Empirical antimicrobial therapy of acute dentoalveolar abscess.

BACKGROUND/AIM: The most common cause of acute dental infections are oral streptococci and anaerobe bacteria. Acute dentoalveolar infections are usually treated surgically in combination with antibiotics. Empirical therapy in such infections usually requires the use of penicillin-based antibiotics. The aim of this study was to investigate the clinical efficiency of amoxicillin and cefalexin in the empirical treatment of acute odontogenic abscess and to assess the antimicrobial susceptibility of the isolated bacteria in early phases of its development. METHODS: This study included 90 patients with acute odontogenic abscess who received surgical treatment (extraction of a teeth and/or abscess incision) and were divided into three groups: two surgical-antibiotic groups (amoxicillin, cefalexin) and the surgical group. In order to evaluate the effects of the applied therapy following clinical symptoms were monitored: inflammatory swelling, trismus, regional lymphadenitis and febrility. In all the patients before the beginning of antibiotic treatment suppuration was suched out of the abscess and antibiotic susceptibility of isolated bacteria was tested by using the disk diffusion method. RESULTS: The infection signs and symptoms lasted on the average 4.47 days, 4.67 days, and 6.17 days in the amoxicillin, cefalexin, and surgically only treated group, respectively. A total of 111 bacterial strains were isolated from 90 patients. Mostly, the bacteria were Gram-positive facultative anaerobs (81.1%). The most common bacteria isolated were Viridans streptococci (68/111). Antibiotic susceptibility of isolated bacteria to amoxicillin was 76.6% and cefalexin 89.2%. CONCLUSION: Empirical, peroral use of amoxicillin or cefalexin after surgical treatment in early phase of development of dentoalveolar abscess significantly reduced the time of clinical symptoms duration in the acute odontogenic infections in comparison to surgical treatment only. Bacterial strains isolated in early stages of dentoalveolar abscess showed high sensitivity to amoxicillin and cefalexin.

[Clinical efficacy of ampicillin in treatment of acute odontogenic abscess].

BACKGROUND/AIM: Antibiotics choice and the duration of their application in the therapy of acute odontogenic abscess is considered to be controversial. The aim of this study was to investigate the clinical efficacy of ampicillin in treatment of acute odontogenic abscess and to assess the antimicrobial susceptibility of the isolated bacteria in early phase of abscess development. METHODS: This study included 60 patients with acute odontogenic abscess who were surgically treated (extraction of teeth and/or abscess incision) divided into two groups, ampicillin group and surgical group (without antibiotic treatment). RESULTS: In the ampicillin group of patients treatment lasted on the average 4.67 days, while in the surgical group 6.17 days. A total of 78 bacterial strains were isolated from 60 patients. The most often bacteria were found to be Gram-positive facultative anaerobs (68/78). The most common bacteria isolated were Viridans streptococci (43/78). Susceptibility of isolated bacteria to ampicillin were 70.5%. CONCLUSION: Peroral use of ampicillin, after surgicel treatment in an early phase of dentoalveolar abscess development, statistically significantly reduced the time of clinical symptoms of acute odontogenic abscess in comparison to surgical treatment only. The isolated bacterial strains in an early phase of dentoalveolar abscess development showed a high sensitivity to ampicillin.

Effects of topical application of metronidazole-containing mucoadhesive lipogel in periodontal pockets.

INTRODUCTION: Metronidazole is the drug of choice in the treatment of periodontal pockets up to 5 mm in depth. It is topically applied--directly into the periodontal pockets. There are no registred trademark preparations for this purpose in the market of Serbia and Montenegro. The aim of our latest research was to test the efficacy of newly formulated preparation containing 25% metronidazole suspended in a lipogel in vitro--in anaerobic cultures isolated from the periodontal pockets, and in vivo--by the direct application into periodontal pockets. METHODS: Preparation efficacy was tested in a randomized controlled study involving 25 patients, and was confirmed by the membrane-free agar diffusion method on the anaerobic strains isolated from the periodontal pockets. The duration of the testing was 30 days. The preparation was applied twice--immediately after the taking of the first swab, and on day 15, when the control swab was taken for the assessment of the effects of the applied preparation. RESULTS: Seven anaerobic strains were isolated and tested, and each was confirmed as highly susceptible to metronidazole. Anaerobic strains were not isolated in any of the pockets treated with metronidazole-containing lipogel. The strains isolated in the control pockets were the same as were those at the beginning of the study. CONCLUSION: Metronidazole, in a lipogel-type base applied in the concentration of 25%, provided an efficient treatment of anaerobic infection in the periodontal pockets.

[Assessment of feasibility of formulation of a preparation for growth inhibition of metronidazole-resistant strains isolated from periodontal pockets].

INTRODUCTION: Topical metronidazole benzoate preparations, applied directly into the space between the teeth and, periodontal tissue, are the treatment of choice for periodontal pockets. Oleogels and hydrogels, as the biomucoadhesive bases for the manufacturing of these preparations, were developed in our previous trials. The aim of our latest research was to develop a preparation that would solve the problem of inhibiting the metronidazole-resistant anaerobic strains, isolated from the periodontal pockets. METHODS: Metronidazole-resistant strains were isolated from the periodontal pocket swabs, using the established susceptibility testing. Further testing of the antimicrobial activity of the prepared formulations was performed by the membrane-free diffusion method in agar gel. Oleogels and hydrogels were tested with: tetracycline (2.5%), metronidazole (25%), and metronidazole benzoate (40%), as well as with oleogels and hydrogels containing the combination of 2.5% tetracycline and 40% metronidazole benzoate. RESULTS: Satisfying results were achieved with the preparation containing 2.5% tetracycline along with metronidazole benzoate. The main fact revealed by this study was that there was no synergism in tetracycline and metronidazole benzoate activities, if the strain was susceptible to both active substances. CONCLUSION: The best results in the inhibition of the growth of metronidazole-resistant anaerobic strains were obtained by 2.5% tetracycline and metronidazole benzoate preparations in oleogel base.

[Influence of the base on the release of antibiotics from ointments].

BACKGROUND: Officinal basis for the antibiotic ointments according to the 4th Yugoslav Pharmacopoeia is a hydrophobic base containing only aliphatic hydrocarbons. The fact that antibiotics are predominantly not lipophylic raises the question about the suitability of that particular type of the base for the manufacturing of antibiotic ointments. Recent studies of the lipid analysis of the skin corneal layer indicated that lipids had shown the bilamellar organization in the skin intercorneal space. Such structural organization could be seen in the ambiphylic bases whose structure was based on carefully selected emulsifier couple, consisting of the lyotropic and thermotropic liquid crystals. The aim of this study was to test the velocity of antibiotics (klindamycin hydrochloride, erythromycin base and chloramphenicol) release from the hydrophobic ointment-type bases, and from ambiphylic bases of anionic and non-ionic types. METHODS: Membrane-free agar diffusion test as the basic method for testing the release velocity in vitro and Staphylococcus aureus as the strain highly susceptible to the chosen antibiotics were used. All the analyzed samples were manufactured as the suspension-type ointments. RESULTS: The highest growth inhibition zone of the Staphylococcus aureus strain for all three analyzed antibiotics was achieved from the non-ionogenic ambiphylic base; the clear growth inhibition zone area for Staphylococcus aureus strain in the preparations containing anionic ambiphylic base was smaller by 10-31.28%, and in the preparations containing aliphatic hydrocarbon-type base, the decrease was 11.46 - 31.28%, compared to the results achieved with the non-ionogenic ambiphylic base. CONCLUSION: The optimal release velocity for the analyzed antibiotics was achieved from the non-ionic ambiphylic base.