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Antibiotic therapy

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Introduction

Results on resistance of anaerobes in dental infections are critically discussed.
Penicillin was effective only in 70-80% of bacteria, in contrast to combination of an aminopenicillin with β-lactamase inhibitor, which was effective in 95% of germs (Schaumann et al. 2000, Sobottka et al. 2002).
Based on these results, the Paul-Ehrlich-Society for Chemotherapy has changed its recommendations for oral therapy. Penicillin V is not any more the drug of first choice in dentogenic infections (Vogel et al. 2002).
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Recommendations for therapy of bacterial infectious diseases in the dental practice (in adults)

(Vogel et al. 2002)

Diagnosis Drug of choice Alternatives Degree of evidence
(with expansion tendency)
  • Apical periodontitis
  • Dentitio difficilis
  • Dentogenic abscess
    		•  Aminopenicillin +
    β-lactamase inhibitor    		 Clindamycin
    "modern macrolides"    		 I
    Acute sinusitis Group 2/3 cephalosporins
    Aminopenicillin +
    β-lactamase-inhibitor    		 "modern macrolides"
    Ketolide
    Group 3/4 fluorquinolones    		 I
    Acute necrotising gingivitis,
    Angina Plaut Vincent    		 Phenoxypenicillin +
    Metronidazole    		 Clindamycin III
    Sialadenitis Aminopenicillin +
    β-lactamase-inhibitor
    Clindamycin
    Group 2/3 cephalosporins    		    

    Recommended middle daily dose of oral antibiotics in adults

    (according to Vogel et al. 2002, Al-Nawas 2002)

    Correction of dose and limitations in systemic diseases

    Penicillins

    Group Substance Brand names (examples) Recommended middle daily dose (SD =single dose)
    Phenoxypenicillins =oral penicillins Phenoxymethyl-penicillin
    (Penicillin V)    		 Infectocillin®
    Isocillin®
    Megacillin oral®    		 3x 1,5 Mill. U.
      Propicillin Baycillin® 3x 1 Mill. U.
      Azidocillin Infectobicillin H® 2x 750mg
    Aminopenicillins Amoxycillin Amoxypen ®
    Infectomox®    		 3x 750mg
      Bacampicillin Ambacamp®
    Penglobe®    		 1,6-2,4g in 2-3 SD
    Aminopenicilline with β-lactamase-inhibitors Amoxycillin
    +clavulate    		 Augmentan® 3x 625 mg
      Sultamicillin Unacid PD oral® 2x 750mg


    Cephalosporins

    Group Substance Brand names (examples) Recommended middle daily dose (SD=single dose)
    Group I
    cephalosporins    		 Cephalexin Oracef® 3x 1g
      Cefadroxil Bidocef® 2x 1g
      Cefaclor Panoral® 3x 500mg
    Group II
    cephalosporins    		 Cefuroximaxetil Zinnat®
    Elobact®    		 2x 250mg
      Loracarbef Lorafem® 2x 400g
    Group III
    cephalosporins    		 Cefpodoxime Orelox® 2x 200mg
      Cefetamet Globocef® 2x 500mg
      Ceftibuten Keimox® 1x 400 mg
      Cephoral® 2x 200mg


    Macrolides

    Group Substance Brand names (examples) Recommended middle daily dose (SD=single dose)
      Erythromycin Erythrocin® 3x 500mg
      Clarithromycin Klacid® 2x 250mg
      Roxithromycin Rulid® 1x 300mg
    Azalid Azithromycin Zithromax® 1x 500mg


    Lincosamines

    Group Substance Brand names (examples) Recommended middle daily dose (SD=single dose)
      Clindamycin Sobelin® 0,6-1,8g in 4 SD


    Nitroimidazole

    Group Substance Brand names (examples) Recommended middle daily dose (SD=single dose)
      Metronidazole Clont®
    Flagyl®    		 3x 400mg


    sources

    • Al-Nawas (2002)   Einsatz von Antibiotika in der zahnärztlichen Praxis   DZZ 57
    • Schaumann R, Ackermann G, Pless B, Claros MC, Goldstein EJ, Rodloff AC (2000)   In vitro activities of fourteen antimicrobial agents against obligately anaerobic bacteria   Int J Antimicrob Agents.16:225-32
    • Sobottka I, Cachovan G, Sturenburg E, Ahlers MO, Laufs R, Platzer U, Mack D (2002)   In vitro activity of moxifloxacin against bacteria isolated from odontogenic abscesses   Antimicrob Agents Chemother.46:4019-21
    • Vogel F, Scholz H, al-Nawas B, Elies W, Kresken M, Lode H, Muller O, Naber KG, Petersen E, Shah P, Sorgel F, Stille W, Tauchnitz C, Trautmann M, Ullmann U, Wacha H, Wiedemann B; Paul Ehrlich Society for Chemotherapy (2002)   Ration