The Use of Antibiotics in Odontogenic Infections: What Is the Best Choice?
Journal of Oral and Maxillofacial Surgery:
Odontogenic infections are a common problem in dentistry, and their treatment often requires the use of antibiotics besides the removal of the source of infection, which frequently makes it more difficult for clinicians to make a decision regarding the choice of antibiotic.
The pathogenesis of odontogenic infection is polymicrobial, consisting of various facultative and strict anaerobes. The dominant isolates are strictly anaerobic gram-negative rods and gram-positive cocci.
The pyogenic oro-fascial infections are most commonly odontogenic in origin. They may range from periapical abscesses to superficial and deep infections in the neck. If untreated, they generally spread into the contiguous fascial spaces (masseteric, sublingual, submandibular, temporal, buccal, canine and parapharyngeal) and may lead to additional complications.
Figure
Different locations of odontogenic infections. (A) Submandibular and sublingual region. (B) Submandibular region. (C) Cervical region. (D) Palate. (E) Orbital region. (F) Submandibular and buccal region.
The most important element in treating odontogenic infections is elimination of the primary source of the infection with antibiotics as adjunctive therapy.
The choice of antibiotic for the management of odontogenic infection depends ideally on the definitive laboratory results of culture and antibiotic sensitivity testing. A pragmatically rational approach to empirical antibiotic selection is acceptable clinically and legally, if the choice is based on specific data and on contemporary experience with the microbiology of the oral cavity.
In the case of Odontogenic infections, once drainage has been performed and/or the cause of infection has been removed, all antibiotics tested are equally effective with respect to clinical cure, and the choice of antibiotics is not as successful as the local (surgical) intervention treatment procedure.
When the real need for antibiotic therapy is detected, antibiotics should be used for the shortest time possible until the patient's clinical cure is achieved.
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Purpose
This study aimed to answer the following questions through the Patient, Intervention, Comparison, Outcome (PICO) format:
When should antibiotics be used in dental infections (DIs)?
Which are the most effective drugs?
How long antibiotics should be administered?
Materials and Methods
This was a systematic review using the PubMed, Scopus, and Cochrane databases without restriction as to the period researched. The variables analyzed in each article were the number of odontogenic infections in each study, type of study, surgical intervention performed, antibiotics administered, statistical differences between groups studied, and patients' evolution after treatment.
Results
The search included 1,109 articles. After the full reading of 46 articles, 16 were included in the final review and 30 were excluded. A sample of 2,197 DI cases was obtained, in which 15 different antibiotics were used, with a 98.2% overall cure rate.
Conclusions
The studies showed that antibiotics were prescribed only in situations of regional and/or systemic body manifestations. In the case of DIs, once drainage has been performed and/or the cause of infection has been removed, all antibiotics tested are equally effective with respect to clinical cure, and the choice of antibiotics is not as successful as the local intervention treatment procedure.
When the real need for antibiotic therapy is detected, antibiotics should be used for the shortest time possible until the patient's clinical cure is achieved.
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