Cochrane · intervention · CD004969

Antibiotic use for irreversible pulpitis

Agnihotry, A, Thompson, W, Fedorowicz, Z, et al. · Cochrane Database of Systematic Reviews · 2019 · Cochrane Library

Oral Health Endodontics and dental trauma5 versionsAMSTAR 2: not assessed

Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.

Questions

5

current version

GRADE rated

3

No studies

2

Included studies

1

as reported

No studies 2 · 40%Ungraded 0 · 0%Very low 0 · 0%Low 3 · 60%Moderate 0 · 0%High 0 · 0%

Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.

Review question

Element	Planned (methods)	Found (results)
Population	Adults over 18 years presenting with a single tooth with a clinical diagnosis of irreversible pulpitis (traumatised teeth excluded)	Forty adult patients (17 male, 23 female), age range 30 to 34 years, presenting as an emergency with spontaneous moderate to severe pain associated with a tooth (n=40)
Intervention	Administration of any systemic antibiotic at any dosage plus any analgesic at any dosage in the acute preoperative phase of irreversible pulpitis	Penicillin 500 mg plus analgesics (ibuprofen 600 mg; acetaminophen with codeine 30 mg) (n=20)
Comparison	Administration of placebo plus any analgesic at any dosage in the acute preoperative phase of irreversible pulpitis	Placebo plus analgesics (n=20)
Outcomes	Patient-reported pain (intensity/duration) and pain relief on a categorical scale; Type, dose and frequency of medication required for pain relief; Any adverse effects related to hypersensitivity or other reactions to antibiotics or analgesics	Patient-reported pain intensity SPID and SPPID (n=40); Patient-reported pain relief (not reported); Total ibuprofen tablets (n=40); Total paracetamol + codeine tablets (n=40); Number of adverse events (not reported)
Study designs	Randomised controlled trials (RCTs)	Randomised double-blind placebo-controlled trial (n=1)
Timing	Acute preoperative phase (pre-endodontic treatment)	7-day follow-up (n=1)

Search date: 2019-02. Databases: Cochrane Oral Health's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid; Embase Ovid; ClinicalTrials.gov; WHO International Clinical Trials Registry Platform

Questions and results

Current version only

Systemic antibiotic (oral penicillin 500 mg) plus analgesic vs Placebo plus analgesic

Population: Adults over 18 years presenting with a single tooth with a clinical diagnosis of irreversible pulpitis

CD004969.PUB5 (current) · 5 questions

Outcome	Effect	Evidence	Status / GRADE
Total number of ibuprofen tablets 7 days same question in other reviews	MD -0.40 [-4.23, 3.43] -0.40 [-4.23, 3.43] tablets	1 study · 40 participants	Low Downgraded: imprecision
Number of adverse events same question in other reviews	Number of adverse events: Outcome not reported.	NR	No studies
Patient-reported pain intensity (sum of pain intensity difference (SPID) and sum of pain percussion intensity difference (SPPID)) 7 days same question in other reviews	Corresponding risk (Antibiotics): The in between-group differences (median +/- IQR) in SPID for the penicillin group were 6.0 +/- 10.5, and for placebo 6.0 +/- 9.5. The SPPID for the penicillin group was 3.5 +/- 7.5…	1 study · 40 participants	Low Downgraded: imprecision
Total number of paracetamol (acetaminophen) with codeine (Tylenol) tablets 7 days same question in other reviews	MD 2.45 [-1.23, 6.13] 2.45 [-1.23, 6.13] tablets	1 study · 40 participants	Low Downgraded: imprecision
Patient-reported pain relief same question in other reviews	Patient-reported pain relief: Outcome not reported.	NR	No studies

Systemic antibiotic (oral penicillin 500 mg) plus analgesic vs Placebo plus analgesic

Population: Adults over 18 years presenting with a single tooth with a clinical diagnosis of irreversible pulpitis

