SD. Group-B (combination of gentamicin and systemic antibiotics) showed significant reduction in inflammation (p=0.03), culture negativity(p=0.001), increase clinical cure (p=0.02) and pathological eradication (p=0.03) as compared to Group-A (systemic antibiotics alone). Gender, age and duration of diabetes mellitus had insignificant association with outcomes (p>0.05). Conclusion: Diabetic foot infections are significant contributors of morbidity in our country. Combination of gentamicin cream with systemic antibiotics is highly effective in inflammation reduction, increasing clinical cure rate and pathological eradication as compared to systemic antibiotics alone in diabetic foot infections. Early identification of risk factors, proper patients care and multidisciplinary approach for diabetic foot infections prevention is required. [ABSTRACT FROM AUTHOR]

Background: Microbial biofilm accumulation is the main cause of peri-implantitis. The majority of surgical peri-implantitis treatment protocols suggests adjunctive use of systemic antibiotics to target specific putative bacteria. The aim of this systematic review was to critically evaluate the adjunctive use of systemically administered antibiotics in surgical treatment of peri-implantitis by reviewing previously published systematic reviews and primary studies. Methods: A systematic literature search was conducted in four electronic databases (MEDLINE, The Cochrane Library, EMBASE, and Web of Science) for randomised controlled trials, cohort studies, case–control studies, and systematic reviews reporting surgical treatment of peri-implantitis with and without adjunctive systemically administered antibiotic therapy. The included systematic reviews and primary studies were qualitatively assessed using AMSTAR and GRADE, respectively. No restrictions were set for date of publication, journal, or language. Results: The literature search identified 681 papers. Only seven systematic reviews and two primary studies met the inclusion criteria. Four out of seven included systematic reviews concluded that no evidence exists for use of systemic antibiotics to improve the clinical outcomes in surgical treatment of peri-implantitis. One review did not estimate the level of evidence, one did not clearly state any beneficial effect, whereas one reported a limited adjunctive effect. Further, the two included primary studies did not show a long-term significant benefit of adjunctive use of systemically administrated antibiotics. However, one study reported a short-term adjunctive effect in patients with modified surface implants. Due to heterogeneity in study design, low number of included primary studies, and grade of bias, no meta-analysis was performed. Conclusion: The use of systemically administered antibiotics as an adjunct to surgical interventions of peri-implantitis cannot be justified as a part of a standard treatment protocol. A pervasive problem is the lack of uniform diagnosis criteria for peri-implantitis, deficient information about patient characteristics, absence of high quality long-term randomised controlled trials, and authors' declaration on conflict of interest. [ABSTRACT FROM AUTHOR]

Abstract Background Osteomyelitis of the foot is a major complication of diabetes that can be limb and life threatening. Systemic antibiotic pharmacotherapy is often used first line to eradicate infection and allow restoration of devitalised bone. The aim is to conduct a systematic review of the effectiveness of systemic antibiotics on osteomyelitis of the foot in adults with diabetes mellitus. Methods A systematic review of all interventional studies treating osteomyelitis with systemic antibiotics in participants with diabetes mellitus and an ulcer of the foot below the malleoli will be conducted. Studies not available in English and in people below the age of 18 will be excluded. Study selection will follow the Patient Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA‐P guidelines). The quality of the studies will be assessed using the Cochrane risk‐of‐bias tool (RoB 2) for all randomised controlled trials and the Newcastle–Ottawa Scale (NOS) will be used for non‐randomised controlled trials. Electronic databases will be searched with no timeline restrictions. Data Extraction All identified references will be imported to the Rayyan Application. Studies for eligibility will be screened by two reviewers. One reviewer will perform the data extraction and quality appraisal will be conducted by two authors. If sufficient data is available, the quality will be analysed and a meta‐analysis will be performed. Data synthesis will be conducted, and meta‐analysis undertaken using RevMan 5.4.1 Meta‐analysis software. Non‐parametric data may be compared between selective intervention and outcomes. Discussion The results of this systematic review will identify the effectiveness of systemic antibiotic therapy on osteomyelitis of the foot in people with diabetes based on the set outcome measure criteria. The findings will establish if there are existing consistent standards or variation in practice when treating diabetic foot osteomyelitis (DFO). The study may establish if guidelines are required to standardise practice when treating DFO with systemic antibiotic therapy. This systematic review protocol will synthesise the existing evidence on the effectiveness of systemic antibiotic therapy for treating DFO. Trial registration International Prospective Register for Systematic Reviews (PROSPERO) number CRD42021245424.

