Evidence map›Paper›PMID 42008044›Full record

SynthesisClinical oral investigations2026

Antibiotic resistance in odontogenic infections: A systematic review of current evidence and implications for guideline-based therapy.

Andrea Irmgard Schmid, Richard Werkmeister, Bilal Al-Nawas, Julia Heider

Abstract readSystematic Review
In one paragraph

Synthesis in Clinical oral investigations, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Andrea Irmgard SchmidDepartment of Oral and Maxillofacial Surgery, Federal Armed Forces Hospital, Rübenacherstraße 170, Koblenz, 56072, Germany. Andreairschmid@gmail.com.
Richard WerkmeisterDepartment of Oral and Maxillofacial Surgery, Federal Armed Forces Hospital, Rübenacherstraße 170, Koblenz, 56072, Germany.
Bilal Al-NawasDepartment of Oral and Maxillofacial Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Augustusplatz 2, 55131, Mainz, Germany.
Julia HeiderDepartment of Oral and Maxillofacial Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Augustusplatz 2, 55131, Mainz, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesThis review aims to summarize and evaluate the current evidence on antibiotic resistance in odontogenic infections, with a special focus on empirical therapy, resistance patterns, and guideline-based recommendations. The update of the German S3 guideline “Odontogenic Infections” provides the clinical and methodological framework for this review. MATERIALS AND

methodsA systematic literature search was performed to identify studies published between 2016 and 2025 on antibiotic resistance in odontogenic infections. Both retrospective and prospective studies were included. Special attention was given to resistance rates of commonly used antibiotics and the differentiation of therapy in patients with suspected penicillin allergy. The selected studies were integrated into the German guideline development process to ensure relevance and consistency with current clinical practices.

resultsThe review confirms increasing resistance rates for Penicillin G/V and aminopenicillins, particularly against Staphylococcus spp. In contrast, the combination of an aminopenicillin with a beta-lactamase inhibitor remains effective in most cases. Clindamycin shows notable resistance and is associated with higher rates of adverse effects. Recent studies suggest that certain cephalosporins, such as cefazolin, may be safe alternatives for patients with non-confirmed penicillin allergies. Clinical strategies such as PEN-FAST scoring and de-labeling are gaining increasing importance in managing suspected allergies.

conclusionsEmpirical antibiotic therapy in odontogenic infections should be based on current resistance data and individualized patient risk profiles. Aminopenicillins with beta-lactamase inhibitors remain the first-line choice; clindamycin should be reserved for selected cases with a justified suspicion of penicillin allergy. CLINICAL RELEVANCE: This review supports evidence-based antibiotic selection and promotes individualized therapy decisions to improve outcomes and minimize the development of antibiotic resistance. The findings have been integrated into the updated German S3 guideline, providing practical recommendations for dental and surgical care.

Indexed as

Anti-Bacterial AgentsDrug Resistance, BacterialHumansPractice Guidelines as TopicAnti-Bacterial AgentsAntibiotic therapyAntimicrobial resistanceOdontogenic abscessOral infectionsPenicillin allergyS3 guideline update

Identifiers

PMID42008044
PMCPMC13095914

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.