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Evidence-Based Principles of Antibiotic Therapy

  • Thomas R. Flynn
Chapter

Abstract

Oh, for the days when I could just write a prescription for penicillin and know that it would be effective for my patient! Those days are over. Now, I have to worry about whether the antibiotic will cover the usual organisms in the infection; if there are highly antibiotic-resistant bacteria present; if my prescription will select for resistant organisms in the patient, or her family, or his community; if the patient will have a toxic or allergic reaction; or if it will interact with one of the many other drugs the patient is taking. What if my patient can’t afford the antibiotic or doesn’t take it as prescribed? How long will he really take the antibiotic for? Just until he feels better? Should I be prescribing this antibiotic at all?

Modern antibiotic therapy for odontogenic infections has become quite complex. This chapter will provide the available evidence that answers the above questions as well as is possible with our current knowledge. It lists the ten principles of the modern use of antibiotics and provides the evidence supporting those principles. Some of these principles apply to the issue of antibiotic selection and others to proper administration of antibiotics.

Keywords

Odontogenic infection Antibiotic therapy Antibiotic resistance Antibiotic drug interactions Antibiotic toxicities Antibiotic cost Prophylactic antibiotics 

References

  1. Al-Nawas B, Walter C, Morbach T, Seitner N, Siegel E, Maeurer M, Krummenauer F. Clinical and microbiological efficacy of moxifloxacin versus amoxicillin/clavulanic acid in severe odontogenic abscesses: a pilot study. Eur J Clin Microbiol Infect Dis. 2009;28:75–82.CrossRefGoogle Scholar
  2. American Academy of Orthopaedic Surgeons, American Dental Association (2012) Prevention of orthopaedic implant infection in patients undergoing dental procedures: evidence-based guideline and evidence report. Rosemont, IL: American Academy of Orthopaedic Surgeons. Available at: wwwaaosorg/research.Google Scholar
  3. American Dental Association, American Academy of Orthopaedic Surgeons. Antibiotic prophylaxis for dental patients with total joint replacements. J Am Dent Assoc. 2003;134:895–8.CrossRefGoogle Scholar
  4. Andersson DI, Hughes D. Antibiotic resistance and its cost: is it possible to reverse resistance? Nat Rev Microbiol. 2010;8:260–71.CrossRefGoogle Scholar
  5. Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis:diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association. Circulation. 2005;111(23):e394–434.PubMedGoogle Scholar
  6. Bartlett JG, Dowell SF, Mandell LA, File TMJ, Musher DM, Fine MJ, for the Infectious Diseases Society of America. Practice guidelines for the management of community-acquired pneumonia in adults. Clin Infect Dis. 2005;31:347–82.CrossRefGoogle Scholar
  7. Bliziotis IA, Samonis G, Vardakas KZ, Chrysanthopoulou S, Falagas ME. Effect of aminoglycoside and beta-lactam combination therapy versus beta-lactam monotherapy on the emergence of antimicrobial resistance: a meta-analysis of randomized, controlled trials. Clin Infect Dis. 2005;41(2):149–58.CrossRefGoogle Scholar
  8. Brennan MT, Runyon MS, Batts JJ, et al. Odontogenic signs and symptoms as predictors of odontogenic infection: a clinical trial. J Am Dent Assoc. 2006;137:62–6.CrossRefGoogle Scholar
  9. Brook I. Emergence and persistence of beta-lactamase-producing bacteria in the oropharynx following penicillin treatment. Arch Otolaryngol Head Neck Surg. 1988;114:667–70.CrossRefGoogle Scholar
  10. Brook I, Frazier EH, Gher ME. Aerobic and anaerobic microbiology of periapical abscess. Oral Microbiol Immunol. 1991;6(2):123–5.CrossRefGoogle Scholar
  11. Brook I, Gober AE. Monthly changes in the rate of recovery of penicillin-resistant organisms from children. Pediatr Infect Dis J. 1997;16:255–7.CrossRefGoogle Scholar
  12. Chardin H, Yasukawa K, Nouacer N, Plainvert C, Aucouturier P, Ergani A, Descroix V, Toledo-Arenas R, Azerad J, Bouvet. A reduced susceptibility to amoxicillin of oral streptococci following amoxicillin exposure. J Med Microbiol. 2005;58:1092–7.CrossRefGoogle Scholar
