Principles and practice of antibiotic therapy

The role of phenoxymethylpenicillin, amoxicillin, metronidazole and clindamycin in the management of acute dentoalveolar abscesses--a review

Antibiotics are the most widely prescribed category of drugs issued on prescription by general dental practitioners. Despite this there remains little evidence-based literature on what should be prescribed for any given clinical situation, at what dosage and for how long. Given the current climate of evidence-based research, the need to keep antibiotic prescribing to an acceptable minimum, increasing levels of resistance of micro-organisms and widespread hospital infections with 'superbugs', there is a distinct need for appropriate prescribing guidelines. Considering best practice, an extensive review of the literature and a thorough understanding of current empirical treatment regimes, an attempt has been made to recommend suitable antibiotic prescribing for the adult patient suffering from acute dentoalveolar infections based on evidence.

The clinical significance of anaerobic bacteria in acute orofacial odontogenic infections

A review of the literature on orofacial odontogenic infections indicates that the underlying microflora is typically polymicrobial, predominantly involving strictly anaerobic gram-positive cocci and gram-negative rods, along with facultative and microaerophilic streptococci. Although no single species has been consistently implicated in all of these infections, the pathogenic potential of some of these organisms has been documented by many studies. This potential can be explained by a number of virulence factors demonstrated in anaerobic bacteria, as well as by synergistic interrelationships with other members of the infectious flora. Awareness of the anaerobic component of orofacial odontogenic infections dictates to a large extent the selection of antimicrobial therapy, mainly because of the frequency of beta-lactamase production by anaerobic gram-negative rods.

Efficacy of piperacillin-tazobactam in the treatment of surgical wound infection after clean-contaminated head and neck oncologic surgery

BACKGROUND

Although perioperative antibiotic prophylaxis has significantly reduced surgical wound infection rates, this complication is still a frequent complication of head and neck cancer surgery. Because these infections are typically polymicrobial, our study evaluated the safety and efficacy of piperacillin-tazobactam in the treatment of surgical wound infection after clean-contaminated head and neck oncologic surgery.

METHODS

In this multicenter, prospective clinical trial, 70 patients with surgical wound infection received piperacillin-tazobactam.

RESULTS

Of patients who were evaluable, 92.4% were also clinically cured or improved, and the bacteriologic eradication rate was 80.3%. Of the 70 patients enrolled in the study, six (8.5%) experienced six adverse events: two cases of moderate diarrhea, one allergic skin reaction, and three cases of phlebitis. No deaths were attributable to the study drug.

CONCLUSIONS

Piperacillin-tazobactam is a good choice of treatment as monotherapy for surgical wound infection after clean-contaminated head and neck oncologic surgery.