Kuriyama T, Absi E G, Williams D W, Lewis M A O
Honorary Post-doctoral Research Fellow, University Dental Hospital, Cardiff.
Br Dent J. 2005 Jun 25;198(12):759-63; discussion 754; quiz 778. doi: 10.1038/sj.bdj.4812415.
The aim of this audit was to measure the outcome of treatment of acute dentoalveolar infection and to determine if this was influenced by choice of antibiotic therapy or the presence of penicillin-resistance.
A total of 112 patients with dentoalveolar infection were included in the audit. All patients underwent drainage, either incisional (n=105) or opening of the pulp chamber (n=7) supplemented with antibiotic therapy. A pus specimen was obtained from each patient for culture and susceptibility. Clinical signs and symptoms were recorded at the time of first presentation and re-evaluated after 48 or 72 h.
A total of 104 (99%) of the patients who underwent incisional drainage exhibited improvement after 72 h. Signs and symptoms also improved in five of the seven patients who underwent drainage by opening of the root canal although the degree of improvement was less than that achieved by incisional drainage. Penicillin-resistant bacteria were found in 42 (38%) of the 112 patients in this study. Of the 65 patients who were given penicillin, 28 had penicillin-resistant bacteria. There was no statistical difference in the clinical outcome with regard to the antibiotic prescribed and the presence of penicillin-resistant bacteria. Strains of penicillin-resistant bacteria were isolated more frequently in patients who had previously received penicillin (p<0.05).
Incisional drainage appeared to produce a more rapid improvement compared to drainage by opening of the root canal. The presence of penicillin-resistant bacteria did not adversely affect the outcome of treatment. The observations made support surgical drainage as the first principle of management and question the value of prescribing penicillin as part of treatment.
本次审计的目的是衡量急性牙源性感染的治疗结果，并确定其是否受到抗生素治疗选择或青霉素耐药性的影响。
共有112例牙源性感染患者纳入本次审计。所有患者均接受了引流，其中105例行切开引流，7例行开髓引流，并辅以抗生素治疗。从每位患者获取脓液标本进行培养和药敏试验。在首次就诊时记录临床症状和体征，并在48或72小时后重新评估。
104例（99%）接受切开引流的患者在72小时后症状改善。7例通过开髓引流的患者中，有5例症状也有所改善，尽管改善程度不如切开引流。本研究112例患者中，42例（38%）发现有耐青霉素细菌。在65例使用青霉素的患者中，28例有耐青霉素细菌。所开抗生素及耐青霉素细菌的存在对临床结果无统计学差异。在先前接受过青霉素治疗的患者中，耐青霉素细菌菌株分离更为频繁（p<0.05）。
与开髓引流相比，切开引流似乎能使症状改善更快。耐青霉素细菌的存在并未对治疗结果产生不利影响。这些观察结果支持手术引流作为首要治疗原则，并质疑将青霉素作为治疗一部分的价值。
