Prophylactic penicillin versus penicillin taken at the first sign of swelling in cases of asymptomatic pulpal-periapical lesions: A comparative analysis

In order to ascertain whether the time of administration of an antibiotic affects the occurrence of flare-ups and non-flare-up-associated swelling and pain, an analysis of components of two prospective endodontic studies on patients having asymptomatic teeth with pulpal necrosis and associated periapical radiolucent lesions (PN/PL) was done. In the first study, prophylactic penicillin was used. In the second study, penicillin (or erythromycin for patients allergic to penicillin) was taken by the patient at the first sign of swelling (patient controlled). For the patient-controlled group, as compared to the prophylactic penicillin group, there was statistically significantly more (1) incidence of flare-ups ( p < 0.05); (2) non-flare-up-associated swelling ( p < 0.001); (3) non-flare-up-associated pain ( p < 0.05); (4) combined moderate and severe pain ( p < 0.05); (5) combined incidence of flare-ups and swelling ( p < 0.001); (6) combined incidence of flare-ups and pain ( p < 0.01); and (7) combined incidence of flare-ups and both swelling and pain ( p < 0.001). There were statistically significantly fewer instances of (1) no patient post-treatment problems ( p < 0.001) and (2) combined mild pain and no patient post-treatment problems ( p < 0.001). Hence, for asymptomatic teeth with PN/PL, it appears that prophylactic antibiotics are preferable to antibiotics taken by the patient at the first sign of swelling.