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  1. Nami Y, Haghshenas B, Abdullah N, Barzegari A, Radiah D, Rosli R, et al.
    J Med Microbiol, 2015 Feb;64(Pt 2):137-46.
    PMID: 25525206 DOI: 10.1099/jmm.0.078923-0
    Genetic and environmental factors can affect the intestinal microbiome and microbial metabolome. Among these environmental factors, the consumption of antibiotics can significantly change the intestinal microbiome of individuals and consequently affect the corresponding metagenome. The term 'probiotics' is related to preventive medicine rather than therapeutic procedures and is, thus, considered the opposite of antibiotics. This review discusses the challenges between these opposing treatments in terms of the following points: (i) antibiotic resistance, the relationship between antibiotic consumption and microbiome diversity reduction, antibiotic effect on the metagenome, and disease associated with antibiotics; and (ii) probiotics as living drugs, probiotic effect on epigenetic alterations, and gut microbiome relevance to hygiene indulgence. The intestinal microbiome is more specific for individuals and may be affected by environmental alterations and the occurrence of diseases.
    Matched MeSH terms: Anti-Bacterial Agents/therapeutic use*
  2. Morrow CJ, Kreizinger Z, Achari RR, Bekő K, Yvon C, Gyuranecz M
    Vet Microbiol, 2020 Nov;250:108840.
    PMID: 33068825 DOI: 10.1016/j.vetmic.2020.108840
    Mycoplasma synoviae (n = 26) and M. gallisepticum (n = 11) isolates were gained from 164 clinical samples collected from China, India, Indonesia, Malaysia, Philippines, Republic of Korea and Thailand. Most isolates were from commercial chicken production systems. A method of filtering (0.45 μm) samples immediately after collection was convenient allowing over a week for transit to the laboratory. Minimum inhibitory concentrations (MICs) were characterized by a broth microdilution method to enrofloxacin, difloxacin, oxytetracycline, chlortetracycline, doxycycline, tylosin, tilmicosin, tylvalosin, tiamulin, florfenicol, lincomycin, spectinomycin and lincomycin and spectinomycin combination (1:2). Increased MICs to various antimicrobials were seen in different isolates but appeared largely unrelated to the antimicrobial treatment histories. Overall, the results were similar to other MIC surveys around the world. Generally, low MICs to tetracyclines, tiamulin and tylvalosin were observed. Increased tilmicosin MICs were observed in both M. synoviae and M. gallisepticum isolates (≥64 μg/ml MIC90 values) and this was seen in all isolates with high tylosin MICs. Increases in lincomycin MICs were mostly associated with increases in tilmicosin MICs. The results also suggested that antimicrobial use after mycoplasma vaccination may interfere with vaccine strain persistence and efficacy (field strains were more commonly observed in flocks that had treatments after vaccination) and this area warrants more investigation. The study shows that isolation and MIC determination can be done from remote locations and suggests that this may provide information that will allow more effective use of antimicrobials or other methods of control of avian mycoplasma in chickens (e.g. live vaccines) and therefore more responsible use of antimicrobials from a one health perspective.
    Matched MeSH terms: Anti-Bacterial Agents/pharmacology*
  3. Wan Nur Ismah WAK, Takebayashi Y, Findlay J, Heesom KJ, Jiménez-Castellanos JC, Zhang J, et al.
    PMID: 29263066 DOI: 10.1128/AAC.01814-17
    Fluoroquinolone resistance in Gram-negative bacteria is multifactorial, involving target site mutations, reductions in fluoroquinolone entry due to reduced porin production, increased fluoroquinolone efflux, enzymes that modify fluoroquinolones, and Qnr, a DNA mimic that protects the drug target from fluoroquinolone binding. Here we report a comprehensive analysis, using transformation and in vitro mutant selection, of the relative importance of each of these mechanisms for fluoroquinolone nonsusceptibility using Klebsiella pneumoniae as a model system. Our improved biological understanding was then used to generate 47 rules that can predict fluoroquinolone susceptibility in K. pneumoniae clinical isolates. Key to the success of this predictive process was the use of liquid chromatography-tandem mass spectrometry to measure the abundance of proteins in extracts of cultured bacteria, identifying which sequence variants seen in the whole-genome sequence data were functionally important in the context of fluoroquinolone susceptibility.
    Matched MeSH terms: Anti-Bacterial Agents/pharmacology
  4. Abrami M, Golob S, Pontelli F, Chiarappa G, Grassi G, Perissutti B, et al.
    Int J Pharm, 2019 Mar 25;559:373-381.
    PMID: 30716402 DOI: 10.1016/j.ijpharm.2019.01.055
    Bacterial infections represent an important drawback in the orthopaedic field, as they can develop either immediately after surgery procedures or after some years. Specifically, in case of implants, they are alleged to be troublesome as their elimination often compels a surgical removal of the infected implant. A possible solution strategy could involve a local coating of the implant by an antibacterial system, which requires to be easily applicable, biocompatible and able to provide the desired release kinetics for the selected antibacterial drug. Thus, this work focusses on a biphasic system made up by a thermo-reversible gel matrix (Poloxamer 407/water system) hosting a dispersed phase (PLGA micro-particles), containing a model antibacterial drug (vancomycin hydrochloride). In order to understand the key parameters ruling the performance of this delivery system, we developed a mathematical model able to discriminate the drug diffusion inside micro-particles and within the gel phase, eventually providing to predict the drug release kinetics. The model reliability was confirmed by fitting to experimental data, proposing as a powerful theoretical approach to design and optimize such in situ delivery systems.
    Matched MeSH terms: Anti-Bacterial Agents/chemistry*
  5. Chang CY, Chan KG
    J Infect, 2020 Sep;81(3):e29-e30.
