Clinical and microbiological efficacy of moxifloxacin versus amoxicillin/clavulanic acid in severe odontogenic abscesses: a pilot study

Abstract

The aim of this study targeted the evaluation of the in vivo effect of moxifloxacin in the treatment of patients with severe odontogenic abscesses. This was a prospective, two-armed, randomised, unblinded, monocentric pilot study, which enrolled 21 hospitalized patients with severe odontogenic abscesses. After extraoral incision, patients were either treated with moxifloxacin 400 mg i.v. once daily or amoxicillin/clavulanic acid 2.2 g i.v. three times daily. Primary clinical endpoint was the time until clinical remission, represented by simultaneous assertion of the following criteria: body temperature <38.5 degrees C, no pain at palpation, and mouth opening similar or better than preoperatively. White blood cell count, C-reactive protein, pain, health related quality of life (HR-QoL) and length of hospital stay were recorded as secondary outcome criteria. The mean duration until reaching the primary end point was 6.6 (range, 4.3-8.8) days in the moxifloxacin group and 6.0 (range, 3.8-8.2) days in the amoxicillin/clavulanic acid group. Median days of in-house treatment ranged between five and six days for both groups. HR-QoL was highly impaired in both groups preoperatively and reached near normal on days three and four in both samples. In this pilot investigation, moxifloxacin showed promising results as compared to amoxicillin/clavulanic acid. Therefore, a larger prospective clinical trial using moxifloxacin in severe odontogenic abscesses appears encouraging. We suggest a combination of body temperature, palpatory pain, and subjective pain as a parameter for successful intervention; however, both findings need prospective validation by means of a phase III evaluation.

Comparative Efficacy and Safety of Moxifloxacin and Clindamycin in the Treatment of Odontogenic Abscesses and Inflammatory Infiltrates: a Phase II, Double-Blind, Randomized Trial

“…Our results are well in line with the only other clinical trial with patients with odontogenic abscesses by Al-Nawas et al (2). In their pilot study of adjunctive antibiotic treatment after extraoral incision for 21 hospitalized patients overall with severe odontogenic abscesses, the time to clinical remission was used as the primary efficacy endpoint.…”

“…MXF at 400 mg once daily showed promising results in comparison to 2.2 g AMX-CLA three times a day (t.i.d.) (2).…”

“…For the adjuvant therapy of patients with severe chronic periodontitis, MXF was more effective than DOX and reduced the bacterial load and all inflammatory parameters (11). In a pilot study of hospitalized patients with severe odontogenic abscesses, MXF showed promising results (2).…”

“…In odontogenic abscesses typically 3 to 6 different bacterial species are present (2). The microbiota involved in endodontic abscesses are dominated by anaerobic bacteria (21) that are considered clinically relevant (24).…”

“…For the commonly recommended antibiotics penicillin (PEN) and clindamycin (CLI), increasing resistance rates have been reported (2). Of 87 strains isolated from patients with odontogenic abscesses in a monocentric study, only 69% were susceptible to penicillin and 75% were susceptible to CLI (22).…”