title: Antibiotic concentrations in saliva: a systematic review of the literature, with clinical implications for the treatment of sialadenitis.
abstract: OBJECTIVE
  The current recommendations for the treatment of bacterial salivary gland infections are mainly empirical. Therefore, an evidence-based literature review was conducted to identify antibiotics with favorable pharmacokinetics in saliva and to establish recommendations for the antibiotic treatment of sialadenitis.
  
  
  METHODS
  The authors performed a systematic review of the pertinent literature published from 1985 to 2013. If the predefined inclusion criteria were met, the articles were screened for various variables: antibiotic type, mode of administration, type of examined saliva, peak salivary antibiotic concentrations, biochemical methodology, and minimal inhibitory concentrations of bacteria implicated in sialadenitis (Staphylococcus aureus, Viridans streptococci, various gram-negative strains, and anaerobes).
  
  
  RESULTS
  The review included 18 studies. The systematic analysis of the reported results concurred that intravenously administered cephalosporins achieve the highest concentrations in saliva, followed by orally administered cephalosporins and fluoroquinolones. These concentrations exceed the minimal inhibitory concentrations of the bacteria of interest. Phenoxymethylpenicillin and tetracyclines are not secreted in the saliva at bactericidal levels. The antibiotic peak salivary levels depended on the type of saliva examined (parotid vs submandibular vs minor salivary gland) and the biochemical method of measurement (high-performance liquid chromatography vs bioassay).
  
  
  CONCLUSIONS
  Cephalosporins and fluoroquinolones display superior pharmacokinetics in saliva and cover the spectrum of all bacteria implicated in sialadenitis. Within the limitations of this review, they can be recommended for the treatment of bacterial salivary gland infections.
authors.affiliation: Resident, Department of Oral and Maxillofacial Surgery, Ludwig Maximilians University of Munich, Munich, Germany. Electronic address: matthias_troeltzsch@hotmail.com.
authors.forename: Matthias
authors.initials: M
authors.lastname: Troeltzsch
authors.affiliation: Resident, Department of Oral and Maxillofacial Surgery, Ludwig Maximilians University of Munich, Munich, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Pache
authors.affiliation: Resident, Department of Oral and Maxillofacial Surgery, Ludwig Maximilians University of Munich, Munich, Germany.
authors.forename: Florian Andreas
authors.initials: FA
authors.lastname: Probst
authors.affiliation: Resident, Department of Oral and Maxillofacial Surgery, University of Göttingen, Göttingen, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Troeltzsch
authors.affiliation: Professor and Chair, Department of Oral and Maxillofacial Surgery, Ludwig Maximilians University of Munich, Munich, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Ehrenfeld
authors.affiliation: Consultant, Department of Oral and Maxillofacial Surgery, Ludwig Maximilians University of Munich, Munich, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Otto
mesh_terms: D061605:Administration, Intravenous; D000284:Administration, Oral; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000493:pharmacokinetics*; D002511:Cephalosporins / Q000008:administration & dosage / Q000493:pharmacokinetics; D055094:Evidence-Based Dentistry; D024841:Fluoroquinolones / Q000008:administration & dosage / Q000493:pharmacokinetics; D006801:Humans; D008826:Microbial Sensitivity Tests; D012463:Saliva / Q000378:metabolism*; D012793:Sialadenitis / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D024841:Fluoroquinolones