title: Microbiology of odontogenic infections in deep neck spaces: a retrospective study.
abstract: The primary treatment of deep neck spaces odontogenic infection (DNSOI) with suppuration is surgery. Systemic antimicrobial therapy is an important adjunct. The initial prescription of antimicrobial therapy is empirical. Over the last decade we have observed a change in practice with the use of second-generation cephalosporins, in conjunction with metronidazole, replacing benzylpencillin and metronidazole. More recently evidence has emerged suggesting that antimicrobial resistance in nosocomial infections could be related to the widespread use of second and third-generation cephalosporins. This study was therefore initiated to determine whether this change in prescribing was justified. A total of 75 cases were retrospectively identified by scrutiny of the operating theatre data. These patients presented with significant DNSOI that required surgical drainage. Streptococcus milleri and mixed anaerobes were predominant. Only in three cases (4%) there were penicillin-resistant microorganisms. The substitution of benzylpenicillin for cefuroxime as an initial empiric therapy for DNSOI seems likely to have been equally efficacious in the large majority of cases. On the other hand, studies in preference of cephalosporins are based on in vitro trials. A multi-centre randomized controlled clinical trial directly comparing initial empiric second-generation cephalosporin therapy with benzylpenicillin in non-allergic patients is justified.
authors.affiliation: Department of Vascular Surgery, Ninewells Hospital, Dundee, United Kingdom. hibatlaith@yahoo.co.uk
authors.forename: Laith Hussein
authors.initials: LH
authors.lastname: Al-Qamachi
authors.forename: Hiba
authors.initials: H
authors.lastname: Aga
authors.forename: Jeremy
authors.initials: J
authors.lastname: McMahon
authors.forename: Alistair
authors.initials: A
authors.lastname: Leanord
authors.forename: Nicholas
authors.initials: N
authors.lastname: Hammersley
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001421:Bacteria, Anaerobic / Q000302:isolation & purification; D002444:Cefuroxime / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004322:Drainage; D005491:Focal Infection, Dental / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D006801:Humans; D008795:Metronidazole / Q000627:therapeutic use; D009333:Neck / Q000382:microbiology*; D010400:Penicillin G / Q000627:therapeutic use; D010403:Penicillin Resistance; D012189:Retrospective Studies; D013290:Streptococcal Infections / Q000188:drug therapy / Q000601:surgery; D034364:Streptococcus milleri Group / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D008795:Metronidazole; D002444:Cefuroxime; D010400:Penicillin G