Can anyone tell me what type of antibiotic can be prescribed after a root canal treatment to prevent per apical problem?
Dear Cajouste,
As a general rule you shouldn't need to prescribe antibiotics after routine root canal treatment. For example when RCT is performed to treat irreversible pulpitis, periapical periodontitis, etc. With these conditions the bacterial load is contained with the pulp and root canals and therefore the irrigant used during the procedure (e.g. hyochlorite or chlorhexidine) should kill these bacteria and allow the body to fight infection and heal itself apically. We should always be mindful or the impact of prescribing antibiotics upon antibiotic resistance.
The patient should only receive antibiotics if there are signs of systemic infection or gross localised pain and soft tissue swelling (however in this case extraction of the tooth may be a better course of treatment). While it is common practice to give a broad spectrum penicillin such as Amoxicillin (250-500mg three times daily for 5-7 days) you may wish to add more anaerobic bacterial cover such as the addition of Metronidazole or switch to Co-amoxiclav (Amoxicillin and clavulinic acid).
However, in summary you shouldn't prescribe antibiotics after routine root canal treatment. Best practice is to monitor the patient and review your treatment with escalation if necessary.
Hope this helps,
Karl
ok so if we have this evidence and we have a Cochrane review on this topic http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004969.pub2/abstract
But in a recent study conducted in Spain a substantial number (86%) of respondents continue to Rx antibiotics!!! See [Segura-Egea JJ, Velasco-Ortega E, Torres-Lagares D, Velasco-Ponferrada MC, Monsalve-Guil L, Llamas-Carreras JM. Pattern of antibiotic prescription in the management of endodontic infections amongst Spanish oral surgeons. International Endodontic Journal 2010;43(4):342-50.0
WHY?
This is a very good question! Why don't the findings of research get translated to, and enacted in practice? Is it that the knowledge/ practice change doesn't reach the correct people? Is it that they don't "believe" the answers? Is it just too difficult to change practice because it means you weren't doing the right thing before? I'm sure there are many more, and more complex reasons for lack of translation of research into practice. As someone who "does" research I'd like to find out more about translation - anybody know anywhere good to find out more?
The evidence has been put into guidance ie has been 'translated' for quite some time. FGDP, AAE etc. The problem is .....lack of audit.. and control.. This may occur with other medical specialties but doesnt appear to have been identified as a priority by our profession. So lets solve the audit problem
I guess by translation, I'm thinking more of translation actually into the clinical setting - actioning the evidence. In the UK, remuneration is used as a carrot (or non-remuneration as a stick) but the evidence that these are directly linked to care provision is mixed...for example - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2864198/
I think if you look at the 'guidance' I have mentioned you will see that it has been prepared by clinicians for clinicians. Nik Palmer did most of the work for the FGDP and the AAE have this as the ' standard of care'.
The carrot and stick approach maybe no better or for that matter worse than other 'methods' and even if its mixed its OK ie there is benefit/no benefit as with most things.
Some benefit is better than no benefit and there is no evidence that implementing the carrot and stick approach will cause harm ie it is worse. So the "some benefit + lack of benefit" is better than doing nothing ie no benefit
Does that make sense?
Yes, it makes sense. I can't get access to the standards of care by FGDP even though I'm a fully examined and paid up member without paying extra which in itself is a barrier to general practitioners.
This probably applies to AEE as well..... it seems iniquitous more especially as Nik Palmer probably did all the work underpinned/funded thru NIHR for the benefit of FGDP and yet they wont release these without a fee. Somethings wrong with the 'system'. Is it broke? EBM seems broken did you see the posts on BMJ?
http://www.bmj.com/content/348/bmj.g22?tab=responses Seen my comment 6th Jan..??
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