What is the appropriate antibiotic administration to prevent MRONJ development after tooth extraction?

IF 2.4 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of Bone and Mineral Metabolism Pub Date : 2025-07-02 DOI:10.1007/s00774-025-01617-8

Eiji Iwata, Hiroaki Ohori, Yuriko Susukida, Nanae Yatagai, Masahiko Kashin, Taiki Matsui, Naoki Takata, Masaki Kobayashi, Daisuke Miyai, Akira Tachibana, Masaya Akashi

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引用次数: 0

Abstract

Background: There are no established guidelines for antibiotic administration to prevent the development of medication related-osteonecrosis of the jaw (MRONJ) after tooth extraction in patients receiving antiresorptive agents (ARAs). Since 2022, the duration of antibiotic administration during extractions in such patients has been intentionally shortened to prevent antimicrobial resistance at our hospitals.

Methods: This retrospective study involved 160 patients on low-dose bisphosphonates (BPs) requiring tooth extractions between 2019 and 2024 at four Japanese institutions. In 2019-2021, patients received amoxicillin (AMPC) 500 mg 1 h before and 750 mg per day for 2 days post-extraction. In 2022-2024, a single 500 mg dose of AMPC was administered 1 h pre-extraction. Patients were managed with tension-free wound suturing and regular follow-up. The rates of MRONJ development were compared between the two periods.

Results: MRONJ developed in 3 out of 170 teeth (1.76%) in 2019-2021, and in 2 out of 147 teeth (1.36%) in 2022-2024, with no significant difference (P = 1.000). All MRONJ cases were low-stage (Stage 1) and healed completely within 12-16 weeks. Four out of five MRONJ cases (80%) exhibited radiopaque changes around the root. When all teeth in both groups were surveyed, MRONJ development was significantly higher in teeth with such changes compared to those without (4/58 vs. 1/259; P = 0.004).

Conclusion: A single preoperative dose of AMPC may be sufficient for tooth extractions in patients on low-dose BPs. However, teeth with radiopaque changes around the root require careful monitoring postextraction.

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为防止拔牙后MRONJ的发展，适当的抗生素使用是什么？

背景：对于接受抗吸收药物（ARAs）治疗的患者拔牙后发生药物相关性颌骨骨坏死（MRONJ），目前尚无明确的抗生素给药指南。自2022年以来，我们有意缩短了这类患者拔牙时使用抗生素的时间，以防止在我们医院出现抗生素耐药性。方法：本回顾性研究纳入了2019年至2024年间在日本四家机构接受低剂量双膦酸盐（bp）治疗、需要拔牙的160例患者。2019-2021年，患者在拔牙前1小时服用阿莫西林（AMPC） 500 mg，拔牙后2天每天服用750 mg。2022-2024年，单次给药500 mg AMPC预提取1 h。对患者进行无张力伤口缝合和定期随访。比较两个时期MRONJ的发展速度。结果：2019-2021年170颗牙中有3颗出现MRONJ(1.76%)， 2022-2024年147颗牙中有2颗出现MRONJ(1.36%)，差异无统计学意义（P = 1.000）。所有MRONJ病例均为低分期（一期），在12-16周内完全愈合。5例MRONJ患者中有4例（80%）表现为根周不透射线改变。当对两组的所有牙齿进行调查时，有这些变化的牙齿的MRONJ发育明显高于没有这些变化的牙齿(4/58比1/259；p = 0.004)。结论：术前单剂量AMPC可满足低剂量bp患者拔牙的需要。然而，对于牙根周围放射不透明的牙齿，拔牙后需要仔细监测。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Bone and Mineral Metabolism 医学-内分泌学与代谢

CiteScore

6.30

自引率

3.00%

发文量

审稿时长

6-12 weeks

期刊介绍： The Journal of Bone and Mineral Metabolism (JBMM) provides an international forum for researchers and clinicians to present and discuss topics relevant to bone, teeth, and mineral metabolism, as well as joint and musculoskeletal disorders. The journal welcomes the submission of manuscripts from any country. Membership in the society is not a prerequisite for submission. Acceptance is based on the originality, significance, and validity of the material presented. The journal is aimed at researchers and clinicians dedicated to improvements in research, development, and patient-care in the fields of bone and mineral metabolism.