Controversies in antibiotic choices for odontogenic infections. endodontics PMID: 16122650 Epub 2006 Apr 21.

摘要

To the Editor:We would like to make a few comments regarding the opinions expressed in the letter of Drs. Limeres, Tomas, Alvarez, and Diz, entitled "Empirical Antimicrobial Therapy for Odontogenic Infections" 2005; 100:263-4. This is because, as interesting as it may be such a discussion on antibiotic selection, it is important to assess any therapeutic suggestions in conjunction with previously available data, particularly when outcomes from differing treatments have not been statistically determined.The initial choice of specific antibiotics for the treatment of odontogenic infections is based upon established knowledge of the pathogenic flora which includes streptococci and anaerobes.1'2 Accordingly, clindamycin is currently recommended either as alternative therapy for penicillin allergic patients1 or as primary choice for serious odontogenic infections including Ludwig angina and parapharyngeal space abscesses.2 Cutting across these recommendations, Dr. Limeres and colleagues implied that moxifloxacin should be preferred to clindamycin on the basis of its better activity against viridans streptococci, in the face of the increasing antimicrobial resistance of these organisms. Our objections to their argument are as follows:1. The conclusion was largely based on previous work of the same group of authors on the susceptibility patterns of viridans streptococci isolated solely from bacteremic cases following dental extractions. This extrapolation did not take account of the predominant role of anaerobic bacteria in odontogenic infections neither the complex bacterial ecology of these infections. Actually, in a recent study on the antimicrobial susceptibilities of bacteria isolated from odontogenic abscesses, the best activity against important anaerobic pathogens, including Fusobacterium nucleatum and Peptostreptococcus micros, was achieved by clindamycin with 100% of isolates being susceptible, whereas only 86% of these bacteria were found susceptible to moxifloxacin; in the same study activitiesof the two agents against Pre-votella organisms were comparable.