牙科抗生素管理干预的系统回顾。

IF 1.8 3区 医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE Community dentistry and oral epidemiology Pub Date : 2024-10-14 DOI:10.1111/cdoe.13009
Leanne Teoh, Christin Löffler, Michelle Mun, Anirudha Agnihotry, Harpinder Kaur, Karen Born, Wendy Thompson
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引用次数: 0

摘要

背景:抗菌药耐药性是对全球健康的重大威胁。抗菌药物管理就是通过减少不适当的抗菌药物处方来应对这一问题。牙医开具的抗生素处方约占全球抗生素处方总量的 10%,但高达 90% 的牙医抗生素处方是不恰当的。本系统性综述旨在更新 2017 年的一篇综述,利用牙科抗生素管理核心成果的国际共识,评估牙科抗生素管理干预措施的效果:方法:于 2023 年 4 月对以下数据库进行了系统检索:方法:2023 年 4 月,对以下数据库进行了系统检索:Cochrane 口腔健康组试验登记、Cochrane 对照试验中央登记、MEDLINE(通过 OVID)、EMBASE(通过 OVID)、Dentistry and Oral Sciences Source、美国国立卫生研究院试验登记、世界卫生组织国际临床试验登记平台和 ISRCTN 登记数据库。关于优化和/或减少牙科抗生素处方的干预措施的随机对照试验(或明确报告了分组机制和纳入标准的非随机研究)均符合纳入条件。两名作者独立筛选符合条件的研究。使用 Cochrane Risk of Bias 2 工具评估偏倚风险,使用 GRADE 评估证据的确定性。如果研究结果报告相似,则计划进行荟萃分析,否则进行叙述性综合分析:共纳入三项符合条件的研究,随机抽取了 2148 名参与者。干预措施包括教育、审核和反馈以及书面行为改变信息、指南摘要、实践访问和患者宣传单。对照组均未接受干预。所纳入的三项研究都对处方抗生素的数量进行了测量,其中两项研究对处方的适当性进行了测量。没有一项研究测量了患者报告的结果或不良后果。两项纳入研究被评估为 "高风险 "偏倚,一项为 "低风险 "偏倚。有高度确定性的证据表明,审计和个性化反馈以及个性化行为改变信息是有效的。现场教育的证据确定性较低。仅靠指南传播无法有效改善抗生素处方。由于报告的结果不同,因此不适合进行荟萃分析:尽管文献中报道了各种牙科抗生素监管干预措施,但没有一项提供了高确定性的有效性证据,仅有三项采用随机设计进行了评估。为了加强证据库,建议进行有充分证据支持的、可靠的随机对照试验,并进行充分的随访,报告国际公认的核心结果,包括平行的过程评估:试验注册:prospero (CRD42023411476)。
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A Systematic Review of Dental Antibiotic Stewardship Interventions.

Background: Antimicrobial resistance is a significant threat to global health. Antimicrobial stewardship is reducing inappropriate antimicrobial prescribing to counter it. Dentists prescribe ~10% of all antibiotics worldwide, yet up to 90% of antibiotic prescriptions by dentists are inappropriate. The aim of this systematic review was to update a 2017 review evaluating the effects of antibiotic stewardship interventions in dental settings, using the international consensus on core outcomes for dental antibiotic stewardship.

Methods: Systematic database searches were undertaken in April 2023, of the: Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials, MEDLINE via OVID, EMBASE via OVID, Dentistry and Oral Sciences Source, the US National Institutes of Health Trials Register, the World Health Organisation International Clinical Trials Registry Platform and the ISRCTN registry databases. Randomised controlled trials (or non-randomised studies with clearly reported mechanism of group formation and inclusion criteria) of interventions to optimise and/or reduce dental antibiotic prescribing were eligible for inclusion. Two authors independently screened for eligible studies. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, certainty of evidence assessed using GRADE. Meta-analysis was planned whether the results of studies reported similar outcomes, otherwise narrative synthesis was undertaken.

Results: Three eligible studies randomising 2148 participants were included. The interventions were combinations of education, audit and feedback and written behaviour change messages, guideline summary, practice visits and patient leaflets. None of the control groups received an intervention. All three included studies measured the quantity of antibiotics prescribed and two measured the appropriateness of prescribing. None measured patient-reported or adverse outcomes. Two included studies were assessed as 'high risk' and one with 'low risk' of bias. There was high-certainty evidence that audit and personalised feedback with individualised behaviour change messages can be effective. Evidence for in-person education was low-certainty. Guideline dissemination alone was ineffective at improving antibiotic prescribing. Due to different outcomes reported, meta-analysis was inappropriate.

Conclusion: Although various dental antibiotic stewardship interventions have been reported in the literature, none provided high-certainty evidence of effectiveness and only three have been evaluated using a randomised design. To strengthen the body of evidence, well-powered, robust, randomised controlled trials are required, with adequate follow-up, reporting the internationally-agreed core outcomes and including a parallel process evaluation is recommended.

Trial registration: PROSPERO (CRD42023411476).

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来源期刊
Community dentistry and oral epidemiology
Community dentistry and oral epidemiology 医学-公共卫生、环境卫生与职业卫生
CiteScore
4.40
自引率
8.70%
发文量
82
审稿时长
6 months
期刊介绍: The aim of Community Dentistry and Oral Epidemiology is to serve as a forum for scientifically based information in community dentistry, with the intention of continually expanding the knowledge base in the field. The scope is therefore broad, ranging from original studies in epidemiology, behavioral sciences related to dentistry, and health services research through to methodological reports in program planning, implementation and evaluation. Reports dealing with people of all age groups are welcome. The journal encourages manuscripts which present methodologically detailed scientific research findings from original data collection or analysis of existing databases. Preference is given to new findings. Confirmations of previous findings can be of value, but the journal seeks to avoid needless repetition. It also encourages thoughtful, provocative commentaries on subjects ranging from research methods to public policies. Purely descriptive reports are not encouraged, nor are behavioral science reports with only marginal application to dentistry. The journal is published bimonthly.
期刊最新文献
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