Pepleomycin-induced pneumonitis resulting in death

Two cases of fatal pneumonitis induced by pepleomycin, a new antitumour antibiotic analogous to bleomycin, are described. In the first case, the patient received radiation in combination with intra-arterial administration of pepleomycin to a total dose of 100 mg. for the treatment of an epidermoid carcinoma of the maxilla. The pulmonary changes were noted two weeks after cessation of the chemotherapy and the patient died of pulmonary insufficiency despite intensive therapy with antibiotics and a steroid. The other case with an epidermoid carcinoma of the cheek and oropharynx was treated by radiation and pepleomycin given to a total dose of 205 mg. Pepleomycin was replaced by predonin soon after bilateral shadows were noticed on a chest radiograph, but the patient died of pneumonitis 10 months later. Various factors which may affect the development of pulmonary toxicity by pepleomycin are discussed.     

Necrotizing fasciitis of the maxillofacial region caused by dental infection. A case report and review

Necrotizing fasciitis (NF) is a destructive and potentially fatal soft tissue infection characterized by extensive necrosis and gas formation in subcutaneous tissues and fascia, with serious involvement of muscles, vessels, nerves, and fat. In the maxillofacial region, NF is less common. The process can represent the evolution of a dental infection supported by aerobic and anaerobic bacteria that are resistant to antibiotic therapy (multidrug resistance) in immunocompromised patients or the natural evolution of untreated infection. Because of the rarity of the disease, diagnosis and treatment are often delayed, which may result in a fatal outcome due to respiratory problems or systemic complications. The success of the treatment is surgical debridement and high doses of antibiotic therapy. The AA described a case of NF in a female, 59 years old, who developed NF in the maxillofacial and neck region following dental infection and after consulting our Institute for remarkable swelling of the right cheek, palpebral and parotid regions, submaxillary region, and neck; this swelling is associated with hyperpyrexia, trismus, poor systemic conditions, and serious respiratory difficulty. Through prompt clinical diagnosis, early surgical treatment, appropriate antibiotic therapy (culture analysis revealed sensitivity to Imipenem and Levofloxacina), and local control of the lesion through surgical medications twice daily, we were able to not only avoid serious and fatal evolution of the process, but also to limit tissue involvement, preventing further extension of the necrosis to other anatomical structures of the region. A satisfactory clinical result was thus obtained.     

The Role of Systemic Condition in the Management of Maxillofacial Infections

Ludwig’s Angina is a rare type of facial infection which formerly invariably was fatal but now with adequate surgical and antibiotic treatment has a much reduced mortality. In spite of the recent advances in therapy, rare and potentially life threatening complications may still arise from time to time and as a result account for significant morbidity and mortality. A case of Ludwig’s angina reported at A.B Shetty Memorial Institute of Dental Sciences, Mangalore, India resulting in fatality, in spite of surgical and antibiotic treatment, due to underlying systemic condition and involvement of multiple resistant organisms. The condition was worsened by subsequent esophageal rupture and death occurred due to multiple organ failure.     

Long term clinical observation of osteomyelitis of the jaw

The incidence of osteomyelitis of the jaw has been reduced because of the recent progress in antibiotic therapy. Unlike typical cases recorded in the usual textbooks, very prolonged and difficult types of chronic osteomyelitis are also encountered. In these cases, it is difficult to recover completely by means of antibiotic therapy alone, and therefore surgical intervention is inevitable. Among 2020 cases recorded in the inpatient clinic from August 1974 to February 1987, 180 cases (8.9%) were cases of inflammatory disease (Table 1), and 46 out of 180 cases were diagnosed as osteomyelitis (25. 6%). Of the 46 cases of osteomyelitis 22 of them were classified as chronic osteomyelitis (47.8%), 13 as acute osteomyelitis (28.3%), and 8 as radiation osteomyelitis (17.4%) (Table 2). The three cases presented in this study required surgical intervention. In one case of chronic osteomyelitis surgical treatment, extraction of a tooth and sequestrectomy, was performed. Another two cases, which occurred in patients with radiation osteomyelitis, required sequestrectomy and segmental mandibulectomy, respectively.     

Chemoprophylaxis of dental patients with prosthetic joints: a simulation model

A computer simulation model was created to assess the risks and effects of no prophylaxis, oral penicillin, and oral cephalexin regimens for dental patients at risk for late prosthetic joint infection (LPJI). Given the assumptions made, this analysis suggests that there is a very small risk of LPJI (29-68 cases per 10(6) dental visits), which is outweighed by a greater risk of death from a fatal antibiotic reaction. Thus, routine predental antibiotic prophylaxis for all dental patients with prosthetic joints may lead to higher mortality. However, clinical experience suggests that antibiotic prophylaxis may be appropriate in "high risk" patients.     

