[Pharmacokinetic/pharmacodynamic analysis of antibiotic therapy in dentistry and stomatology].
BACKGROUND
This study evaluates the efficacy of various antimicrobial treatments for orofacial infections on the basis of pharmacokinetic/pharmacodynamic (PK/PD) criteria.


METHODS
A complete a literature search was undertaken to establish the MIC90 values of the five microorganisms most frequently isolated in odontogenic infections and the pharmacokinetic parameters of 13 antibiotics used in these infections. Pharmacokinetic simulations were then carried out with mean population parameters and efficacy indexes were calculated for the 47 treatment regimens analyzed. For drugs showing time-dependent antibacterial killing, the time above MIC (t > MIC) was calculated. For drugs with concentration-dependent bactericidal activity, the AUC/MIC was calculated.


RESULTS
Amoxicillin-clavulanic (500 mg/8 h or 1000 mg/12 h) and clindamycin (300 mg/6 h) in the time-dependent killing group and moxifloxacin (400 mg/24 h) in the concentration-dependent group showed adequate efficacy indexes against the five pathogens considered to be the most commonly implicated in odontogenic infections. The spiramycin plus metronidazole combination, present in the commercial formulation Rhodogyl, did not reach satisfactory PK/PD indexes.


CONCLUSIONS
PK/PD indexes, which are useful predictors of the potential efficacy of antibacterial therapy, were used with ontogenic infections in the present study. The PK/PD simulations showed that amoxicillin-clavulanic, clindamycin and moxifloxacin were the most suitable antibiotics for this kind of infection. Clinical trials are required to confirm that this methodology is useful in these pathologic processes.
Isla
Arantxazu
A
Laboratorio de Farmacia y Tecnología Farmacéutica, Facultad de Farmacia, Universidad del País Vasco, Vitoria-Gasteiz, Spain.
Canut
Andrés
A
Rodríguez-Gascón
Alicia
A
Labora
Alicia
A
Ardanza-Trevijano
Bruno
B
Solinís
María Angeles
MA
Pedraz
José Luis
JL
D000465:Algorithms; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000493:pharmacokinetics / Q000494:pharmacology* / Q000627:therapeutic use; D019540:Area Under Curve; D001372:Aza Compounds / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy*; D002981:Clindamycin / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D002986:Clinical Trials as Topic / Q000379:methods; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D024841:Fluoroquinolones; D016967:Fusobacterium nucleatum / Q000187:drug effects; D006801:Humans; D008826:Microbial Sensitivity Tests; D009059:Mouth Diseases / Q000188:drug therapy* / Q000382:microbiology; D000077266:Moxifloxacin; D010462:Peptostreptococcus / Q000187:drug effects; D010518:Periodontitis / Q000188:drug therapy / Q000382:microbiology; D016966:Porphyromonas gingivalis / Q000187:drug effects; D018713:Prevotella intermedia / Q000187:drug effects; D011804:Quinolines / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D013997:Time Factors; D034363:Viridans Streptococci / Q000187:drug effects
D000900:Anti-Bacterial Agents; D001372:Aza Compounds; D024841:Fluoroquinolones; D011804:Quinolines; D002981:Clindamycin; D019980:Amoxicillin-Potassium Clavulanate Combination; D000077266:Moxifloxacin