    PMID: 32628960 DOI: 10.1016/j.jinf.2020.06.077
    Matched MeSH terms: Anti-Bacterial Agents/therapeutic use*
  6. AlMatar M, Albarri O, Makky EA, Var I, Köksal F
    Curr Drug Targets, 2020;21(13):1326-1343.
    PMID: 32564749 DOI: 10.2174/1389450121666200621193018
    Iron, which is described as the most basic component found in nature, is hard to be assimilated by microorganisms. It has become increasingly complicated to obtain iron from nature as iron (II) in the presence of oxygen oxidized to press (III) oxide and hydroxide, becoming unsolvable at neutral pH. Microorganisms appeared to produce organic molecules known as siderophores in order to overcome this condition. Siderophore's essential function is to connect with iron (II) and make it dissolvable and enable cell absorption. These siderophores, apart from iron particles, have the ability to chelate various other metal particles that have collocated away to focus the use of siderophores on wound care items. There is a severe clash between the host and the bacterial pathogens during infection. By producing siderophores, small ferric iron-binding molecules, microorganisms obtain iron. In response, host immune cells produce lipocalin 2 to prevent bacterial reuptake of siderophores loaded with iron. Some bacteria are thought to produce lipocalin 2-resistant siderophores to counter this risk. The aim of this article is to discuss the recently described roles and applications of bacterial siderophore.
    Matched MeSH terms: Anti-Bacterial Agents/chemistry
  7. Noman E, Al-Gheethi A, Radin Mohamed RMS, Talip B, Al-Sahari M, Al-Shaibani M
    J Hazard Mater, 2021 10 05;419:126418.
    PMID: 34171673 DOI: 10.1016/j.jhazmat.2021.126418
    The current review highlighted the quantitative microbiological risk assessment of Vibrio parahaemolyticus in Prawn farm wastewaters (PFWWs) and the applicability of nanoparticles for eliminating antibiotic-resistant bacteria (ARB). The high availability of the antibiotics in the environment and their transmission into human through the food-chain might cause unknown health effects. The aquaculture environments are considered as a reservoir for the antibiotic resistance genes (ARGs) and contributed effectively in the increasing of ABR. The metagenomic analysis is used to explore ARGs in the non-clinical environment. V. parahaemolyticus is among the pathogenic bacteria which are transmitted through sea food causing human acute gastroenteritis due to available thermostable direct hemolysin (tdh), adhesins, TDH related hemolysin (trh). The inactivation of pathogenic bacteria using nanoparticles act by disturbing the cell membrane, interrupting the transport system, DNA and mitochondria damage, and oxidizing the cellular component by reactive oxygen species (ROS). The chloramphenicol, nitrofurans, and nitroimidazole are among the prohibited drugs in fish and fishery product. The utilization of probiotics is the most effective and safe alternative for antibiotics in Prawn aquaculture. This review will ensure public understanding among the readers on how they can decrease the risk of the antimicrobial resistance distribution in the environment.
    Matched MeSH terms: Anti-Bacterial Agents/pharmacology
  8. Al Fraijat B, Al-Tawarah NM, Khlaifat AM, Qaralleh H, Khleifat KM, M A, et al.
    Trop Biomed, 2019 Sep 01;36(3):620-629.
    PMID: 33597484
    Urinary Tract Infections (UTIs) consider as the most common infections worldwide, with higher risk in patients experienced Acute Appendicitis (AA). The purpose of this study was, to investigate the bacterial profile of UTIs in patients with non-ruptured AA postsurgically, and to assess age- and gender-related links of all AA cases in Karak region, Jordan. Urine samples obtained from 46 cases (32 male and 14 female) aged between 16-70 years were diagnosed as non-ruptured AA, following with isolation and characterization of isolated bacteria. Out of 46 AA cases, uropathogens isolated from 25 (54.3%) UTI cases. Out of these isolates; 42 (73.7%) were gram-negative isolates and 15 (26.3%) were gram-positive bacteria. The percentage of isolates were E. coli (26.3%), Enterobacter species (21%), Enterococcus faecalis and Klebsiella pneumoniea (10.5%) for each, Streptococcus saprophytics and Pseudomonas aeruginosa (7%) for each, Yersinia spp. and S. milleri (8.8%). Out of UTI cases, 20 cases (80%) possessed mixed culture, each of them had at least one of Enterobacterial species. i.e. Enterobacter spp. or E. coli or both. More precisely, out of all these positivecases, 2 cases had pure gram positive-bacterial infection (8%), while pure gram negative bacterial infection comprised 48% of them and the rest (44%) were mixed (gram-negative and gram-positive) bacterial infection. Moreover, study revealed a high prevalence rate of AA cases 24 (52.2%) in the ages of 16-22 years, then declining the rate with increasing the age, reaching the lowest rate (4.3%) in ages of 60-70. In addition to age factor, the males significantly more susceptible to AA cases than females by 2.2-fold. Antibiotic sensitivity test revealed high resistance capability of E. coli to the most used antibiotics except for nitrofurantoin. Bacterial isolates showing sensitivity against ciprofloxacin, trimethoprim/sulfamethoxazole, amoxicillin-Clavulanic acid and nitrofurantoin, with a superiority for the first two. Results demonstrate high prevalence rate of UTIs in patients with AA. For avoiding, the needless use of antibiotics through sticking to our accountability as healthcare provisioner to pursuit the antimicrobial management.
    Matched MeSH terms: Anti-Bacterial Agents/pharmacology
  9. Engler D, Meyer JC, Schellack N, Kurdi A, Godman B
    J Chemother, 2021 Feb;33(1):21-31.
    PMID: 32693710 DOI: 10.1080/1120009X.2020.1789389
    Antimicrobial resistance (AMR) is a growing problem worldwide. South Africa has recently released its Antimicrobial Resistance National Strategy Framework (referred to as the Framework) to instigate antimicrobial stewardship programmes (ASPs). Consequently, there is a need to assess compliance with the Framework.

