Antibiotic synergy as a strategy for combating multidrug-resistant bacteria: a review of mechanisms and clinical implications

Multidrug-resistant bacteria (MDRB) are a global concern due to their resistance to multiple antibiotics. The rise of MDRB is attributed to factors like antibiotic misuse and horizontal gene transfer. Limited treatment options led to increased morbidity, mortality, and healthcare costs. MDRB spreads within healthcare and community settings, posing risks to vulnerable populations. Urgent efforts are needed to combat MDRB, including antibiotic synergy, which enhances therapeutic efficacy. Synergy disrupts bacterial processes, improves penetration and intracellular accumulation, and inhibits resistance mechanisms. It is crucial in treating biofilm-associated infections. Methods like checkerboard assays and time-kill assays assess synergistic effects, while high-throughput screening enables rapid identification. The rise of multidrug resistance has prompted urgent calls for concerted efforts to address this global health crisis. Antibiotic synergy broadens treatment options, allows dose reduction, and addresses biofilm infections. Careful implementation is necessary to minimize resistance and drug interactions. Successful case studies highlight the potential of antibiotic synergy against MDRB.

Causes, diagnosis, treatment and prognosis of root perforations

A perforation is an artificial communication that occurs between the root canal system and the tissues enclosing a tooth. It can be made by the dentist during tooth preparation and passage into the root canal system, or it can happen naturally due to resorption or dental decay and cause connectivity between the root canal and periodontium. Both iatrogenic and non-iatrogenic factors can lead to a root being perforated. Most often, it happens at the coronal aspect of the tooth. Iatrogenic perforations can always be distinguished by the extensive bleeding that occurs after the wound. Serous discharge or fistula from the perforated site, sensitivity on percussing, isolated periodontal pocketing, and chronic gingivitis when the inflammation has reached the alveolus can all be signs of unresolved perforations. Cone beam computed tomography can be used to correctly identify and evaluate resorbing lesions and subsequent perforations. Successful perforation management involves adequately sealing the breach, using the right material, and closing the perforation in the right place as soon as feasible. Perforation management can be done in one of two ways: non-surgically or surgically. The prognosis of teeth with root perforations that have had endodontic treatment relies on a number of variables, including the amount of time that passed before the defect was sealed, the site of the perforation, the effectiveness of the perforation seal, and the size of the perforation. Due to the poor prognosis, teeth with suboptimal periodontal health or those with very wide perforations may be extracted.