Cervicofacial actinomycosis (a case report)

Actinomycosis is now a very uncommonly diagnosed human disease. Major medical centers report approximately one case a year. The pathogenesis of actinomycosis is unclear, but trauma provides a portal of entry. The cervicofacial form is the most common and usually appears as a chronic swelling with one or more draining sinus tracts. For treatment, penicillin in high doses is suggested. This case report presents a case of cervicofacial actinomycosis in a 14 year old boy which was misdiagnosed for a long time and the treatment of the disease with mezlocillin, a new antibiotic in the treatment of actinomycosis.

[The intestinal microflora of patients with inflammatory diseases of the maxillofacial area]

The microflora of the large intestine in patients with odontogenic phlegmons of different localization were studied. 80.8% of such patients were found to have microecological disturbances, characterized by a decrease in the number of bacteria belonging to the genera Bifidobacterium, Lactobacillus, Enterococcus and Bacteroides and by an increase in the number of opportunistic microorganisms.

Management of maxillofacial infections: a review of 50 cases

Maxillofacial infections often place the oral and maxillofacial surgeon in situations where timely decisions have to be made. These decisions can be life-saving. This study reviews 50 infections treated over a 3-year period. The results reveal rapid resolution of the infections by adhering to fundamental principles in their management: recognition of airway compromise, surgical intervention, and the administration of the appropriate antibiotic. A protocol for the management of maxillofacial infections is described.

[A microbiological evaluation of the use of roxithromycin in oral odontogenic infections]

Odontogenic infections are the primary infections caused by indigenous oral bacteria, when a factor changes their perfect equilibrium. We studied 30 samples from patients with odontogenic infections that were submitted to therapy with roxithromycin. Our results showed that 79% of aerobic and 71% of anaerobic bacteria, responsible for odontogenic infections, were sensitive to roxithromycin.

[Roxithromycin in dental infections]

Roxithromicin is a semisynthetic macrolide antibiotic, with similar antibacterial activity to erythromycin. It is characterized by an excellent pharmacokinetic profile and a good tissue penetration. Particularly at the dose of 300 mg per day the dental tissue diffusion is extremely good, and this is important to oppose the oral cavity infections. Oral cavity infections can be either odontogenic or non odontogenic. Odontogenic infections are typically primary and are caused by commensal bacteria (oral Streptococci, Bacteroides sp., Veillonella sp. and Fusobacterium sp.). The antibacterial spectrum of roxithromycin is very large and includes many of the most frequent strains responsible for oral cavity infections. A very interesting characteristic of roxithromycin is its penetration in macrophages (uptake) that allow a more rapid inhibition of bacterial activity. To evaluate the clinical efficacy and tolerance of roxithromycin in the treatment of odontogenic infections, an open study was performed. This study evaluated both the microbiological and clinical aspects. Thirty patients (21 females and 9 males) who had not been previously treated with antibiotic or antibacterial drugs, affected by infective dysodontiasis, gingivitis and periodontal diseases, received 300 mg per day (once a day) of roxithromycin for an average period of 6 days. The symptomatology considered was: intumescence, redness, pain, lymphangitis and presence of trismus. Clinical symptomatology was assessed at the start and at the end of the treatment. The symptomatological improvement due to roxithromycin was rapid and very effective. After 6 days of therapy, the improvement was statistically significant (p < 0.01) compared to basal conditions. No adverse reactions or side-effects were complained during the study. No changement were detected in laboratory parameters.(ABSTRACT TRUNCATED AT 250 WORDS)

[The therapy of inflammatory diseases of the maxillofacial area with the use of imidazole derivatives]

Qualitative and quantitative composition of associations of the agents of odontogenic infection were studied making use of present-day bacteriologic methods and of analysis of the microflora sensitivity to trichopol and nitazole, imidazole derivatives. The microflora was found to be represented by associations with the predominance of obligate and facultative anaerobes. The anaerobes were found highly sensitive to trichopol, both in vivo and in vitro, and even more so to nitazole, the drug manufactured in this country.

[The efficacy of preparations with antioxidant action in the combined treatment of phlegmons of the maxillofacial area]

The efficacy of hexamethylene tetramine (urotropin) was studied in 62 patients with maxillofacial phlegmons. The resultant good effect is explained by the pathogenetic action of the drug. The antiinflammatory effect of urotropin may be explained, on the one hand, by its known antiseptic effect, and, on the other hand, by its membrane-protective effect on the cellular elements, this creating the optimal conditions for the wound reparation.

[The use of alginic acid-based preparations for treating suppurative wounds of the maxillofacial area and neck]

The effects of algin-based drugs--algipor, algimaf, teralgim--on the course of maxillofacial purulent wounds healing were under study. Cytologic and morphometric data and findings of pH measurements evidence a high efficacy of teralgim and of algipor and algimaf combinations with trypsin immobilized on a cloth base during the first phase of the wound process. Application of these drugs was conducive to a sooner wound purification and to stimulation of the reparative processes.

