Al-Qamachi Laith Hussein, Aga Hiba, McMahon Jeremy, Leanord Alistair, Hammersley Nicholas
Department of Vascular Surgery, Ninewells Hospital, Dundee, United Kingdom.
Br J Oral Maxillofac Surg. 2010 Jan;48(1):37-9. doi: 10.1016/j.bjoms.2008.12.007. Epub 2009 Jan 28.
The primary treatment of deep neck spaces odontogenic infection (DNSOI) with suppuration is surgery. Systemic antimicrobial therapy is an important adjunct. The initial prescription of antimicrobial therapy is empirical. Over the last decade we have observed a change in practice with the use of second-generation cephalosporins, in conjunction with metronidazole, replacing benzylpencillin and metronidazole. More recently evidence has emerged suggesting that antimicrobial resistance in nosocomial infections could be related to the widespread use of second and third-generation cephalosporins. This study was therefore initiated to determine whether this change in prescribing was justified. A total of 75 cases were retrospectively identified by scrutiny of the operating theatre data. These patients presented with significant DNSOI that required surgical drainage. Streptococcus milleri and mixed anaerobes were predominant. Only in three cases (4%) there were penicillin-resistant microorganisms. The substitution of benzylpenicillin for cefuroxime as an initial empiric therapy for DNSOI seems likely to have been equally efficacious in the large majority of cases. On the other hand, studies in preference of cephalosporins are based on in vitro trials. A multi-centre randomized controlled clinical trial directly comparing initial empiric second-generation cephalosporin therapy with benzylpenicillin in non-allergic patients is justified.
伴有化脓的颈部深部间隙牙源性感染（DNSOI）的主要治疗方法是手术。全身抗菌治疗是重要的辅助手段。抗菌治疗的初始处方是经验性的。在过去十年中，我们观察到治疗方法发生了变化，第二代头孢菌素联合甲硝唑取代了苄青霉素和甲硝唑。最近有证据表明，医院感染中的抗菌耐药性可能与第二代和第三代头孢菌素的广泛使用有关。因此开展了本研究，以确定这种处方变化是否合理。通过仔细审查手术室数据，共回顾性确定了75例病例。这些患者患有严重的DNSOI，需要手术引流。米勒链球菌和混合厌氧菌占主导地位。只有3例（4%）存在耐青霉素微生物。在大多数病例中，用头孢呋辛替代苄青霉素作为DNSOI的初始经验性治疗似乎同样有效。另一方面，支持头孢菌素的研究是基于体外试验。开展一项多中心随机对照临床试验，直接比较非过敏患者初始经验性第二代头孢菌素治疗与苄青霉素治疗，是合理的。