Data on the impact of systemic antibiotics at the time of catheter insertion are scarce. Therefore, we assessed the association between concurrent antibiotic administration at insertion and short-term catheter-related infections. We used individual data gathered from five large, randomized, controlled ICU trials. We analysed adult patients who required arterial, short-term central venous or dialysis catheter insertion in the ICU. The effect of antibiotics at insertion on major catheter-related infection (MCRI), catheter-related bloodstream infection (CRBSI) and colonization was estimated using multivariate marginal Cox and propensity score models. We included 10 269 patients and 18 743 catheters from 36 ICUs. Antibiotic use was ongoing at the time of 11 361 catheter insertions (60.6%). After adjusting for well-known risk factors for intravascular catheter infection, we observed a similar risk for MCRI (HR 0.83, 95%CI 0.62–1.10, p 0.19) and CRBSI (HR 0.85, 95%CI 0.60–1.22, p 0.38) between the antibiotic and no-antibiotic groups. A confirmatory analysis using propensity score showed consistent results. No specific antibiotic subclasses reduced the risk of MCRI. Non-fermenting Gram-negative bacilli were more frequently observed in the antibiotic group. Ongoing antibiotic administration at the time of catheter insertion was not associated with a decrease risk of catheter-related infections and should not be carried out for preventing such infections. Our results bring new insights to antimicrobial stewardship in critically ill patients and may direct empirical antimicrobial therapy if an intravascular catheter infection is suspected. [ABSTRACT FROM AUTHOR]

This review aimed to evaluate the effectiveness of systemic antibiotics as adjunctive treatment to subgingival debridement in patients with periodontitis. Randomized controlled trials were included that assessed the effectiveness of systemic antibiotics in improving periodontal status, indicated by clinical attachment gain level, probable pocket depth reduction, and bleeding on probing reduction of patients with any form of periodontitis at any follow-up time. Network meta-analyses with a frequentist model using random effects was employed to synthesize the data. The relative effects were reported as mean difference with a 95% confidence interval. Subsequently, all treatments were ranked based on their P-scores. A total of 30 randomized controlled trials were included in this network meta-analyses. Minimally important clinical differences were observed following the adjunctive use of satranidazole, metronidazole, and clindamycin for clinical attachment gain level and probable pocket depth reduction. For bleeding on probing reduction, minimally important clinical differences were observed following the adjunctive use of metronidazole and a combination of amoxycillin and metronidazole. However, the network estimates were supported by evidence with certainty ranging from very low to high. Therefore, the findings of this network meta-analyses should be interpreted with caution. Moreover, the use of these antibiotics adjunct to subgingival debridement should be weighed against possible harm to avoid overuse and inappropriate use of these antibiotics in patients with periodontitis.

Systemic amoxicillin–metronidazole was proven to be effective in managing periodontitis in systemically healthy patients. It was demonstrated that systemic antibiotic therapy can effectively improve clinical periodontal parameters and reduce periodontopathogenic organisms in the subgingival biofilm. However, the evidence for prescribing this drug combination to patients with diabetes remains insufficient. This systematic review was designed to evaluate the effectiveness of a systemic amoxicillin–metronidazole combination as an adjunct to nonsurgical periodontal therapy in patients with diabetes presenting with chronic periodontitis. The PubMed, Scopus, and Web of Science databases were electronically searched for randomized clinical trials in January 2022. Randomized clinical trials evaluating systemic amoxicillin–metronidazole therapy as an adjunct to nonsurgical periodontal therapy in patients with type 2 diabetes presenting with periodontitis were selected for screening. The qualities of the studies were assessed using the Cochrane Collaboration’s Tool for Assessing Risk of Bias Version 2.0 (ROB-2), and a GRADE assessment was applied to estimate the overall certainty of the evidence. Using predefined eligibility criteria, four clinical trials examining 209 patients were selected from the 611 articles identified in the search. Two studies reported a better reduction in clinical parameters when SRP was combined with systemic amoxicillin–metronidazole. Systemic amoxicillin–metronidazole was found to be as effective as clindamycin. Surgical therapy with systemic amoxicillin–metronidazole was more effective than nonsurgical therapy with systemic amoxicillin–metronidazole, even though both resulted in reduced clinical parameters. Combined amoxicillin–metronidazole was observed to reduce periodontal probing depth (PPD), clinical attachment level (CAL), and bleeding on probing (BOP) compared to no treatment or NSPT alone. However, the effect was not greater when compared to NSPT with clindamycin or surgical therapy with amoxicillin–metronidazole. Further randomized trials are required before clinical guidelines can be established for the use of systemic amoxicillin–metronidazole. Future randomized controlled clinical trials with long-term follow-ups are required to assess the efficacy of systemic antibiotic therapy in managing periodontitis in patients with diabetes.