  13. Davis WM Jr, Balcom JH 3rd. Lincomycin studies of drug absorption and efficacy. An evaluation by double-blind technique in treatment of odontogenic infections. Oral Surg Oral Med Oral Pathol. 1969;S27:688–96.CrossRefGoogle Scholar
  14. Fahimi J, Singh A, Frazee BW. The role of adjunctive antibiotics in the treatment of skin and soft tissue abscesses: a systematic review and meta-analysis. CJEM. 2015;17:420–32.CrossRefGoogle Scholar
  15. Flynn TR. What are the antibiotics of choice for odontogenic infections, and how long should the treatment course last? Oral Maxillofac Surg Clin North Am. 2011;23:519–36.CrossRefGoogle Scholar
  16. Flynn TR, Shanti RM. Principles of antibiotic therapy for head, neck, and orofacial infections. In: Hupp JR, Ferneini E, editors. Head, neck, and orofacial infections: a multidisciplinary approach. St Louis, MO: Elsevier; 2016. p. 141–63.CrossRefGoogle Scholar
  17. Flynn TR, Shanti RM, Levy M, Adamo AK, Kraut RA, Trieger N. Severe odontogenic infections, part one: prospective report. J Oral Maxillofac Surg. 2006;64:1093–103.CrossRefGoogle Scholar
  18. Flynn TR, Paster BJ, Stokes L, Susarla SM, Shanti RM. Molecular methods for diagnosis of odontogenic infections. J Oral Maxillofac Surg. 2012;70:1854–9.CrossRefGoogle Scholar
  19. Gilmore WC, Jacobus NV, Gorbach SL, Doku HC, Tally FP. A prospective double-blind evaluation of penicillin versus clindamycin in the treatment of odontogenic infections. J Oral Maxillofac Surg. 1988;46:1065–70.CrossRefGoogle Scholar
  20. Haffajee AD, Socransky SS, Gunsolley JC. Systemic anti-infective periodontal therapy: a systematic review. Ann Periodontol. 2003;8:115–81.CrossRefGoogle Scholar
  21. Haffajee AD, Yaskell T, Torresyap G, Teles R, Socransky SS. Comparison between polymerase chain reaction-based and checkerboard DNA hybridization techniques for microbial assessment of subgingival plaque samples. J Clin Periodontol. 2009;36:642–9.CrossRefGoogle Scholar
  22. Halpern L, Dodson TB. Does prophylactic administration of systemic antibiotics prevent postoperative inflammatory complications after third molar surgery? J Oral Maxillofac Surg. 2007;65:177–85.CrossRefGoogle Scholar
  23. Igoumenakis D, Giannakopoulos NN, Parara E, et al. Effect of causative tooth extraction on clinical and biological parameters of odontogenic infection: a prospective clinical trial. J Oral Maxillofac Surg. 2015;73:1254–8.CrossRefGoogle Scholar
  24. Ingham HR, Hood FJ, Bradnum P, Tharagonnet D, Selkon JB. Metronidazole compared with penicillin in the treatment of acute dental infections. Br J Oral Surg. 1977;14:264–9.CrossRefGoogle Scholar
  25. Kim MK, Chuang SK, August M. Antibiotic resistance in severe orofacial infections. J Oral Maxillofac Surg. 2017;75:962–8.CrossRefGoogle Scholar
  26. von Konow L, Nord CE. Ornidazole compared to phenoxymethylpenicillin in the treatment of orofacial infections. J Antimicrob Chemother. 1983;11:207–15.CrossRefGoogle Scholar
  27. Lewis MA, McGowan DA, MacFarlane TW. Short-course high-dosage amoxycillin in the treatment of acute dento-alveolar abscess. Br Dent J. 1986;161:299–302.CrossRefGoogle Scholar
  28. Lewis MA, Carmichael F, MacFarlane TW, Milligan SG. A randomised trial of co-amoxiclav (Augmentin) versus penicillin V in the treatment of acute dentoalveolar abscess. Br Dent J. 1993;175:169–74.CrossRefGoogle Scholar
  29. Lewis MA, Parkhurst CL, Douglas CW, Martin MV, Absi EG, Bishop PA, Jones SA. Prevalence of penicillin resistant bacteria in acute suppurative oral infection. J Antimicrob Chemother. 1995 Jun;35(6):785–91.CrossRefGoogle Scholar
  30. Li XZ, Nikaido H. Efflux-mediated drug resistance in bacteria: an update. Drugs. 2009;69:1555–623.CrossRefGoogle Scholar
  31. Li X, Kolltveit KM, Tronstad L, Olsen I. Systemic diseases caused by oral infection. Clin Microbiol Rev. 2000;13:547–58.CrossRefGoogle Scholar
  32. Lodi G, et al. Antibiotics to prevent complications following tooth extractions. Cochrane Database Syst Rev. 2012;11:CD003811.PubMedGoogle Scholar
  33. Lübbert C, John E, von Müller L. Clostridium difficile infection—guideline-based diagnosis and treatment. Dtsch Arztebl Int. 2014;111:723–31.PubMedPubMedCentralGoogle Scholar
  34. Mangundjaja S, Hardjawinata K. Clindamycin versus ampicillin in the treatment of odontogenic infections. Clin Ther. 1990;12:242–9.PubMedGoogle Scholar
