Effects Of Antibiotic Administration On Post-Operative Endodontic Symptoms In Patients With Pulpal Necrosis: A Systematic Review And Meta-Analysis

Objectives The current systematic review and meta-analysis aimed to assess the efficacy of prophylactic oral antibiotics in the management of post-operative endodontic symptoms in adults with necrotic pulp. Materials and methods A systematic search up to April 2020 was performed to find all randomised controlled trials (RTCs) comparing oral antibiotics with placebo to manage post-endodontic symptoms. The outcome measures were post-operative pain, swelling and/or the combined pain and swelling at different follow-ups. Standardised mean differences (SMDs) and 95% confidence intervals (CIs) were estimated using random-effect inverse-variance method. Additional analysis was performed if heterogeneity existed (P < .05). Results For post-endodontic pain, 8 RCTs (n = 690) were included. Antibiotic prescription had no significant effect on endodontic pain at 6 (SMD = -0.008, 95% CI -0.279 - 0.264,P = .95), 12 (SMD = -0.080, 95% CI -1.39 - 1.23,P = .90), 24 (SMD = -0.044, 95% CI -0.29 - 0.20,P = .72), 48 (SMD = 0.18, 95% CI -0.26 - 0.62,P = .42) and 72 h (SMD= -0.050, 95% CI -0.33 - 0.23,P = .723) post-operatively. For post-endodontic swelling, 4 RCTs (n = 149) were included. Antibiotic prescription had no significant effect on endodontic swelling at 24 (SMD = 0.29, 95% CI -0.72 - 1.32,P = .56), 48 (SMD = -0.23, 95% CI -0.98 - 0.51,P = .54) and 72 hours (SMD= -0.03, 95% CI -1.25 - 1.33,P = .96), post-operatively. For combined pain and swelling, no meta-analysis was performed. Conclusion The administration of prophylactic antibiotics to prevent post-operative endodontic symptoms is not supported by the current evidence.