Objective: The aim of this update was to evaluate the use of local and systemic antibiotics for the treatment of periodontal diseases. PubMed and google scholar databases were used to search through the past 30 years of literature using selected search criteria "Periodontal diseases*[TW] AND (gingivitis*[TW] OR periodontitis*[TW] OR antibiotics*[TW])" to identify articles/book chapters discussing polymerization shrinkage and possible solutions. In total. 46 articles/book chapters met the criteria for inclusion in the literature review. Due to the accumulation of bacteria in the form of dental plaque, the tissues and bone surrounding the teeth can become infected leading to periodontal diseases such as gingivitis and periodontitis. The main purpose of periodontal therapy is to eliminate or control the undesired effects of these bacteria present in the oral cavity in the form of biofilms. The use of antibiotics in conjunction with mechanical instrumentation has been suggested for the successful treatment of periodontal diseases. It can be concluded that the use of antibiotics is justified in cases with rapid signs and symptoms of destruction of periodontal tissues. Hence, antibiotics are suggested in cases of aggressive periodontitis, periodontal abscess, necrotizing ulcerative gingivitis, necrotizing ulcerative periodontitis and periodontitis that do not respond well to mechanical instrumentation alone. However, antibiotics may cause side effects and the bacteria may develop resistance, therefore dentists should keep in mind the adverse effects and benefits while prescribing antibiotics. Moreover, antibiotics should always be given as an adjunct to mechanical instrumentation and oral hygiene instructions to achieve successful outcome. [ABSTRACT FROM AUTHOR]

Objectives: Antibiotic resistance is the main threat to health all over the world. The consumption of antibiotics is one of the factors causing the emergence of multidrug resistance. The purpose of this study was to recognize the patterns, trends, and changes of consumption in Iran and to compare them with those of Organization for Economic Co-operation and Development (OECD) countries. Methods: The data were collected from a national pharmaceutical wholesale data bank. Defined daily dose (DDD) or DDDs per 1000 inhabitants per day (DID) was calculated as a standard indicator for the consumption over 17 years. Results: Were benchmarked with the consumption of OECD countries. Drug utilization 90% (DU90%) method was used to assess the drug consumption pattern. Findings: The antibiotic consumption jumped up from 33.6 DID to 60 DID from 2000 to 2016. Compared to the average consumption of OECD countries, Iran has consumed antibiotics almost triple times. There were 9–11 chemical substances in the DU90% list during these years. Changes in DU90% list occurred within antibiotics classes during the study period. Although the total consumption growth was equal to 79% during these years, consumption of some pharmacological subgroups such as sulfonamide and aminoglycosides has decreased. Conclusion: Albeit the existence of surveillance system for health-related infectious diseases, the consumption of antibiotics has increased drastically, which illustrates the necessity of comprehensive and effective national antibiotic stewardship.

The aim of this follow-up study was, to compare the effects of mechanical periodontal therapy with or without adjunctive amoxicillin and metronidazole on the subgingival microbiome of smokers with periodontitis using 16S rDNA amplicon next generation sequencing. Fifty-four periodontitis patients that smoke received either non-surgical periodontal therapy with adjunctive amoxicillin and metronidazole (n = 27) or with placebos (n = 27). Subgingival plaque samples were taken before and two months after therapy. Bacterial genomic DNA was isolated and the V4 hypervariable region of the bacterial 16S rRNA genes was amplified. Up to 96 libraries were normalized and pooled for Illumina MiSeq paired-end sequencing with almost fully overlapping 250 base pairs reads. Exact ribosomal sequence variants (RSVs) were inferred with DADA2. Microbial diversity and changes on the genus and RSV level were analyzed with non-parametric tests and a negative binomial regression model, respectively. Before therapy, the demographic, clinical, and microbial parameters were not significantly different between the placebo and antibiotic groups. Two months after the therapy, clinical parameters improved and there was a significantly increased dissimilarity of microbiomes between the two groups. In the antibiotic group, there was a significant reduction of genera classified as Porphyromonas, Tannerella, and Treponema, and 22 other genera also decreased significantly, while Selenomonas, Capnocytophaga, Actinomycetes, and five other genera significantly increased. In the placebo group, however, there was not a significant decrease in periodontal pathogens after therapy and only five other genera decreased, while Veillonella and nine other genera increased. We conclude that in periodontitis patients who smoke, microbial shifts occurred two months after periodontal therapy with either antibiotics or placebo, but genera including periodontal pathogens decreased significantly only with adjunctive antibiotics.

