Antibiotic resistance and the indiscriminate use of prescription antibiotics is a worldwide problem.1

It is known that the inappropriate use of antibiotics is one of the main causes of antibiotic resistance. In medicine the problem increases since it is associated with the increase in mortality of patients in hospitals due to antibiotic resistant pathology.2

Health providers are to blame when the prescriptions are not necessary. In spite of this, patients need to be informed of the consequences of misuse of antibiotics in conditions where no bacteria are associated with the illness.

A recent systematic review concluded that there is a lack of knowledge in the general population about antibiotics and there is a need to strengthen educational initiatives for patients, and for health care providers to inform patients about antibiotic consumption.3

In dentistry the use of antibiotics still needs to be explored such as in endodontics, where apical periodontitis and acute apical abscesses are associated with bacteria colonising the dental canal.

The review had two objectives, the addition of systemic antibiotics with or without surgical intervention for the treatment of symptomatic apical periodontitis or acute apical abscess. The dental conditions are associated with pain.

The Cochrane systematic review after a thorough search in English databases included two studies in the final selection. The two studies used penicillin V compared to placebo in the surgical treatment of symptomatic apical periodontitis or acute apical abscess, in both trials patients received analgesics. No trials were found for the second objective; the use of antibiotics versus placebo without a surgical intervention.

The grade of the evidence assessed by the authors was very low for the outcomes of pain and swelling at 24/48 and 72 hrs and concluded that there is insufficient evidence to determine the effects of antibiotics on adults with symptomatic apical periodontitis or acute apical abscess. One must take into account that everyone's pain threshold is different thereby making the outcome subjective with an introduction of bias. From a clinical standpoint, it is absolutely critical that a thorough history is taken that will help determine the length of time the patient has been in pain and if there have been any systemic manifestations of infection such as a fever. In addition to radiographic analysis of periapical pathology, clinical evidence of intraoral and/or extra-oral swelling should be noted. It is uncertain and more trials are suggested to guide practitioners in the management of acute dental infections. Practitioners should weigh the risk and benefits of the prescription of systemic antibiotics and diagnose appropriately the patient's present condition.

Prescriptions of systemic antibiotics are still necessary but it is important to instruct patients about the use of antibiotics and the possible consequences of misuse.