The Effects of Topical Oral Clindamycin Antibiotic Rinses on the Bacterial Content of Saliva on Healthy Human Subjects

Abstract

The use of systemic antibiotics for major head and neck surgical procedures involving the upper aerodigestive tract is now accepted as an important part of perioperative patient care. Despite knowledge of the high counts of bacteria present in saliva, no preoperative regimen for preparing the mouth has been standardized. Surgical wounds come in contact with saliva during the course of many head and neck procedures. While wound infection rates have been decreased with the use of prophylactic systemic antibiotics, serious morbidity still exists from postoperative wound infections. Reducing the bacterial counts in saliva preoperatively may further decrease wound infection rates. A prospective randomized pilot study of twenty healthy human subjects compared the effects of an oral rinse with clindamycin vs. a placebo rinse of normal saline. There was a statistically significant reduction in both aerobic and anaerobic colony counts in the clindamycin group at 4 hours after treatment. For the group that rinsed with placebo, there was an actual increase in counts 4 hours after treatment. It is concluded that oral rinses with clindamycin can reduce the bacterial content of saliva for a sufficient length of time to be effective as a preoperative prophylactic measure for head and neck surgery involving the upper aerodigestive tract. Future studies are planned to evaluate other potentially effective agents. A logical continuation is a clinical study of preoperative and postoperative rinses.

State of the Art Review: Current Status of Topical Nasal Antimicrobial Agents

“…The pulmonary literature may provide help as to the best drug and dose. 25 Clindamycin, 67 which is effective against Gram‐positive bacteria and anaerobes, may be an appropriate alternative, especially when combined with topical corticosteroids or alpha‐adrenergic agents. It must be kept in mind that the use of antimicrobials for nasal/sinus irrigation may lead to increased antibacterial resistance and side effects such as hypersensitivity reactions.…”

The use of prophylactic antibiotics in head and neck oncological surgery

“…Several prospective randomized studies have compared the use of topical antibiotics, such as clindamycin or piperacillin and tozaban, either alone or in combination with systemic prophylaxis. Some preliminary studies have suggested a potential benefit, as they found an objective reduction in bacterial contamination in the intra-operative sites [36,37]. The studies found no statistically significant differences, however, and concluded that their use does not appear to have any benefit in the incidence of postoperative infections [37].…”

Topical Antibiotic Therapy for Recalcitrant Sinusitis

“…Frequency of topical antibiotic administration is also important. Elledge et al 10 demonstrated that topical oral clindamycin reduced bacterial counts of oral flora for up to 4 hours, while Grandis et al 11 documented an effect for up to 8 hours. The optimal dosing frequency for sinusitis using topical antibiotics would be best determined scientifically through studies similar to those of Elledge et al 10 and Grandis et al 11 …”