Antibiotics for Apical Periodontitis and Acute Apical Abscess: Cochrane Review

Method: The Cochrane Oral Health Group Trials Register; CENTRAL; MEDLINE; EMBASE and CINAHL were searched to identify trials; the WHO International Trials Registry Platform and US NIH Trials Registry for ongoing studies, and Open Grey and ZETOC Conference Proceedings for grey literature. Searches were completed in October 2013. 

Result: Two studies meeting the inclusion criteria compared penicillin VK and a matched placebo for adults with acute apical abscess or a symptomatic necrotic tooth when provided in combination with partial/total pulpectomy. Participants in both trials also received oral analgesics. There were no statistically significant differences in patient-reported measures of pain or swelling at any of the time points assessed within the review. The Mean Difference (antibiotic group) for pain (short ordinal numerical scale 0 to 3) was: -0.03 (95% CI -0.53 to 0.47) at 24 hours; 0.32 (95% CI -0.22 to 0.86) at 48 hours; 0.08 (95% CI -0.38 to 0.54) at 72 hours. The Standard Mean Difference (antibiotic group) for swelling was 0.27 (95% CI -0.23 to 0.78) at 24 hours; 0.04 (95% CI -0.47 to 0.55) at 48 hours and 0.02 (95% CI -0.49 to 0.52) at 72 hours. No studies compared the effects of systemic antibiotics with a matched placebo delivered without a surgical intervention for symptomatic apical periodontitis or acute apical abscess in adults.

Conclusion: There is insufficient evidence to determine the effects of systemic antibiotics on adult patients with symptomatic apical periodontitis or acute apical abscess. The two trials were low powered and assessed as being at unclear and high risk of bias respectively. The overall quality of evidence was judged to be very low.