    METHODS: Descriptive study design, collecting quantitative data, among pre-selected public healthcare facilities. One healthcare professional from each participating facility, involved in ASPs, was invited to participate.

    RESULTS: Overall 26 facilities from 8 provinces participated. Average compliance to the Framework was 59.5% for the 26 facilities, with 38.0% for community health centres, 66.9% for referral hospitals and 73.5% for national central hospitals. For 7 facilities compliance was <50% while 5 facilities were >80% compliant.

    CONCLUSION: Although some facilities complied well with the Framework, overall compliance was sub-optimal. With the introduction of universal healthcare in South Africa, coupled with growing AMR rates, ongoing initiatives to actively implement the Framework should be targeted at non-compliant facilities.

    Matched MeSH terms: Anti-Bacterial Agents/therapeutic use*
  10. Teh AH, Lee SM, Dykes GA
    Curr Microbiol, 2016 Dec;73(6):859-866.
    PMID: 27623781
    Campylobacter jejuni is one of the most common causes of bacterial gastrointestinal food-borne infection worldwide. It has been suggested that biofilm formation may play a role in survival of these bacteria in the environment. In this study, the influence of prior modes of growth (planktonic or sessile), temperatures (37 and 42 °C), and nutrient conditions (nutrient broth and Mueller-Hinton broth) on biofilm formation by eight C. jejuni strains with different antibiotic resistance profiles was examined. The ability of these strains to form biofilm on different abiotic surfaces (stainless steel, glass, and polystyrene) as well as factors potentially associated with biofilm formation (bacterial surface hydrophobicity, auto-aggregation, and initial attachment) was also determined. The results showed that cells grown as sessile culture generally have a greater ability to form biofilm (P 
    Matched MeSH terms: Anti-Bacterial Agents/pharmacology*
  11. Ngui LX, Wong LS, Shashi G, Abu Bakar MN
    J Laryngol Otol, 2017 Sep;131(9):830-833.
    PMID: 28412984 DOI: 10.1017/S0022215117000834
    OBJECTIVE: This paper reports on a non-conventional method for the management of facial carbuncles, highlighting its superiority over conventional surgical treatment in terms of cosmetic outcome and shorter duration of wound healing.

