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21/03/2007 à 01h25
Petit morceau d'un article sur l'inefficacité des ATB lors de pulpites irréversibles:
Study selection
Randomised controlled trials (RCT) were included that involved patients over the age of 18 years who had presented with a single tooth with a clinical diagnosis of irreversible pulpitis.
Results
One trial of 40 participants was included. There was a close parallel distribution of the pain ratings in both the intervention and placebo groups over the 7-day study period. The between-group differences in sum pain intensity differences for the penicillin group were 6.010.5, and for placebo 6.09.5 (P=0.776; differences assessed by MannWhitneyWilcoxon test considered to be statistically significant at P=0.05). The sum pain percussion intensity differences for the penicillin group were 3.57.5 and placebo 2.07.0 (P=0.290). There was no significant difference in the mean total number of ibupro-fen tablets (P=0.839) and acetaminophen tablets (P=0.325) taken for pain relief in either group over the study period. The administration of penicillin over placebo did not appear to significantly reduce the quantity of analgesic medication taken (P=0.05) for irreversible pulpitis.
Conclusions
This review based on one methodologically sound but low-powered small sample trial, provides some evidence that there is no significant difference in pain relief between individuals who had untreated irreversible pulpitis who did or did not take antibiotics in addition to analgesics.
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Commentary
The clinical question asked in this review is an important one. Intuitively, the answer is "no", since irreversible pulpitis is not an infection. Nevertheless, numerous studies have shown that there is widespread inappropriate use of antibiotics: up to 74% of people who have pulpitis are given a prescription for antibiotics.1
This report, an excellent example of a high quality rigorous systematic review2 examined early stage pulpal disease and found that systemic antibiotics are not effective in relieving pain in these patients. Although only one RCT was located, despite a comprehensive search strategy, the review concurs with the results of two meta-analyses which studied various interventions in acute apical periodontitis3 and acute apical abscess,4 both of which concluded that there is no evidence to support the use of prophylactic antibiotics in the management of localised endodontic disease in healthy patients.
With the increase in multidrug-resistant infections such as methicillin-resistant staphylococcus aureus (MRSA), a major and very serious nosocomial pathogen which is also emerging in the community, most, if not all, dentists would disapprove of inappropriate use of antibiotics in the abstract situation. While antibiotics are appropriate for patients with serious systemic infection, when confronted with a suffering patient and armed with personal or anecdotal experience of the rare patient whose condition has progressed from pulpitis to serious systemic infection, many clinicians are tempted to prescribe antibiotics despite the evidence of ineffectiveness, believing that this will provide more benefit than harm for their individual patient.
etc...
E. Tavander - Evidence-Based Dentistry (2005)
21/03/2007 à 01h28
tonio Wrote:
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> Petit morceau d'un article sur l'inefficacité des
> ATB lors de pulpites irréversibles:
>
>
Tu viens de te degoter un code d'acces à la littérature ou quoi ?
21/03/2007 à 01h34
annie Wrote:
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> qui donne des AB pour une pulpite?
beaucoup de praticiens