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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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O Ob bj je ec ct ti iv ve e The aim of this audit was to measure the outcome of treatment of acute dentoalveolar infection and to determine if this was influenced by choice of antibiotic therapy or the presence of penicillin-resistance. S Su ub bj je ec ct ts s a an nd d m me et th ho od ds s A total of 112 patients with dentoalveolar infection were included in the audit. All patients underwent drainage, either incisional (n=105) or opening of the pulp chamber (n=7) supplemented with antibiotic therapy. A pus specimen was obtained from each patient for culture and susceptibility. Clinical signs and symptoms were recorded at the time of first presentation and re-evaluated after 48 or 72 h. R Re es su ul lt ts s A total of 104 (99%) of the patients who underwent incisional drainage exhibited improvement after 72 h. Signs and symptoms also improved in five of the seven patients who underwent drainage by opening of the root canal although the degree of improvement was less than that achieved by incisional drainage. Penicillin-resistant bacteria were found in 42 (38%) of the 112 patients in this study. Of the 65 patients who were given penicillin, 28 had penicillin-resistant bacteria.

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.

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.

Objective. The aim of this study was to determine the incidence and bacteriology of bacteremia associated with various oral and maxillofacial surgical procedures. Methods.A total of 237 patients who underwent oral and maxillofacial surgery were included in this study. Blood samples were obtained for bacteriological examination immediately after the essential steps of the surgical procedure had been performed.Results. Bacteremia was detected in patients who underwent surgery for tumor, infection and trauma, and surgical reconstruction of jaw. In particular, decortication for osteomyelitis and tooth extraction resulted in a higher incidence of bacteremia compared with other surgical procedures. The incidence of bacteremia was not affected by oral hygiene, gingival inflammation, blood loss and duration of surgery. Furthermore, concerning tooth extraction, there was no statistical difference in the incidence of bacteremia with respect to the number of teeth extracted and the method of extraction.Extraction of teeth with odontogenic infection (periodontitis, periapical infection and pericoronitis) did however produce a significantly increased incidence of bacteremia compared with infection-free teeth (P<0.01).Viridans streptococci were the predominant group of bacteria isolated from the bacteremias. Conclusion.Oral and maxillofacial surgery involving trans-oral incision produces bacteremia, regardless of the extent and degree of surgical invasion. In particular, surgical procedure at infected sites is more likely to result in bacteremia compared with infection-free sites.

The in vitro susceptibility of 618 Candida isolates to fluconazole, itraconazole, voriconazole, ketoconazole, miconazole, amphotericin B, and nystatin was determined. The isolates were obtained from 559 patients who had attended the UK dental hospital departments in Cardiff, Belfast, Glasgow or London. Antifungal susceptibility was assessed using a broth microdilution method following the National Committee for Clinical Laboratory Standards (NCCLS) M27-A guidelines. The majority of the test strains were C. albicans (n = 521) with few of these being resistant to fluconazole (0.3%). A low incidence of fluconazole resistance (0-6.8%) was similarly evident with all non albicans species (Candida glabrata, 5 of 59 resistant; Candida krusei, 0 of 7 resistant; Candida tropicalis, 0 of 13 resistant; Candida parapsilosis, 0 of 12 resistant; other Candida species, 0 of 6 resistant). Voriconazole, ketoconazole, and miconazole also revealed high activity against both C. albicans and non albicans isolates, and 23.7% of C. glabrata isolates were found to be resistant to itraconazole. There was little difference in the antifungal susceptibilities of Candida isolated from patients who had a history of previous antifungal therapy compared with those who had not received antifungal treatment. In summary, this surveillance study of antifungal susceptibility of oral candidal isolates in the UK, through the collaboration of four dental hospitals, demonstrates that oral Candida species have a high level of susceptibilities to a range of antifungal agents.