    BACKGROUND: The mainstay of treatment for carbuncles involves the early administration of antibiotics in combination with surgical intervention. The conventional saucerisation, or incision and drainage, under normal circumstances results in moderate to large wounds, which may need secondary surgery such as skin grafting, resulting in a longer duration of wound healing and jeopardising cosmetic outcome.

    CASE REPORTS: The reported three cases presented with extensive carbuncles over the chin, face and lips region. In addition to early commencement of intravenous antibiotics, the pus was drained, with minimal incision and conservative wound debridement, with the aim of maximal skin conservation. This was followed by thrice-daily irrigation with antibiotic-containing solution for a minimum of 2 consecutive days. The wounds healed within two to four weeks, without major cosmetic compromise.

    CONCLUSION: The new method showed superior cosmetic outcomes, with a shorter duration of wound healing. Conservative surgical management can be performed under regional anaesthesia, which may reduce morbidity and mortality; patients with facial carbuncles often have higher risks with general anaesthesia.

    Matched MeSH terms: Anti-Bacterial Agents/therapeutic use*
  12. Chai KH, Soo-Hoo TS
    Med J Malaya, 1970 Sep;25(1):43-5.
    PMID: 4249494
    Matched MeSH terms: Anti-Bacterial Agents/pharmacology
  13. Teow SY, Ali SA
    Pak J Pharm Sci, 2017 May;30(3):891-895.
    PMID: 28653935
    This study evaluated the impact of pH (7.4 and 6.5), bovine serum albumin (BSA), and human serum albumin (HSA) on Curcumin activity against 2 reference, 1 clinical, and 10 environmental strains of Staphylococcus aureus (S. aureus). Minimal inhibitory concentrations (MICs) of Curcumin against S. aureus were statistically indifferent (p>0.05) at pH7.4 and pH6.5. Activity of Curcumin against S. aureus was reduced by two folds in the presence of 1.25-5% BSA/HSA.
    Matched MeSH terms: Anti-Bacterial Agents/pharmacology
  14. Koh LL, O'Rourke S, Brennan M, Clooney L, Cafferkey M, McCallion N, et al.
    Ir J Med Sci, 2018 May;187(2):423-427.
    PMID: 28689228 DOI: 10.1007/s11845-017-1649-1
    BACKGROUND: Both Staphylococcus aureus and coagulase negative Staphylococci are common causes of late-onset neonatal sepsis in the neonatal intensive care unit (NICU), usually relating to intravascular access device infections.

    AIMS: This project aimed to review the impact on antimicrobial treatment and clinical outcome in the NICU setting, of the introduction of the Xpert MRSA/SA BC test (Cepheid, USA) for the identification of staphylococci in blood cultures.

    METHODS: A retrospective audit was carried out of the pre- and post-intervention periods; the intervention was the introduction of the Xpert MRSA/SA BC test.

    RESULTS: In total, 88 neonates had positive blood cultures with Staphylococcus spp., comprising 42 neonates in the pre-intervention and 46 in the post-intervention groups. The pre-intervention group had a higher birth weight (1.541 kg vs. 1.219 kg, p = 0.05) and higher platelet count (288 vs. 224 × 109/L, p = 0.05). There was a trend towards a shorter duration of antimicrobial therapy in term infants and in the length of admission; however, this was not statistically significant (p = 0.2). All of the nine infants post-intervention with significant bacteraemia (S. aureus =3, CoNS =6) were changed to the optimal antimicrobial at the time the result was available.

    CONCLUSIONS: This study shows that the introduction of the Xpert MRSA/SA BC test can lead to a reduction in the length of admission and duration of antimicrobials in term infants; however, the difference was not statistically significant. All nine infants with clinically significant bacteraemia were treated with the appropriate antimicrobial when the Xpert MRSA/SA BC test result was available.

