Systematic Review Protocol on Antibiotic Use for infection related Orofacial Pain: Policy and Practice Implications

Dental pain and intraoral swelling, commonly resulting from pulpal and periapical infections, are leading causes of emergency visits. Overuse of antibiotics in such cases contributes to antimicrobial resistance. The appropriateness of antibiotic use must be evaluated to ensure rational prescribing and minimize unnecessary prescriptions.

This review aims to evaluate the effectiveness and associated signs and symptoms of empiric antibiotic treatment for ≤5 days compared to >5 days in patients presenting with dental pain.

This protocol has been conducted following PRISMA-P guidelines. A comprehensive search of four electronic databases, such as PubMed, Scopus, Cochrane and Embase was performed to find pertinent studies. This study will follow PICOS framework, including individuals receiving antibiotic treatment for oro-facial pain. Randomized controlled trials evaluating the use of empirical antibiotics for <5 days, compared to >5 days for dental pain management. Outcomes assessed will be pain reduction, quality of life improvement, adverse events related to antibiotic, clinical resolution, microbiological and radiological findings, biomarkers, antimicrobial resistance, cost implications. Independent reviewers will screen the studies, assess the risk of bias by using RoB-2 and certainty of evidence by using GRADE. Where feasible, a meta-analysis will be conducted to synthesize findings and provide a quantitative summary of the results.

The study commenced in February 2025 and is anticipated to be completed by May 2025.

This review will evaluate the effectiveness of antibiotic prescriptions for dental pain, minimizing adverse effects and identifying guideline adherence gaps. Findings will support antibiotic stewardship and inform policies to promote rational use, aiming to curb antimicrobial resistance while ensuring effective, evidence-based pain management in dental practice.