Clinical update: a nonhealing fractured mandible.
Bisphosphonates have shown significant clinical benefit in reducing skeletal fractures in patients with multiple myeloma or bone: penicillin VK 500 mg or amoxicillin 500 mg; both 4 times daily (QID) initially and twice daily (BID) for maintenance, If penicillin allergic: 1. Clindamycin 150 to 300 mg QID. 2. Vibramycin 100 mg once daily (QD). 3. Erythromycin ethylsuccinate 400 mg 3 times daily (TID). 4. Antifungals when required: 5. Nystatin oral suspension 5 to 15 mL QID or 100,000 IU/mL. 6. Mycelex troches (clotrimazole 10 mg) x 5/day. 7. Fluconazole 200 mg initially, then 100 mg QD. 8. Other potential systemic antifungals include itraconazole or ketoconazole. 9. Antivirals, if required: 10. Acyclovir 400 mg BID. 11. Valacyclovir hydrochloride 500 mg to 2g BID.
Cope
Diane
D
Florida Cancer Specialist, Fort Myers, USA. dgcope@comcast.net
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D002986:Clinical Trials as Topic; D005260:Female; D017102:Fracture Healing; D006801:Humans; D007572:Jaw Fractures / Q000150:complications / Q000503:physiopathology*; D010020:Osteonecrosis / Q000175:diagnosis / Q000188:drug therapy; D011859:Radiography