Ikeda Tetsuya, Kuraguchi Jun, Kogashiwa Yasunao, Yokoi Hidenori, Satomi Takafumi, Kohno Naoyuki
Department of Oto-Rhino-Laryngology, Oral Surgery, Kyorin University School of Medicine, Tokyo, Japan.
Department of Oto-Rhino-Laryngology, Oral Surgery, Kyorin University School of Medicine, Tokyo, Japan.
Bone. 2015 Apr;73:217-22. doi: 10.1016/j.bone.2014.12.021. Epub 2014 Dec 27.
BRONJ has become a well-known, occasionally severe side effect of bisphosphonate therapy, as well as a clinical problem. Although treatment recommendations exist, no standard therapy has yet been established for BRONJ. Also, these recommendations identify several limitations that prevent clinicians from confidently diagnosing BRONJ. The aim of the present study was to establish a treatment approach in which all patients with exposed, infected bone or intraoral/extraoral fistulas were treated with sitafloxacin (STFX). We examined 20 BRONJ patients, fourteen with cancer and six with osteoporosis. We used the current updated definition of BRONJ (12), except that we included patients who had shown symptoms for a minimum of only one month, rather than two months. Thus half of our patients had infection with no exposed, necrotic bone in the oral cavity. We purposely excluded all patients exhibiting no signs of infection (current Stages 0 and 1). In addition, each potentially causative organism was isolated from pus collected from an intraoral or extraoral fistula in ten patients on their first visit to our department. 90% of the patients had received a course of treatment with common antibiotics. STFX was administered to all patients. We then re-evaluated the lesion every other week, to determine whether epithelialization was present. We recommended surgical treatment for cases without epithelialization within 4 weeks after the onset of administration of STFX even if bone was not exposed at the lesion. 19 of our 20 cases of Stages 2-3 BRONJ responded to 2-10 weeks of STFX treatment by entering either a remission or healed phase. While surgery was done on thirteen cases, seven others reached such phases without surgery. Every patient had at least one bacterial species that showed resistance to common antibiotics. All species in all patients were susceptible to STFX. Our results indicate that STFX, with or without minor surgery, gives a high probability of controlling infection in BRONJ patients with persistent infection after use of common antibiotics, leading to remission and/or complete healing in 95% of patients.
颌骨坏死已成为双膦酸盐治疗中一种广为人知的、偶尔会很严重的副作用，也是一个临床问题。尽管存在治疗建议，但尚未确立针对颌骨坏死的标准疗法。此外，这些建议指出了一些局限性，使得临床医生难以确切诊断颌骨坏死。本研究的目的是建立一种治疗方法，即对所有有暴露感染骨或口内/口外瘘管的患者使用西他沙星（STFX）进行治疗。我们检查了20例颌骨坏死患者，其中14例患有癌症，6例患有骨质疏松症。我们采用了当前更新的颌骨坏死定义（12），只是我们纳入了症状出现至少仅1个月而非2个月的患者。因此，我们一半的患者感染时口腔内没有暴露的坏死骨。我们特意排除了所有没有感染迹象的患者（当前的0期和1期）。此外，从10例患者首次到我们科室就诊时从口内或口外瘘管采集的脓液中分离出了每种潜在的致病微生物。90%的患者接受过一轮常用抗生素治疗。所有患者均给予西他沙星治疗。然后我们每隔一周对病变进行重新评估，以确定是否存在上皮化。我们建议，即使病变处没有暴露骨，在开始使用西他沙星治疗4周后仍未上皮化的病例应进行手术治疗。我们20例2 - 3期颌骨坏死病例中有19例在接受2 - 10周的西他沙星治疗后进入缓解期或愈合期。13例患者接受了手术，另外7例未手术也进入了这些阶段。每位患者至少有一种细菌对常用抗生素耐药。所有患者的所有菌种对西他沙星均敏感。我们的结果表明，无论是否进行小手术，西他沙星都极有可能控制使用常用抗生素后仍持续感染的颌骨坏死患者的感染，使95%的患者进入缓解期和/或完全愈合。
