Reconsidering the Evidence for Routine Dental Implant Antibiotic Prophy

In 2017, the World Health Organization officially sounded the alarm: The world is running out of antibiotics. While it’s hard to wrap our heads around that headline, it’s a hard truth, and we need to face it, just as surely as we need to face other threats to our long-term survival as a species.

There are very few new antibiotic drugs in the development pipeline today, according to WHO, that are classed as “innovative treatments that will add value to the current antibiotic treatment arsenal.” That is because most drugs under development at the time of the WHO survey were either modifications of existing classes of drugs, or would not treat the twelve classes of priority pathogens that are becoming increasingly antibiotic-resistant:

Priority 1: CRITICAL

  • Acinetobacter baumannii, carbapenem-resistant
  • Pseudomonas aeruginosa, carbapenem-resistant
  • Enterobacteriaceae, carbapenem-resistant, ESBL-producing

Priority 2: HIGH

  • Enterococcus faecium, vancomycin-resistant
  • Staphylococcus aureus, methicillin-resistant, vancomycin-intermediate and resistant
  • Helicobacter pylori, clarithromycin-resistant
  • Campylobacter spp., fluoroquinolone-resistant
  • Salmonellae, fluoroquinolone-resistant
  • Neisseria gonorrhoeae, cephalosporin-resistant, fluoroquinolone-resistant

Priority 3: MEDIUM

  • Streptococcus pneumoniae, penicillin-non-susceptible
  • Haemophilus influenzae, ampicillin-resist

Since new drugs to combat bacterial illness do not seem to be an option in the near future, it is incumbent on prescribing professionals in every medical field to ensure we are cautious, responsible stewards of these medications. Once antibiotic resistance has established itself among virulent pathogenic strains with high potential for transmission, mortality and morbidity, we may not be able to easily make up lost ground.

This is where dentists come in, and with emerging science on their side, they can be superheroes in the fight against antibiotic resistance.

In March 2019, the journal Clinical Oral InvestigationsI published the results of a meta-analysis intended to survey evidence surrounding the efficacy of antibiotic prophylaxis for post-operative infection (POI) in overall healthy patients. An assessment of 1,022 abstracts and 22 full-text articles (1,934 patients) did not detect differences in POI rates between antibiotic and non-antibiotic-treated groups of patients, either at either 1-2 weeks or at 3-4 months post-op.

The study’s authors conclude their results are grounds for a full revaluation of antibiotic prophylaxis regimens, and it is difficult to conclude differently among rising concerns that we may be in danger of losing first-line and even second-line antibiotic effectiveness against some pathogens.

If we work together as interdisciplinary health professionals to educate patients, monitor them closely, and find ways to minimize unnecessary antibiotic prescriptions today, we may buy ourselves time—safely, without risking lives or health. With that time, our pharmaceutical development efforts can, I hope, stave off the coming antibiotic crisis until the point at which advances in artificial intelligence, understanding of the human genome, and pharmacy science are ready to outwit the bacteria once again.

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