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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.