Comment: The quality of evidence is downgraded by imprecise results (few patients and wide confidence intervals).
A Cochrane review included one study with a total of 40 subjects. There was a close parallel distribution of the pain ratings in both the intervention (penicillin) and placebo groups over the 7 day study period. There was insufficient evidence to claim or refute a benefit for penicillin for pain intensity. There was no significant difference in the mean total number of ibuprofen tablets and Tylenol tablets over the study period (table ). Secondary outcome on reporting of adverse events was not addressed in the study.
| Outcome | Assumed risk-control (95% CI) | Corresponding risk-antibiotics (95% CI) | Participants (studies) |
|---|---|---|---|
| Total number of ibuprofen tablets | The mean total number of ibuprofen tablets in the control groups was 9.6 tablets | The mean total number of ibuprofen tablets in the intervention groups was 0.40 lower (4.23 lower to 3.43 higher) | 40 (1 study) |
| Total number of paracetamol (acetaminophen) + codeine tablets | The mean total number of acetaminophen + codeine tablets in the control groups was 4.45 tablets | The mean total number of acetaminophen + codeine tablets in the intervention groups was 2.45 higher (1.23 lower to 6.13 higher) | 40 (1 study) |
Prescribing of antibiotics for irreversible pulpitis should not be seen as a substitute for immediate pulpectomy which is now widely accepted as the 'standard of care'.