Objective. The aim of this study is to obtain helpful information for an effective antimicrobial therapy against orofacial odontogenic infections; such information would be obtained from recent bacteriologic features and antimicrobial susceptibility data.Study design. The bacteriology and antimicrobial susceptibility of major pathogens in 163 patients with orofacial odontogenic infections to seven antibiotics was examined.Results. Mixed infection of strict anaerobes with facultative anaerobes (especially viridans streptococci) was observed most often in dentoalveolar infections, periodontitis, and pericoronitis. Penicillin (penicillin G) was effective against almost all pathogens, although it did not work well against ß-lactamase-positive Prevotella. Cefmetazole was effective against all test pathogens. Erythromycin was ineffective against viridans streptococci and most Fusobacterium. Clindamycin exerted a strong antimicrobial activity on anaerobes. Minocycline was effective against almost all of the test pathogens. The antimicrobial activity of levofloxacin against viridans streptococci was not strong.Conclusions. An antibiotic that possesses antimicrobial activity against both viridans streptococci and oral anaerobes should be suitable for treatment of dentoalveolar infection, periodontitis, and pericoronitis. Penicillin remains effective as an antimicrobial against most major pathogens in orofacial odontogenic infections.Cefmetazole, clindamycin, and minocycline may be effective against most pathogens, including penicillin-unsusceptible bacteria. 2Although numerous patients suffer from orofacial odontogenic infections, many of these infections can be managed without the use of antibiotics, e.g., by tooth extraction, endodontic therapy, and surgical treatment, including drainage. However, when an acute bacterial infection has progressed or antimicrobial therapy might be of benefit to patients, antibiotics are prescribed. [1][2][3][4][5][6] When antibiotics are prescribed for the treatment of orofacial odontogenic infections, clinicians should choose them on a case-specific basis, and the choice should be based on several factors, e.g., laboratory data, patient's health, age, allergies, drug absorption and distribution ability, and plasma levels. [1][2][3][4][5][6] Penetration and metabolism of the drug, type or location of the infection, previous use of antibiotics, and cost are other factors to be considered. [1][2][3][4][5][6] The laboratory data regarding bacteriology and antimicrobial susceptibility is crucial information for the clinician considering the administration of the antimicrobial therapy. 3,6,[7][8][9] However, it may take several days or even longer to obtain such data. Hence, antibiotics may be chosen empirically. ß-Lactam antibiotics, especially penicillins, have traditionally been recommended as a first-line antibiotic because they work well against most causative bacteria and because penicillins have a low incidence of side effects. [1][2][3][4][5][6] Furthermore, such medicines are relativ...

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Purpose: The purpose of this study was to compare the morphologic changes of the upper airway space in Class III patients underwent mandibuler set back or bimaxillary surgery (maxillary advancement and mandibular setback) by computed tomography at 2 levels: soft palate and base of tongue Materials and Methods:The sample is consisted of 47 patients in 2 groups who had been diagnosed with Class III skeletal deformities and had been treated by mandibular setback or bimaxillary surgery (maxillary advancement and mandibular setback).Anteroposterior, lateral, cross sectional area dimensions of the airway at the level of soft palate and base of tongue was measured pre-and postoperatively on computed tomography images.Results: However, anteroposterior dimensions of the airway decreased in both groups (p<.0001), the reduction was significantly less in cases treated with bimaxillary surgery (p<.05). In mandibular setback surgery group, the cross sectional area of the airway decreased significantly (p<.001) Although, the cross sectional area of the airway decrease in bimaxillary surgery group, the reduction was not statistically significant (p>.05).Conclusions: This study suggested that bimaxillary surgery could prevent narrowing of the upper airway in the correction of Class III deformities rather than mandibular setback surgery .

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Amoxicillin would still be advocated therefore as being a suitable first-line agent, while reduced susceptibility of Prevotella strains remains a matter of concern with penicillins. Amoxicillin/clavulanate, clindamycin, and metronidazole are useful alternatives in combating the anaerobic bacteria involved in dentoalveolar infection.

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The incidence of beta-lactamase production in anaerobic gram-negative rods isolated from 93 pus specimens of orofacial odontogenic infections and the antimicrobial susceptibility of these isolates against 11 antibiotics were determined. A total of 191 anaerobic gram-negative rods were isolated from the specimens. Beta-lactamase was detected in 35.6% of the black-pigmented Prevotella and 31.9% of the nonpigmented Prevotella. However, no strains among the other species isolated produced beta-lactamase. Ampicillin, cefazolin and cefotaxime showed decreased activity as regards beta-lactamase-positive Prevotella strains, whereas the activity of ampicillin/sulbactam, cefmetazole, and imipenem continued to be effective against such strains. All tested beta-lactam antibiotics were effective against Porphyromonas and Fusobacterium. Erythromycin showed decreased activity against nonpigmented Prevotella and Fusobacterium. Clindamycin, minocycline and metronidazole were powerful antibiotics against which anaerobic gram-negative rods could be tested. The present study showed that beta-lactamase-positive strains were found more frequently in the Prevotella strains than in any of the other species of anaerobic gram-negative rods. The effectiveness of adding sulbactam to ampicillin was demonstrated, as well as the difference in cephalosporin activity against beta-lactamase-positive strains.

Introduction: Bacterial infection is a major cause of periapical periodontitis. Eradication