  35. Mansfield JM, Campbell JH, Bhandari AR, et al. Molecular analysis of 16S rRNA genes identifies potentially periodontal pathogenic bacteria and archaea in the plaque of partially erupted third molars. J Oral Maxillofac Surg. 2012;70:1507–14.CrossRefGoogle Scholar
  36. Marcussen KB, Laulund AS, Jørgensen HL, Pinholt EM. A systematic review on effect of single-dose preoperative antibiotics at surgical osteotomy extraction of lower third molars. J Oral Maxillofac Surg. 2016;74:693–703.CrossRefGoogle Scholar
  37. Matijević S, Lazić Z, Kuljić-Kapulica N, Nonković Z. Empirical antimicrobial therapy of acute dentoalveolar abscess. Vojnosanit Pregl. 2009;66:544–50.CrossRefGoogle Scholar
  38. Moreno-Drada JA, García-Perdomo HA. Effectiveness of antimicrobial prophylaxis in preventing the spread of infection: a systematic review and meta-analysis. J Oral Maxillofac Surg. 2016;74:1313–21.CrossRefGoogle Scholar
  39. Palavecino EL. Rapid methods for detection of MRSA in clinical specimens. Methods Mol Biol. 2014;1085:71–83.CrossRefGoogle Scholar
  40. Rega AJ, Aziz SR, Ziccardi VB. Microbiology and antibiotic sensitivities of head and neck space infections of odontogenic origin. J Oral Maxillofac Surg. 2006;64:1377–80.CrossRefGoogle Scholar
  41. Ren YF, Malmstrom HS. Effectiveness of antibiotic prophylaxis in third molar surgery: a meta-analysis of randomized controlled clinical trials. J Oral Maxillofac Surg. 2007;65:1909–21.CrossRefGoogle Scholar
  42. Sassone L, Fidel R, Figueiredo L, Fidel S, Faveri M, Feres M. Evaluation of the microbiota of primary endodontic infections using checkerboard DNA-DNA hybridization. Oral Microbiol Immunol. 2007;22:390–7.CrossRefGoogle Scholar
  43. Shrout MK, Scarbrough F, Powell BJ. Dental care and the prosthetic joint patient: a survey of orthopedic surgeons and general dentists. J Am Dent Assoc. 1994;125:429–36.CrossRefGoogle Scholar
  44. Singer AJ, Thode HC Jr. Systemic antibiotics after incision and drainage of simple abscesses: a meta-analysis. Emerg Med J. 2014;31:576–8.CrossRefGoogle Scholar
  45. Socransky SS, Haffajee AD. Dental biofilms: difficult therapeutic targets. Periodontol 2000. 2002;28:12–55.CrossRefGoogle Scholar
  46. Sollecito TP, Abt E, Lockhart PB, Truelove E, et al. The use of prophylactic antibiotics prior to dental procedures in patients with prosthetic joints: evidence-based clinical practice guideline for dental practitioners—a report of the American Dental Association Council on Scientific Affairs. J Am Dent Assoc. 2015;146:11–6.CrossRefGoogle Scholar
  47. Tong DC, Rothwell BR. Antibiotic prophylaxis in dentistry: a review and practice recommendations. J Am Dent Assoc. 2000;131:366–74.CrossRefGoogle Scholar
  48. Vergis EN, Demas PN, Vaccarello SJ, Yu VL. Topical antibiotic prophylaxis for bacteremia after dental extractions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;91:162–5.CrossRefGoogle Scholar
  49. von Konow L, Köndell PA, Nord CE, Heimdahl A. Clindamycin versus phenoxymethylpenicillin in the treatment of acute orofacial infections. Eur J Clin Microbiol Infect Dis. 1992;11(12):1129–35.CrossRefGoogle Scholar
  50. Weiss H. Relation of portals of entry to subacute bacterial endocarditis. Arch Int Med. 1934;54:710–9.CrossRefGoogle Scholar
  51. Williams AC. Ludwig’s angina. Surg Gynecol Obstet. 1940;70:140–9.Google Scholar
  52. Williams AC, Guralnick WC. The diagnosis and treatment of Ludwig’s angina: a report of twenty cases. N Engl J Med. 1943;228:443–50.CrossRefGoogle Scholar
  53. Wilson W, Taubert KA, Gewitz M, Lockhart PB, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. J Am Dent Assoc. 2008;139:3S–24S.CrossRefGoogle Scholar
  54. Yan LK, Zhang J, Ng MJ, Dang Q. Statistical characteristics of moxifloxacin-induced QTc effect. J Biopharm Stat. 2010;20:497–507.CrossRefGoogle Scholar
  55. Zanger UM, Schwab M. Cytochrome P450 enzymes in drug metabolism: regulation of gene expression, enzyme activities, and impact of genetic variation. Pharmacol Ther. 2013;138:103–41.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Thomas R. Flynn
    • 1
  1. 1.Private Practice, Department of Oral and Maxillofacial SurgeryHarvard School of Dental MedicineBostonUSA

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