CD004969.PUB4 · 5 questions

Outcome	Effect	Evidence	Status / GRADE
Patient-reported pain relief	Patient-reported pain relief - not reported. Illustrative comparative risks: See comment. Relative effect: Not estimable. No of participants (studies): -. Quality: See comment. Comment: Not assessed.	NR	No studies
Patient-reported pain intensity (sum of pain intensity difference (SPID) and sum of pain percussion intensity difference (SPPID)) 7 days	Illustrative comparative risks (Study population): Not estimable. Relative effect (95% CI): Not estimable. 40 (1 study). Quality: low. Comment: The in-between group differences in SPID and SPPID were not statistically…	1 study · 40 participants	Low Downgraded: imprecision
Total number of ibuprofen tablets 7 days	MD -0.40 [-4.23, 3.43] -0.40 [-4.23, 3.43] tablets	1 study · 40 participants	Low Downgraded: imprecision
Number of adverse events	Number of adverse events - not reported. Illustrative comparative risks: See comment. Relative effect: Not estimable. No of participants (studies): -. Quality: See comment. Comment: Not assessed.	NR	No studies
Total number of paracetamol (acetaminophen) with codeine (Tylenol) tablets 7 days	MD 2.45 [-1.23, 6.13] 2.45 [-1.23, 6.13] tablets	1 study · 40 participants	Low Downgraded: imprecision

Systemic antibiotic (oral penicillin 500 mg) plus analgesic vs Placebo plus analgesic

Population: Adults over 18 years presenting with a single tooth with a clinical diagnosis of irreversible pulpitis

CD004969.PUB3 · 5 questions

Outcome	Effect	Evidence	Status / GRADE
Total number of ibuprofen tablets 7 days	MD -0.40 [-4.23, 3.43] -0.40 [-4.23, 3.43] tablets	1 study · 40 participants	Low Downgraded: imprecision
Number of adverse events	Number of adverse events - not reported. Illustrative comparative risks: See comment. Relative effect: Not estimable. No of participants (studies): -. Quality: See comment. Comment: Not assessed.	NR	No studies
Patient-reported pain relief	Patient-reported pain relief - not reported. Illustrative comparative risks: See comment. Relative effect: Not estimable. No of participants (studies): -. Quality: See comment. Comment: Not assessed.	NR	No studies
Patient-reported pain intensity (sum of pain intensity difference (SPID) and sum of pain percussion intensity difference (SPPID)) 7 days	Illustrative comparative risks (Study population): Not estimable. Relative effect (95% CI): Not estimable. 40 (1 study). Quality: low. Comment: The in-between group differences in SPID and SPPID were not statistically…	1 study · 40 participants	Low Downgraded: imprecision
Total number of paracetamol (acetaminophen) with codeine (Tylenol) tablets 7 days	MD 2.45 [-1.23, 6.13] 2.45 [-1.23, 6.13] tablets	1 study · 40 participants	Low Downgraded: imprecision

Systemic antibiotic (oral penicillin 500 mg) plus analgesic vs Placebo plus analgesic

Population: Adults over 18 years presenting with a single tooth with a clinical diagnosis of irreversible pulpitis

CD004969.PUB2 · 4 questions

Outcome	Effect	Evidence	Status / GRADE
Total number of paracetamol (acetaminophen) with codeine (Tylenol) tablets 7 days	Total number of Tylenol tablets (mean +/- SD): penicillin 6.9 +/- 6.87, placebo 4.45 +/- 4.82, P = 0.325. No significant difference.	1 study · 40 participants	Ungraded
Number of adverse events	No adverse effects to either the antibiotics or analgesics were reported in this trial.	1 study · 40 participants	Ungraded
Patient-reported pain intensity (sum of pain intensity difference (SPID) and sum of pain percussion intensity difference (SPPID)) 7 days	SPID (median +/- IQR): penicillin 6.0 +/- 10.5, placebo 6.0 +/- 9.5, P = 0.776. SPPID: penicillin 3.5 +/- 7.5, placebo 2.0 +/- 7.0, P = 0.290 (Mann-Whitney-Wilcoxon). Between-group differences not statistically…	1 study · 40 participants	Ungraded
Total number of ibuprofen tablets 7 days	Total number of ibuprofen tablets (mean +/- SD): penicillin 9.2 +/- 6.02, placebo 9.6 +/- 6.34, P = 0.839. No significant difference.	1 study · 40 participants	Ungraded

Systemic antibiotics (any, at any dosage) in the acute preoperative phase vs Analgesic, placebo, or no treatment

Population: Adults over 18 years presenting with a single tooth with a clinical diagnosis of irreversible pulpitis

CD004969 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR Acute preoperative phase	Protocol only (2004): no search conducted and no studies included. Planned comparison: systemic antibiotics versus placebo/analgesics/no treatment for pain relief in irreversible pulpitis.	NR	No studies