[The clinical efficacy of roxithromycin in patients with acute odontogenic infections]

The clinical efficacy of a macrolide antibiotic, roxithromycin, was evaluated in 24 patients affected by acute odontogenic infections. Patients were treated with a first dose of 300 mg p.o. which was followed by 150 mg p.o. 12-hourly for the following two days. Total responses were evaluated by an arbitrary scale. The results showed that an excellent and good response was obtained in 99.96% of treated patients. On the basis of clinically compared data and the drug safety it may be concluded that roxithromycin can be successfully used in the treatment of odontogenic infections.

[The therapy of odontogenic abscesses. Pharmacological experimentation with lincomycin or amoxicillin]

A clinical and microbiological study was carried out to assess the therapeutic efficacy of two different antibiotics, lincomycin and amoxicillin, in the treatment of patients suffering from odontogenic abscesses. Microbiological analyses revealed that the majority of infections were supported by mixed aerobic and anaerobic bacterial flora. The assessment of clinical parameters clearly showed that patients receiving pharmacological treatment with lincomycin achieved a more rapid and efficacious recovery from disease in comparison to patients treated with amoxicillin.

Orofacial odontogenic infections: review of microbiology and current treatment

Orofacial odontogenic infections are common. Current evidence indicates that anaerobes play a major role in these infections and that the most common microbial isolates are Bacteroides, fusobacteria, peptococci, and peptostreptococci as well as some viridans streptococci. Drainage must be established where possible. Penicillin is still the drug of first choice for therapy, with metronidazole a good alternative. Nevertheless, not all clinicians are aware of current views and, therefore, this article is a state-of-the-art review for the practicing clinician of the microbiology and antimicrobial therapy of orofacial odontogenic infections.

[The use of the preparation baliz-2 in inflammatory processes of the maxillofacial area]

Examinations of 137 patients with inflammatory diseases of the maxillofacial area and neck, treated with baliz-2, have shown that this agent is characterized by a manifest antibacterial action on the wound microflora, helps thinning the purulent exudate, and accelerates detachment of the necrotic mass. No cases of local irritation were recorded.

Pediatric maxillofacial infections: a retrospective study of 113 patients

This is a retrospective review of 113 hospitalized children with maxillofacial infections. The upper face (orbits, paranasal sinuses, maxillary teeth, and cheeks) was affected most frequently in younger children (mean age = 4.03 years), and the source of infection was often unknown. The patients were treated empirically with a second-generation cephalosporin. Lower-face infections (mandibular teeth, submental, sublingual, and submandibular structures) occurred more frequently in older children (mean age = 5.56 years) and were likely to be of odontogenic origin. Empiric therapy in lower face infections usually consisted of penicillin.

Organisms isolated from severe odontogenic soft tissue infections: their sensitivities to cefotetan and seven other antibiotics, and implications for therapy and prophylaxis

Cefotetan is a new cephamycin antibiotic characterised by excellent B-lactamase stability and anti-anaerobe activity, coupled with a long half life of 3-4 h which permits twice daily dosage. A clinical trial of cefotetan in the treatment of severe oro-facial infections is presented, together with a detailed analysis of the causative organisms and their sensitivities to eight antibiotics. 50/50 patients achieved clinical cure with a treatment regime comprising cefotetan therapy and incision and drainage, with patients being transferred to oral cephradine for the final phase of therapy. Side effects were minimal and there were no instances of relapse. Significant resistance among alpha-haemolytic streptococci and bacteroides organisms to penicillin was observed. The streptococci were resistant due to mechanisms other than beta-lactamase production. In the light of these findings and the reports of other workers it is suggested that penicillin V may no longer be the most appropriate drug for endocarditis prophylaxis, despite the most recent recommendations of the American Heart Association. Furthermore, if penicillin V is used for this purpose, a penicillin free interval of 6-8 weeks may be inadequate before this drug is used. Cefotetan is not suitable for prophylaxis against endocarditis.

Evaluation of treatment provided patients hospitalized with orofacial odontogenic infections: a retrospective study

The purpose of this study was to evaluate the treatment that patients receive when they are hospitalized for orofacial infections. Results indicated that dental consultations were not always obtained by medical personnel prior to the diagnosis and treatment of patients and that the antibiotic therapy employed did not always involve the recognized drug of choice.

[Use of a new cobetalactamine in the therapy of acute and chronic odontogenic processes]

Treatment of 70 patients with acute and chronic odontogenic processes for 5-35 days (mean 10.9 days) with a new cobetalactamine is reported. Rapid resolution was noted in nosological groups marked by the presence of acute infection. Particular interest is attached to the effect of the drug on chronicisting infections, such as apical granuloma, maxillary osteitis, and radicular cysts, since these forms displayed a high degree of vascular isolation, were often sustained by a mixed flora, and had been previously treated with other antibiotics. Follow-up four weeks after the conclusion of treatment showed a low incidence of recurrences that was in all events lower than in earlier experiments with chemical antibiotics. There were no instances of intolerance or allergy.