| Abstract | Cilj: Glavni cilj istraživanja bio je utvrditi stavove o opravdanosti primjene antibiotika u endodonciji na području Republike Hrvatske.
Materijali i metode: Provedeno je presječno istraživanje koje je uključilo doktore dentalne medicine u Republici Hrvatskoj u razdoblju od početka svibnja do kraja kolovoza 2018. godine. Istraživanje je temeljeno na on-line anketnom upitniku kojeg su ispitanici anonimno ispunjavali. Prvo pitanje odnosilo se na ispitanikovu dob, dok se su se ostala pitanja bazirala na različite kliničke slučajeve u kojima su ispitanici dali svoja mišljenja o mogućem propisivanju antibiotika. Istraživanje je odobrilo Etičko povjerenstvo Medicinskog fakulteta Sveučilišta u Splitu.
Rezultati: Ispunjena je ukupno 141 on-line anketa. Kada su u pitanju zdravi pacijenti, 7,09% ispitanika propisalo bi antibiotik za simptomatski ireverzibilni pulpitis, a 2,13% za polip pulpe. Prethodno endodontskom zahvatu u svrhu izjegavanja postoperativnih komplikacija, 3,55% ispitanika propisalo bi antibiotik za pulpitis, 12,05% za nekrozu pulpe, a 19,85% za kronični apikalni parodontitis. 56,73% ispitanika propisalo bi antibiotik za lokaliziranu fluktuirajuću oteklinu bez pojave sistemskih znakova infekcije (povišene temperature i limfadenopatije). U slučaju boli unutar tri dana nakon uspješno obavljenog endodontskog zahvata, antibiotik bi propisalo 12,05% ispitanika, a u slučaju postojanja fistule koja ne prolazi unatoč višeposjetnom endodontskom liječenju 48,22% ispitanika. Rizičnim pacijentima prilikom trepanacije zubne pulpe, antibiotsku profilaksu propisalo bi 41,84% ispitanika, prilikom pleksus anestezije 9,93%, a prilikom provodne anestezije 16,32%. Prije intraligamentarne anestezije antibiotsku profilaksu rizičnim pacijentima propisalo bi 34,04% ispitanika. Pacijente s oštećenim ili kongenitalno malformiranim srčanim zaliscima, indikacijom za profilaksu smatra 70,21% ispitanika, a pacijente s umjetnim zglobom kuka 28,36%. Nekoliko ispitanika propisalo bi antibiotik unutar dvije godine od ugradnje proteze. Pacijentima na imunosupresivnoj terapiji antibiotik bi profilaktički propisalo 54,6% ispitanika.
Zaključci: Ovo istraživanje ukazuje na navike ispitanika koje nisu u skladu s najnovijim smjernicama o propisivanju antibiotika u endodonciji. Terapijsko propisivanje antibiotika je prekomjerno dok se antibiotska profilaksa u rizičnih pacijenata za određene slučajeve ne provodi u dovoljnoj mjeri. |
| Abstract (english) | Objective: The main purpose of this research was to determine attitudes of dental medicine doctors in Croatia regarding the proper use of antibiotic in endodontics.
Material and Methods: A cross-sectional study included dental practitioners in Republic of Croatia from the beginning of May to the end of August 2018. The research was based on an online questionnaire in which participants filled out their answers anonymously. The first question referred to the respondent's age, while the other questions were based on a different clinical cases in which respondents gave their opinions about possible antibiotic prescribing. The study was approved by the Ethics Committee of the University of Split School of Medicine.
Results: A total of 141 online surveys were completed. 7.09% of respondents would prescribe an antimicrobial therapy for symptomatically irreversible pulpitis and 2.13% for pulp polyp for healthy patients. Prior to endodontic treatment, in addition to avoid postoperative complications, 3.55% of respondents would prescribe antibiotics for pulpitis, 12.05% for pulp necrosis and 19.85% for chronic apical periodontitis. 56.73% of respondents would prescribe an antibiotic for localized fluctuating swelling without the appearance of systemic signs of infection (elevated body temperature and lymphadenopathy). In the case of pain, within three days of successfully completed endodontic treatment, an antibiotic would be prescribed by 12.05% of dentists and in the case of fistula that persists despite the multipath endodontic treatment, 48.22% of dentists. For the purpose of dental pulp trepanation in immunocompromised patients, antibiotic prophylaxis would be prescribed by 41.84% of respondents, during infiltration anesthesia 9.93% and during block anesthesia 16.32%. Before intraligmental anesthesia, antibiotic prophylaxis in immunocompromised patients would be prescribed by 34.04% of respondents. Patients with damaged or congenital valvular malformations are considered to be indication for antibiotic prophylaxis by 70.21% of the respondents and patients with hip joint prosthesis by 28.36%. Few respondents would prescribe antibiotics within two years of joint operation. To the patients on immunosuppressive therapy, antibiotic would prophylactically be prescribed by 54.6% of the respondents.
Conclusions: This study shows that attitudes of respondents are not in line with the latest guidelines on prescribing antibiotics in endodontics. Therapeutic prescribing of antibiotics is excessive while antibiotic prophylaxis in immunocompromised patients in certain cases is not sufficiently implemented. |