Lethal invasive mucormycosis: case report and recommendations for treatment

A case of lethal invasive mucormycosis (IM), a rare fungal infection which predominantly affects immunocompromised patients, is reported in a 73-year-old female patient who presented with a cervical abscess. The patient had asthma treated with steroids and had previously undiagnosed diabetes mellitus. Despite surgical treatment and parenteral antibiotic therapy, there was fatal progression of the condition. The pathogenesis, histological appearances and treatment of mucormycosis are discussed, particularly the importance of urgent histological examination of debrided tissue to distinguish this condition from necrotizing fasciitis (NF) earlier than microbiological culture alone would allow, thus permitting the early introduction of appropriate antifungal therapy.     

The flare-up phenomenon in endodontics: a clinical perspective and review

The acute endodontic cellulitis exacerbation, which can be potentially fatal, is a definitive entity in endodontic flare-ups. Aerobic microbes, particularly streptococci, are the predominant causative microbes isolated. There was a noticeable absence of obligate anaerobes. This is significant for the selection of an antibiotic for therapy. Treatment parameters were presented. An endodontic cellulitis exacerbation is most unlikely with obligate anaerobes. An endodontic flare-up perspective was attempted with some clinical parameters. The proponents of routine one-visit endodontic treatment with prophylactic drugs to prevent cellulitis exacerbations do not appear to offer any advantage to the more traditional approaches to endodontic treatment of the patient, which may be more beneficial.     

Refractory chronic periodontitis: effect of oral tetracycline hydrochloride and root planing

Refractory chronic periodontitis of 16 patients was treated by root planing and adjunctive tetracycline hydrochloride therapy. The antibiotic was taken orally one hour before root planing and continued for six days at a dosage of 250 mg six hourly. The clinical data for each patient were recorded as the number of probing depths in each of the 1-3 mm, 4-6 mm and 7-10 mm ranges. The Multivariate Analysis of Variance (MANOVA) procedure for repeated measurements was used to analyse the data. The results demonstrated that the number of sites with probing depths of 4-6 mm and 7-10 mm associated with incisors, canines, premolars and molars decreased with a corresponding increase in the number of sites in the 1-3 mm range. Incisor and canine teeth showed a better response to treatment than premolars, which responded better than molars. The cases were followed for varying periods of time from six months to two years following antibiotic therapy. The probing depth reduction achieved following root planing and tetracycline hydrochloride therapy was maintained during this review period.     

Microbiology in diagnosis and treatment of severe periodontitis. A report of four cases

The purpose of this report is to illustrate the use of microbiology in the diagnosis and treatment in four cases of severe adult periodontitis. All four patients were subgingivally infected with Actinobacillus actinomycetemcomitans which was the basis for an adjunct minocycline therapy. Scaling and root planing plus minocycline were not able to establish a clinically stable periodontal condition. A. actinomycetemcomitans was not eliminated from the pockets in any of the patients. Good clinical and microbiological results were obtained after continuous conventional treatment with an adjunct therapy of metronidazole plus amoxycillin. With a 7 day course of this antibiotic therapy, the pockets of all four patients became free of A. actinomycetemcomitans and were still negative on repeated sampling on recall visits. Microbiological monitoring of severe periodontitis in adults seems to be a valuable adjunct to clinical examination. Furthermore, effective antibiotic therapy in A. actinomycetemcomitans-associated periodontitis appears of paramount importance in obtaining a stable periodontal situation.     

The clinical relevance of microbiologic testing: a comparative analysis of microbiologic samples secured from the same sites and cultured in two independent laboratories

A field study using five different private periodontal practices was conducted; it compared two microbiologic culture samples simultaneously secured from the same sites within 23 individual patients and submitted for bacterial identification and antibiotic sensitivity testing to two separate laboratories. The results from the two laboratories were often different. In no instance did both laboratories agree on the presence of identical bacterial species. When only bacteria above threshold levels were compared, agreement was found in only nine of 23 cases. When examining antibiotic sensitivity, using 100% kill of all tested pathogens as the ideal, agreement between the two laboratories was poor. The laboratories agreed on the use of amoxicillin 17% of the time, tetracycline 26% of the time, and metronidazole 48% of the time. The use of amoxicillin and metronidazole in combination yielded a 78% agreement when the results of both laboratories were combined. It would appear from the data that the empirical use of amoxicillin-metronidazole combination therapy may be more clinically sound and cost effective than culturing and antibiotic selection based on the results of culture from any single microbiologic testing laboratory.     

