Is clindamycin effective in preventing infectious complications after oral surgery? Systematic review and meta-analysis of randomized controlled trials

Targeted Clindamycin Delivery Systems: Promising Options for Preventing and Treating Bacterial Infections Using Biomaterials

Targeted therapy represents a real opportunity to improve the health and lives of patients. Developments in this field are confirmed by the fact that the global market for drug carriers was worth nearly $40 million in 2022. For this reason, materials engineering and the development of new drug carrier compositions for targeted therapy has become a key area of research in pharmaceutical drug delivery in recent years. Ceramics, polymers, and metals, as well as composites, are of great interest, as when they are appropriately processed or combined with each other, it is possible to obtain biomaterials for hard tissues, soft tissues, and skin applications. After appropriate modification, these materials can release the drug directly at the site requiring a therapeutic effect. This brief literature review characterizes routes of drug delivery into the body and discusses biomaterials from different groups, options for their modification with clindamycin, an antibiotic used for infections caused by aerobic and anaerobic Gram-positive bacteria, and different methods for the final processing of carriers. Examples of coating materials for skin wound healing, acne therapy, and bone tissue fillers are given. Furthermore, the reasons why the use of antibiotic therapy is crucial for a smooth and successful recovery and the risks of bacterial infections are explained. It was demonstrated that there is no single proven delivery scheme, and that the drug can be successfully released from different carriers depending on the destination.

Influence of Drying Technique on Physicochemical Properties of Synthetic Hydroxyapatite and Its Potential Use as a Drug Carrier

Naturally occurring hydroxyapatite (HA) is the mineral phase of bone tissue. It is characterized by its bioactivity toward stimulating bone cells to proliferate and thus form new apatite layers. For this reason, it is a material commonly used in implantology for filling defects or covering implants (such as endoprostheses). There are several methods to obtain synthetic HA, and by controlling parameters such as temperature, pressure or the drying process, physicochemical parameters of the final powder can be affected. In the present study, HA was obtained by wet precipitation technique and subjected to two different drying methods, determining whether this parameter significantly affects the properties of the final material obtained. Analyzed Fourier-transform infrared spectroscopy (FT-IR) confirmed the presence of functional groups typical for HA. X-ray diffraction analysis (XRD) demonstrated that the materials are partially amorphous; however, the only phase was identified in HA. Scanning electron microscopy (SEM) was used to evaluate the surface morphology and the density, and average grain diameter was measured. Furthermore, HA powders were subjected to modification with the antibiotic clindamycin to determine the potential for use as a carrier for the active substance. The release rate of the drug was determined by high-performance liquid chromatography (HPLC). The differences in the characteristics of the powders were relatively small; however, they affected the rate of drug release from the material as well as the shape of the grains. The method of drying the powders was shown to affect the shape of the grains, as well as the porosity of the sinters prepared from it. A higher amount of clindamycin released into PBS was observed in material with more pores. The materials have demonstrated the potential to be used as a carrier for the active substance; however, further biological, as well as physicochemical, analysis is required.

Does pre-operative clindamycin administration during dental implant surgery reduce implant failure or post-surgical complications?

Study design Prospective randomised placebo-controlled clinical trial.Cohort selection and data analysis Sixty-two healthy adults who underwent single dental implant placement without previous infection of the surgical bed or the need for bone grafting were included in this clinical trial. They were randomly divided into two groups (test and control). The test group was given a single dose of oral clindamycin (600 mg) one hour before surgery and the control group with a placebo. The surgical procedures were carried out by one oral surgeon and all the patients were observed post-operatively on days 1, 7, 14, 28, and 56 by a single observer for clinical, radiological, surgical variables, adverse events, and complications. Statistical analysis was performed with STATA 15 software and the number required to treat or harm (NNT/NNH) was also evaluated.Results In the test group, the authors observed two implant failures and one patient experienced gastrointestinal disturbances and diarrhoea. They also observed post-operative infections in three patients (two in the control group and one in the test group which eventually failed).Conclusions The authors concluded that pre-operative clindamycin administration during dental implant surgery in healthy adults may not reduce implant failure or post-surgical complications.

Factors associated with complications of submental intubation in 339 patients with facial fractures: A German retrospective cohort study

PURPOSE

For nearly four decades, submental intubation (SI) has been introduced and employed to avoid tracheostomy in facial trauma cases where nasal/oral intubation is infeasible or associated with possible risks. The purposes of this study were to estimate the frequency and to identify variables associated with complications of SI (CSI).

METHODS

The authors organised a retrospective cohort study and enrolled a group of patients with facial trauma and SI during a seven-year interval at two German level one trauma centres where SI has routinely been used in complex facial trauma cases. The predictor variables included demographic, medical, dental, fracture-related, operative, and postoperative parameters. The outcome variable was CSI. We used descriptive, bivariate, and multivariate analyses at the 0.05 significant level.

RESULTS

The sample included 339 patients (24.5% females, 9.4% had complications) with an average age of 58.2 ± 12.0 years (range, 17-89). Bivariate analyses revealed nine significant variables. However, forward stepwise multiple logistic regression modelling identified three variables statistically associated with CSI: smoking (OR, 691.8; 95% CI, 75.9 to 6303.9; P < 0.0001; number needed to harm [NNH], 6), moderate to high gingival inflammation (OR, 786.7; 95% CI, 66 to 9378.9; P = 0.002; NNH, 12), and postoperative use of chlorhexidine mouthwash (OR, 0.03; 95% CI, 0.001 to 0.77; P = 0.0003; number needed to treat [NNT], 2).

CONCLUSIONS

smokers and subjects with gingivitis were more likely to experience CSI. Postoperative chlorhexidine rinsing was the potentially modifiable, albeit low-OR, factor. These findings could help to draw an effective guideline against the CSI.

Use of antibiotics after lower third molar surgery - useful or harmful procedure? A randomized, double-blind, placebo-controlled trial

Introduction/Objective. The aim of the present study was to investigate the effects of moxifloxacin and cefixime in preventing postoperative infection following mandibular third molar surgery. Methods. Double-blind study was completed by 157 patients undergoing surgical removal of mandibular third molars. Patients were randomly assigned to three groups: moxifloxacin (M), cefixime (C) and placebo (P). Patients in each group were classified into two subgroups: subgroup (a) without previous history of pericoronitis and subgroup (b) with previous history of pericoronitis. All patients were evaluated at the postoperative follow-ups on the first, second and seventh postoperative day. Results. Postoperative infections were registered only in patients with history of pericoronitis. Antibiotic prophylaxis with cefixime, and moxifloxacin, reduced the occurrence of postoperative infection. Overall incidence of postoperative infections was 6.4%. All postoperative infections were registered in placebo-group, where the incidence of postoperative infection was 19.2%. Microbiological tests verified the clinically obtained results. Isolated microflora was resistant to penicillin-derived antibiotics in 50% of cases. Conclusion. Prophylactic use of antibiotics after third molar surgery should be weighted against potential risks and benefits and could be considered in cases with previous history of pericoronitis, when complicated surgical extraction is performed.