The aim of this follow-up study was, to compare the effects of mechanical periodontal therapy with or without adjunctive amoxicillin and metronidazole on the subgingival microbiome of smokers with periodontitis using 16S rDNA amplicon next generation sequencing. Fifty-four periodontitis patients that smoke received either non-surgical periodontal therapy with adjunctive amoxicillin and metronidazole (n = 27) or with placebos (n = 27). Subgingival plaque samples were taken before and two months after therapy. Bacterial genomic DNA was isolated and the V4 hypervariable region of the bacterial 16S rRNA genes was amplified. Up to 96 libraries were normalized and pooled for Illumina MiSeq paired-end sequencing with almost fully overlapping 250 base pairs reads. Exact ribosomal sequence variants (RSVs) were inferred with DADA2. Microbial diversity and changes on the genus and RSV level were analyzed with non-parametric tests and a negative binomial regression model, respectively. Before therapy, the demographic, clinical, and microbial parameters were not significantly different between the placebo and antibiotic groups. Two months after the therapy, clinical parameters improved and there was a significantly increased dissimilarity of microbiomes between the two groups. In the antibiotic group, there was a significant reduction of genera classified as Porphyromonas, Tannerella , and Treponema , and 22 other genera also decreased significantly, while Selenomonas, Capnocytophaga, Actinomycetes , and five other genera significantly increased. In the placebo group, however, there was not a significant decrease in periodontal pathogens after therapy and only five other genera decreased, while Veillonella and nine other genera increased. We conclude that in periodontitis patients who smoke, microbial shifts occurred two months after periodontal therapy with either antibiotics or placebo, but genera including periodontal pathogens decreased significantly only with adjunctive antibiotics. [ABSTRACT FROM AUTHOR]

The extensive use of antibiotics and the development of antibiotic-resistant microbial strains represent a global concern, therefore during endodontic treatment these drugs should be considered mainly for patients with systemic diseases or with a localized congenital or acquired altered immunity. The prescription of antibiotics for endodontic infections is frequently empirical, which led to the increasing use of drugs with a broad spectrum, even in cases without such indications. The aim of our paper is to conduct a review on the current literature regarding the indications and use of antibiotics, in order to deliver proper recommendations for their prescription in patients under endodontic therapy. The conclusions show that amoxicillin is recommended alone or together with clavulanic acid, due to better absorption and lower risk of side effects, even though Penicillin V potassium, possibly combined with metronidazole is still effective in the majority of cases. [ABSTRACT FROM AUTHOR]

Periodontal diseases are infectious diseases with a mixed microbial aetiology and marked inflammatory response leading to destruction of underlying tissue. Periodontal therapy aims to eliminate pathogens associated with the disease and attain periodontal health. Periodontitis is generally treated by nonsurgical mechanical debridement and regular periodontal maintenance care. Periodontal surgery may be indicated for some patients to improve access to the root surface; however, mechanical debridement alone may not be helpful in all cases. In such cases, adjunctive systemic antibiotic therapy remains the treatment of choice. It can reach microorganisms at the base of the deep periodontal pockets and furcation areas via serum, and also affects organisms residing within gingival epithelium and connective tissue. This review aims to provide an update on clinical issues regarding when and how to prescribe systemic antibiotics in periodontal therapy. The points discussed are the mode of antibiotic action, susceptible periodontal pathogens, antibiotic dosage, antibiotic use in treatment of periodontal disease, and mechanism of bacterial resistance to each antibiotic.

Microbial biofilms in the oral cavity are involved in the etiology of various oral conditions, including caries, periodontal and endodontic diseases, oral malodor, denture stomatitis, candidiasis and dental implant failures. It is generally recognized that the growth of bacteria in biofilms imparts a substantial decrease in susceptibility to antimicrobial agents compared with cultures grown in suspension. It is therefore not surprising that bacteria growing in dental plaque, a naturally occurring biofilm, show increased resistance to antimicrobial agents. As result there is pronounced interest and keenness in the development of alternate antimicrobial concepts. Therefore, the application of alternative method to eradicate bacteria from periodontal pockets is desirable. One such approach is photodynamic therapy (PDT). The purpose of this review was to evaluate the effectiveness of PDT for periodontitis as an adjunct to non-surgical treatment of scaling and root planning. This review provides an overview of PDT with emphasis on its current status as an antimicrobial therapy to control oral bacteria. Finally, new frontiers of antimicrobial PDT research will be introduced, including targeting strategies that may open new opportunities for the maintenance of bacterial homeostasis in dental plaque, thereby providing the opportunity for more effective disease prevention and control. Thus, the available knowledge of PDT should encourage a more clinically oriented application of this technique.