严重多发伤合并颌面部坏死性筋膜炎3例

目的：探讨严重多发伤后合并颌面部坏死性筋膜炎的临床特征及治疗方法。方法：回顾近10年诊治的严重多发伤后合并颌面部坏死性筋膜炎3例临床资料,结合文献复习,讨论其发病原因、临床表现和诊治方法。结果：2例获得良好疗效,1例病例死亡。结论：对严重多发伤后合并颌面部的坏死性筋膜炎应引起足够重视,及时有效地外科处理,联合应用抗生素和防治并发症是治疗成功的关键;颌面部皮肤缺损创面,要适时用皮片移植修复。     

Ludwig's angina: a case report with a 5-year follow-up

Aim

Ludwig's angina is a rare aggressive infection, often of dental origin, characterized by a rapid spread of cellulitis in the submandibular and sublingual spaces. Ludwig's angina is potentially fatal, if it obstructs the airways and if it is not treated with appropriate antibiotic therapy.

Penicillin-resistant bacteroides melaninogenicus infection of the mandible

Oral infections caused by gram-negative anaerobes are now recognized more frequently than in the past because of improved culturing techniques. A case of B melaninogenicus infection secondary to a fractured mandible, in which the organisms were both clinically resistant and insensitive on culture to penicillin, is presented. The organism was also shown to produce beta-lactamase. Clindamycin is appropriate dosage resulted in diarrhea, which precluded its continuation. Erythromycin therapy was curative in this case. In all cases in which the clinical course does not reflect the expected reasonable response to the appropriate antibiotic therapy, bacterial resistance to a drug should be considered, and laboratory testing for resistance and sensitivities should be performed.     

The clinical relevance of microbiologic testing. Part 2: a comparative analysis of microbiologic samples secured simultaneously from the same sites and cultured in the same laboratory

A field study using four different private periodontal practices and two independent laboratories was conducted to compare two microbiologic cultures sampled simultaneously from the same sites in 20 individual patients. Both paired samples were submitted separately to one of the two independent laboratories for bacterial identification and antibiotic sensitivity testing. The results from the two samples were quite variable. In only two instances did both specimens reveal the presence of identical bacterial species, but these specimens differed in both threshold levels and antibiotic sensitivity. When only bacteria above threshold levels were compared, total agreement was found in 11 of 20 cases. When examining antibiotic sensitivity, using 100% kill as the ideal, agreement between the two specimens was inconsistent The use or nonuse of tetracycline was in agreement 85% of the time, amoxicillin 75% of the time, metronidazole 70% of the time, and amoxicillin-metronidazole in combination 85% of the time. The two specimens agreed on the empirical use of amoxicillin 45% of the time, tetracycline 60% of the time, and metronidazole 60% of the time. The empirical use of amoxicillin-metronidazole in combination yielded 80% agreement when the results of both specimens were combined. The empirical use of amoxicillin-metronidazole combination therapy may be more clinically sound and cost effective than culturing and antibiotic selection based on the culture from any single microbiologic testing laboratory. This supports the data from a previous study that examined specimens secured simultaneously from the same site and submitted to two different testing laboratories. The failure of microbial testing to achieve a higher level of consistency between samples leaves the clinical efficacy of microbial testing in question.     

Emergence of antibiotic resistant Streptococcus sanguis in dental plaque of children after frequent antibiotic therapy.

PURPOSE: In the pediatric population, several different antibiotic regimens are currently recommended for the treatment of otitis media. This study investigated whether therapy for otitis media was associated with the emergence of antibiotic-resistant oral bacteria. METHODS: Streptococcus sanguis (S. sanguis) was isolated from supragingival dental plaque of children after a recent course of antibiotic. The isolated strains were tested for resistance to penicillin, amoxicillin, trimethoprim-sulfamethoxazole, and erythromycin and compared to isolated strains from age- and sex-matched control subjects, who had received no antibiotics within two years before sampling. RESULTS: While control subjects harbored no resistant strains of S. sanguis, about 60% of children who had received antibiotics harbored S. sanguis which were resistant to at least one of the tested antibiotics. Nearly half of these strains were resistant to two or more antibiotics. Resistance to penicillin and amoxicillin decreased with the age of the child and with the length of time since exposure to the antibiotic. However, resistance to trimethoprim-sulfamethoxazole or erythromycin showed no relationship to the age of the child or the length of time since exposure to the antibiotic. CONCLUSION: The data show that children who had been treated for otitis media with common antibiotic protocols do harbor antibiotic-resistant oral streptococci which may complicate prophylactic and therapeutic regimens for bacterial endocarditis.     

