Justification of algorithms of antimicrobial chemotherapy in the complex treatment of phlegmon head and neck

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Authors

  • R.V. Ushakov 1, PhD in Medical Sciences, full professor of the General and surgical dentistry Department
    ORCID: 0000-0003-4821-1758
  • V.N. Tsarev 2, PhD in Medical Sciences, full professor of the Microbiology, virology, immunology Department, director of the Medico-dental research Institute
    ORCID: 0000-0002-3311-0367
  • T.G. Robustova 2, PhD in Medical Sciences, honorary professor
    ORCID: 0000-0003-0052-3277
  • E.V. Ippolytov 2, PhD in Medical Sciences, professor of the Microbiology, virology, immunology Department
    ORCID: 0000-0003-1737-0887
  • A.A. Labazanov 2, 3, PhD in Medical Sciences, researcher at the Molecular biology research laboratory of the Medico-dental research Institute; maxillofacial surgeon, Scientific Director of Dentistry
    ORCID: 0000-0003-2002-6403
  • 1 Russian Medical Academy of Continuous Professional Education, 125993, Moscow, Russia
  • 2 Moscow State University of Medicine and Dentistry, 127473, Moscow, Russia
  • 3 Clinical Hospital No. 1 of Department of Presidential affairs, 121352, Moscow, Russia

Abstract

Among the inflammatory diseases of the maxillofacial region and neck, a large number of odontogenic phlegmon are detected, in the complex treatment of which antimicrobial chemotherapy plays an important role. Objective: to conduct a retrospective assessment (over the past 35 years) of the sensitivity of pathogens of spilled inflammatory processes of the soft tissues of the maxillofacial region and neck to antimicrobial drugs, as well as to develop algorithms for antimicrobial chemotherapy of phlegmon of the maxillofacial region.
Materials and methods.
The work analyzed antibioticograms performed for the period 1985—2020 using the same algorithm for determining the antibiotic resistance in vitro of representatives of the microbiota of a purulent (putrefactive-necrotic) inflammatory focus in phlegmons of the maxillofacial region and neck of odontogenic origin. Graphs of changes in the sensitivity of clinical strains of microorganisms were compiled. The obtained data on changes in the sensitivity of odontogenic phlegmon pathogens to antibiotics (antimicrobial chemotherapy) allowed us to make a cardinal correction of the previously developed algorithm for antimicrobial chemotherapy of odontogenic phlegmon in accordance with the latest WHO classification — AWaRe. A total of 800 antibioticograms were analyzed.
Results.
Based on the data obtained, graphs of changes in the sensitivity of clinical strains of microorganisms isolated from odontogenic phlegmon from 1985 to 2020 were compiled for each antibiotic. The average percentage of susceptible and resistant strains for each time period (ten years) was taken into account. The results obtained made it possible to obtain individual graphs for each antibiotic according to the number of susceptible/resistant strains isolated at the appropriate time intervals, which allowed us to assess the dynamics of resistance growth over the covered period. An increase in the number of amoxicillin-resistant strains was noted from 22% in 1990 to 60—65% in 2000—2010. The first strains resistant to amoxicillin/clavulanate in odontogenic infection were detected in 2005—2010 — their number was 5%, and now their number has increased by 2 times — 10%. Resistance to ceftriaxone has been reported since 2000 and was first detected in 2010, and then increased from 5% to 35% in 2020. Resistance to lincomycin and clindamycin increased progressively from 28% and 15% in 1990 to 60% and 40% in 2000 respectively, and remained at this level in 2010—2020. Metronidazole resistance increased from 30% in 1990—2000 to 68% in 2020. Based on the sensitivity of pathogens of odontogenic phlegmon, effective drugs and their combinations were selected and an algorithm of antimicrobial chemotherapy was developed.
Conclusion.
The most appropriate approach to empirical antimicrobial chemotherapy of odontogenic phlegmon is combinations of amoxicillin/clavulanate or cephalosporins of III—IV generations with imidazole derivatives, as well as combinations of ciprofloxacin with imidazole derivatives or monotherapy with fluoroquinolones of III-IV generations (levofloxacin, moxifloxacin). Given the significant decrease in the sensitivity of bacteria to metronidazole, it is recommended to add new-generation imidazole derivatives (tinidazole, ornidazole) during combination therapy. Doxycycline, chloramphenicol, and linezolid are effective as reserve drugs.

Key words:

odontogenic phlegmon, maxillofacial region, antibiotic resistance, antibiotic therapy

For Citation

[1]
Ushakov R.V., Tsarev V.N., Robustova T.G., Ippolytov E.V., Labazanov A.A. Justification of algorithms of antimicrobial chemotherapy in the complex treatment of phlegmon head and neck. Clinical Dentistry (Russia).  2021; 24 (3): 69—76

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Received

May 30, 2021

Accepted

July 8, 2021

Published on

September 1, 2021