    Matched MeSH terms: Anti-Bacterial Agents/therapeutic use*
  15. Khan RA, Aziz Z
    Int J Clin Pharm, 2017 Aug;39(4):906-912.
    PMID: 28643112 DOI: 10.1007/s11096-017-0499-2
    Background Antibiotic de-escalation is an important strategy to conserve the effectiveness of broad-spectrum antibiotics. However, the outcome of this strategy for the treatment of ventilator-associated pneumonia (VAP) has not been widely studied in developing countries. Objectives To evaluate the outcome on intensive care unit (ICU) mortality, 28 days mortality, and length of ICU stay among VAP patients who receive de-escalation therapy. Setting This study was conducted in an ICU of a Malaysian public hospital. Method The electronic medical records of patients who developed VAP in the ICU were retrieved and relevant data was collected. Records of antibiotic prescriptions were also reviewed to collect the details of changes to antibiotic therapy (de-escalation). Main outcome measure Impact of antibiotic de-escalation on mortality. Results The mean age of the 108 patients was 46.2 ± 18.2 years; the majority being males (80%). The antibiotic de-escalation rate was about 30%. Out of this, 84% involved a change from broad to narrow-spectrum antibiotics and the remaining, withdrawal of one or more antibiotics. ICU mortality was 23% while 28 days mortality was 37%. There was no statistically significant difference in mortality rate, survival probability and the mean length of ICU stay between the de-escalation and the non-de-escalation group. However, patients with Simplified Acute Physiology Score II of ≥50 were significantly associated with ICU mortality and 28 days mortality. Conclusions In VAP patients, antibiotic de-escalation provides an opportunity to promote the judicious use of antibiotics without affecting the clinical outcomes.
    Matched MeSH terms: Anti-Bacterial Agents/administration & dosage*
  16. Maleki A, Ghafourian S, Pakzad I, Badakhsh B, Sadeghifard N
    Curr Pharm Des, 2018;24(11):1204-1210.
    PMID: 29237374 DOI: 10.2174/1381612824666171213094730
    BACKGROUND: Neisseria meningitidis is considered as a dangerous pathogen threatening human health. Nowadays, the new drug target is focused. Toxin antitoxin (TA) system is recently identified as an antimicrobial drug target. Also, in N. meningitidis, iron-uptake system could be an interesting target for drug discovery.

    METHODS: In this study, fbpA and mazE genes were chosen as new antimicrobial targets and treated with antisense peptide nucleic acid (PNA). Firstly, they were evaluated by bioinformatics and then analyzed by experimental procedures. Secondly, the functionality was evaluated by stress conditions.

    RESULTS: Our results interestingly demonstrated that when fbpA and mazE loci of N. meningitidis were targeted by antisense PNA, 8 µM concentration of fbpA-PNA as well as 30 µM concentration of mazE-PNA inhibited the growth of N. meningitides and were found to be bacteriostatic, whereas 10 μM concentration of fbpA-PNA showed bacteriocidal activity.

    CONCLUSION: Our findings demonstrated the bactriocidal activity of fbpA-PNA and bacteriostatic activity of mazEPNA. Therefore, mazE and fbpA genes should be potent antimicrobial targets but further analysis including in vivo analysis should be performed.

