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Title Preoperative Antibiotics To Prevent Infection In Diabetics: An Expert Opinion
Clinical Question In diabetic dental patients, does routine use of antibiotics better prevent infection as opposed to no antibiotic use?
Clinical Bottom Line There appears to be no difference in susceptibility to infection between diabetic patients who received antibiotics prior to routine dental procedures and those who did not. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 10530114Alexander/1999Diabetic dental patientsExpert opinion
Key resultsThere is no evidence to suggest that well-controlled diabetic patients are more prone to infection than other dental patients. For this reason, antibiotics should only be administered to these patients in cases in which non-diabetic patients would also require them. However, once infected, diabetics may have a more difficult and prolonged course as the disease does affect the immune system. Therefore, poorly controlled diabetics should not receive elective care until their blood glucose levels are brought under control. Should they require emergency surgery, prophylactic antibiotics should be utilized as a precaution.
Evidence Search Search "Wound Healing"[Mesh], Search "Dental Care"[Mesh] Search "Anti-Bacterial Agents "[Pharmacological Action] Search "Diabetes Mellitus"[Mesh]
Comments on
The Evidence
The validity of this evidence is limited. The article is not a systematic review of randomized controlled trials, nor was a meta-analysis performed. A comprehensive Medline search of the literature from the past 25 years was executed, but the individual studies were never assessed for validity. The numbers of trials and patients are never given.
Applicability Considering the vast prevalence of diabetes, this evidence is very applicable, however it must be kept in mind that this is low level evidence.
Specialty/Discipline (Public Health) (Endodontics) (General Dentistry) (Oral Surgery) (Periodontics) (Prosthodontics)
Keywords Diabetes, dental infections, antibiotics
ID# 580
Date of submission: 04/01/2010spacer Revised: 10/13/2011
E-mail klassenc@livemail.uthscsa.edu
Author Carly Klassen
Co-author(s) e-mail
Faculty mentor/Co-author Thomas Oates, DMD, PhD
Faculty mentor/Co-author e-mail OATES@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
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by Thomas Oates (San Antonio, TX) on 01/17/2013
While there remains a lack of comparative studies addressing this question, we have demonstrated very good implant success in diabetic patients independent of glycemic control (PMID: 17332041). It should be noted that this study does not directly address the question, but it does support implant success in this patient population using post-operative antibiotics.
by Kevin Coppola, Mabel Macaden & Warrin Witten (San Antonio, TX) on 01/17/2013
A PubMed search conducted in January 2013 found a vastly limited amount of information on this topic. A more recent article published in 2008 was found (PubMed ID 18647376) that confirmed the CATs conclusions that there is a necessity to strengthen the evidence base in order to properly treat diabetic patients. It also mentioned that preventive antibiotics could produce a harmful effect of antibiotic resistance in patients and that this practice should not be employed until further research has been conducted.

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