Treatment of chronic osteomyelitis in Korea

OBJECTIVE: We sought to investigate the clinical and histopathologic features of chronic osteomyelitis and its treatment in Koreans. STUDY DESIGN: A total of 49 patients (ages 11-79 years; mean, 47.3 years) were examined in this retrospective chart review. In a new treatment protocol used for 39 patients, chronic osteomyelitis of the jaws was treated by surgical intervention and 2 weeks of intravenous antibiotics, followed by 6 weeks of oral antibiotics, whereas a control group consisting of 10 patients was treated by surgery alone. Surgical therapy consisted of decortication or sequestrectomy and saucerization of the affected bone. A successful outcome was defined as the resolution of symptoms after surgery alone or after surgery and 8 weeks of antibiotic therapy. Failure was defined as a case requiring a second operation and 8 additional weeks of antibiotic therapy. RESULTS: A successful outcome was seen in 94.9% of patients on the new treatment protocol, as well as in 60% of control patients. A purulent discharge developed in 2 cases after the new treatment protocol and in 4 control cases, but the patients were treated successfully with a second operation. CONCLUSIONS: Surgery followed by antibiotic therapy for at least 8 weeks is an effective method for treating chronic osteomyelitis of the jaws.     

Ofloxacin in prophylactic therapy of oral infections

86 patients (46 females, 40 males; mean age 37 years) were divided into 2 groups: one group of 40 patients with acute infectious odontostomatitis, and another group of 46 patients going to have their oral cavity surgically operated. The first group was treated with 300 mg oral tablets of ofloxacin 12 hourly for 5 days, the second group with the same posology for 3 days, for prophylactic purposes. 54 cases (24 in the first group and 30 in the second one) had Fans drugs integrating antibiotic therapy. At the end of the antibiotic treatment the first group showed a complete abatement of symptoms in 16 cases, a significant improvement in 19 cases, and better clinical conditions in 5 cases. The second group, examined again 4 and 7 days after surgical intervention, showed the prophylactic antibiotic treatment beneficial in 30 cases after 4 days, and in 14 cases after 7 days; for 2 cases it was necessary to replace the antibiotic drug by other. Side effects in both groups (14 cases) were slight and did not cause any treatment interruption. Given these results and the good tolerability of the drug, we conclude that orally administered ofloxacin is a valid alternative to the parenteral drug for the treatment of infectious odontostomatitis and for prophylaxis after oral surgery.     

Oral avascular bone necrosis associated with chemotherapy and biphosphonate therapy

BACKGROUND: Oral avascular bone necrosis is an important adverse effect of chemotherapy and biphosphate therapy. OBJECTIVE: To report our experience in oral avascular bone necrosis in cancer patients assigned to undergo chemotherapy. PATIENTS AND METHODS: Fourteen patients presenting oral avascular bone necrosis were selected from the clinical files of five Stomatological Clinics in Brazil. Clinical data as well as treatment and prognosis information were obtained from all 14 patients. RESULTS: Twelve patients (86%) were submitted to biphosphonate therapy. The most important symptom was pain, present in all cases, and the mandible was the most common involved site. Most patients (79%) had their conditions managed by antibiotic therapy and surgical debridation; however complete response was achieved in only three cases (21%). CONCLUSION: Avascular bone necrosis is a serious oral side-effect of cancer chemotherapy, particularly in patients using biphosphonates, and antibiotic therapy and surgical debridation were not able to promote complete response in most cases.     

盐酸米诺环素软膏在智齿冠周炎治疗中的作用

目的:比较盐酸米诺环素软膏与碘甘油在治疗智齿冠周炎中的疗效。方法:对148例急性发作的智齿冠周炎,经常规冠周冲洗后,分别采用盐酸米诺环素软膏或者碘甘油给予冠周龈袋或者盲袋上药,借以控制或缓解智齿冠周炎的症状。并据患者炎症轻重分为同时口服抗生素组,和无辅助应用抗生素组,结果进行疗效对比,统计学分析。结果:在辅助全身应用抗生素时,两种局部处理措施的疗效基本相同;但在未给予全身抗生素治疗时,盐酸米诺环素软膏的疗效明显高于碘甘油组。结论:相对碘甘油,采用盐酸米诺环素软膏进行智齿冠周炎的治疗,具有一定的优越性。