Antimicrobial Efficacy of Ampicillin With Ceftriaxone in Comparison With Diclofenac Sodium, Modified Triple Antibiotic Paste, and Calcium Hydroxide Against Enterococcus faecalis: An In-Vitro Study

Objective This in vitro study aimed to assess and compare the antimicrobial effectiveness of ampicillin with ceftriaxone (AC), diclofenac sodium (DS), modified triple antibiotic paste (MTAP), and calcium hydroxide (CH) against <i>Enterococcus faecalis</i> in root canal systems. Materials and methods The antimicrobial activity of the medicaments was assessed by determining the minimum inhibitory concentrations (MIC) via the agar well diffusion method. A total of 40 extracted permanent teeth underwent root canal treatment, and <i>Enterococcus faecalis</i> was introduced into the canal preparations. Intracanal medicaments, including AC, DS, MTAP, and CH, were applied, and their antimicrobial effects were quantified by colony-forming unit (CFU) counts before and after application. The impact on bacterial viability was further examined using confocal laser microscopy on root canal sections treated with different medicaments. Results The MIC results indicated lower concentrations of AC and MTAP, suggesting higher efficacy. AC demonstrated a more significant reduction in CFU counts than DS, MTAP, and CH. Confocal laser microscopy further supported the superior antimicrobial activity of AC. Conclusion The MIC results revealed that AC and MTAP required lower concentrations to inhibit <i>Enterococcus faecalis</i>, indicating higher antimicrobial efficacy. Among the medicaments tested, AC significantly reduced CFU counts more than DS, MTAP, and CH. Confocal laser microscopy analysis further confirmed the superior antimicrobial activity of AC by showing a greater reduction in bacterial viability in the treated root canal sections.