    Matched MeSH terms: Anti-Bacterial Agents/pharmacology*
  17. Osthoff M, Siegemund M, Balestra G, Abdul-Aziz MH, Roberts JA
    Swiss Med Wkly, 2016;146:w14368.
    PMID: 27731492 DOI: 10.4414/smw.2016.14368
    Prolonged infusion of β-lactam antibiotics as either extended (over at least 2 hours) or continuous infusion is increasingly applied in intensive care units around the world in an attempt to optimise treatment with this most commonly used class of antibiotics, whose effectiveness is challenged by increasing resistance rates. The pharmacokinetics of β-lactam antibiotics in critically ill patients is profoundly altered secondary to an increased volume of distribution and the presence of altered renal function, including augmented renal clearance. This may lead to a significant decrease in plasma concentrations of β-lactam antibiotics. As a consequence, low pharmacokinetic/pharmacodynamic (PK/PD) target attainment, which is described as the percentage of time that the free drug concentration is maintained above the minimal inhibitory concentration (MIC) of the causative organism (fT>MIC), has been documented for β-lactam treatment in these patients when using standard intermittent bolus dosing, even for the most conservative target (50% fT>MIC). Prolonged infusion of β-lactams has consistently been shown to improve PK/PD target attainment, particularly in patients with severe infections. However, evidence regarding relevant patient outcomes is still limited. Whereas previous observational studies have suggested a clinical benefit of prolonged infusion, results from two recent randomised controlled trials of continuous infusion versus intermittent bolus administration of β-lactams are conflicting. In particular, the larger, double-blind placebo-controlled randomised controlled trial including 443 patients did not demonstrate any difference in clinical outcomes. We believe that a personalised approach is required to truly optimise β-lactam treatment in critically ill patients. This may include therapeutic drug monitoring with real-time adaptive feedback, rapid MIC determination and the use of antibiotic dosing software tools that incorporate patient parameters, dosing history, drug concentration and site of infection. Universal administration of β-lactam antibiotics as prolonged infusion, even if supported by therapeutic drug monitoring, is not yet ready for "prime time", as evidence for its clinical benefit is modest. There is a need for prospective randomised controlled trials that assess patient-centred outcomes (e.g. mortality) of a personalised approach in selected critically ill patients including prolonged infusion of β-lactams compared with the current standard of care.
    Matched MeSH terms: Anti-Bacterial Agents/therapeutic use*
  18. Md Sidek NL, Halim M, Tan JS, Abbasiliasi S, Mustafa S, Ariff AB
    Biomed Res Int, 2018;2018:5973484.
    PMID: 30363649 DOI: 10.1155/2018/5973484
    Nowadays, bacteriocin industry has substantially grown replacing the role of chemical preservatives in enhancing shelf-life and safety of food. The progress in bacteriocin study has been supported by the emerging of consumer demand on the applications of natural food preservatives. Since food is a complex ecosystem, the characteristics of bacteriocin determine the effectiveness of their incorporation into the food products. Among four commercial media (M17 broth, MRS broth, tryptic soy broth, and nutrient broth) tested, the highest growth of Pediococcus acidilactici kp10 and bacteriocin-like-inhibitory substance (BLIS) production were obtained in the cultivation with M17. BLIS production was found to be a growth associated process where the production was increased concomitantly with the growth of producing strain, P. acidilactici kp10. The antimicrobial property of BLIS against three indicator microorganisms (Listeria monocytogenes, Escherichia coli, and Staphylococcus aureus) remained stable upon heating at 100°C but not detectable at 121°C. The BLIS activity was also observed to be stable and active at a wide pH range (pH 2 to pH 7). The BLIS activity remained constant at -20°C and -80°C for 1 month of storage. However, the activity dropped after 3 and 6 months of storage at 4°C, -20°C, and -80°C with more than 80% reduction. The ability of bacteriocin from P. acidilactici kp10 to inhibit food-borne pathogens while remaining stable and active at extreme pH and temperature is of potential interest for future applications in food preservatives.
    Matched MeSH terms: Anti-Bacterial Agents/pharmacology*
  19. Menon RK, Gopinath D, Li KY, Leung YY, Botelho MG
    Int J Oral Maxillofac Surg, 2019 Feb;48(2):263-273.
    PMID: 30145064 DOI: 10.1016/j.ijom.2018.08.002
    The objectives of this systematic review were to investigate the efficacy of amoxicillin/amoxicillin-clavulanic acid for reducing the risk of postoperative infection after third molar surgery and to evaluate the adverse outcomes in these patients, as well as in healthy volunteers. A systematic search of four databases was performed on May 26, 2017. Eleven studies qualified for the qualitative analysis and eight were found suitable for meta-analysis. The results suggest that both amoxicillin-clavulanic acid and amoxicillin significantly reduce the risk of infection after third molar extraction (overall relative risk (RR) 0.25, P<0.001). However, with the exclusion of randomized controlled trials with a split-mouth design (due to an inadequate crossover period after antibiotic treatment), only amoxicillin-clavulanic acid was found to be effective (RR 0.21, P<0.001). The risk of adverse effects was significantly higher in the amoxicillin-clavulanic acid group (RR=4.12, P=0.023) than in the amoxicillin group (RR 1.57, P=0.405). In conclusion, amoxicillin-clavulanic acid and amoxicillin may significantly reduce the risk of infection after third molar extraction. However, their use in third molar surgery should be viewed with caution, as recent clinical trials on healthy volunteers have shown evidence of the negative impact of amoxicillin use on bacterial diversity and antibiotic resistance.
    Matched MeSH terms: Anti-Bacterial Agents/therapeutic use*
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