Capacidad antiséptica del digluconato de clorhexidina 0.05% y cloruro de cetilpiridinio 0.05%. Estudio clínico prospectivo y microbiológico / Antiseptic capacity of 0.05% Chlorhexidine digluconate and 0.05% Cetylpyridinium chloride. A prospective and microbiological clinical study

Introducción: El objetivo de este estudio consiste en evaluar la eficacia clínica y microbiológica de un colutorio a base de digluconato de clorhexidina (CHX) 0,05% y cloruro de cetilpiridinio (CPC) 0,05%, y otro colutorio sin propiedades antisépticas, empleados como coadyuvantes de los métodos de higiene oral. Material y métodos: Se llevó a cabo un estudio microbiológico que evaluó la capacidad de los colutorios para inhibir la formación y adherencia de un biofilm bacteriano de Streptococcus oralis mediante espectrofotometría, y un ensayo clínico, aleatorizado y doble ciego sobre una muestra de 48 pacientes, los cuales fueron asignados aleatoriamente a cada colutorio. A: CHX 0,05%, CPC 0,05% y lactato de cinc 0,14% y B: permethol 0.10% y provitamina B5 0.50%. El índice de placa (IP), el índice gingival modificado (IGM) y el índice de sangrado (IS) fueron evaluados con periodicidad mensual y trimestral. Resultados: El colutorio a base de CHX 0,05% y CPC 0,05% evidenció una elevada capacidad para inhibir la formación (P=0,013) y adherencia (P=0,001) del biofilm bacteriano Se observaron diferencias estadísticamente significativas en el IP inter-grupos a los tres meses de observación (P<0,001). También se observaron diferencias en el IGM al mes (P=0,034) y a los tres meses de observación (P<0,001); y en el IS al mes (P=0,004) y a los tres meses de observación (P=0,002). Conclusiones: El colutorio a base de CHX 0,05% y CPC 0,05% posee una capacidad superior para reducir la placa bacteriana y la gingivitis

Introduction: The aim of this study was to evaluate the clinical and microbiological efficacy of a mouthrinse containing 0.05% chlorhexidine digluconate (CHX) and 0.05% cetylpyridinium chloride (CPC), and another mouthrinse without antiseptic properties, used as adjuvants to oral hygiene methods. Material and methods: First a microbiological study using spectrophotometry was done to assess the ability of both mouthrinses to inhibit the formation and adhesion of an Streptococcus oralis biofilm. Then, a randomised, double-blind clinical trial was performed on a sample of 48 patients, who were randomly assigned to each mouthrinse. A: 0.05% CHX and 0.05% CPC, and B: 0.10% permethol and 0.50% provitamin B5. Plaque index (PI), modified gingival index (MGI) and bleeding index (BI) were assessed at one and three months. Results: The 0.05% CHX and 0.05% CPC mouthrinse showed a high capacity to inhibit the formation (P=0.013) and adhesion (P=0.001) of the bacterial biofilm. Statistically significant differences were observed in the inter-group PI after three months of monitoring (P<0.001). Differences were also observed in MGI after one month (P=0,034) and after three months of monitoring (P<0,001); and in BI after one month (P=0,004) and after three months of monitoring (P=0,002). Conclusions: The 0.05% CHX and 0.05% CPC mouthrinse has a good capacity to reduce bacterial plaque and gingivitis

Septic arthritis of the knee due to Prevotella loescheii following tooth extraction.

This is a case report of septic arthritis of the knee due to Prevotella loescheii, in a patient with advanced arthrosis. Two weeks beforehand he had undergone a dental root extraction without antibiotic prophylaxis. His knee had become inflamed 48 hours after extraction and he was started on ibuprofen and steroid treatment (prescribed by his primary health care doctor). With a provisional diagnosis of septic arthritis, synovial fluid was taken for study. Antimicrobial therapy was commenced with amoxicillin/clavulanic acid and the patient progressed satisfactorily. Prevotella loescheii was identified by anaerobic culture. A site of origin for the infection was never found. Joint infection is generally secondary to haematogenous dissemination of bacteria from habitual sites such as odontogenic locations. We suggest that patients with inflammatory arthropathies should be considered as candidates for antibiotic prophylaxis in oral surgery and invasive dental procedures. We suggest, in these cases, the use of antibiotic with spectrum against aerobic and anaerobic bacteria.

Septic arthritis of the knee due to Prevotella loescheii following tooth extraction

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This is a case report of septic arthritis of the knee due to Prevotella loescheii, in a patient with advanced arthrosis. Two weeks beforehand he had undergone a dental root extraction without antibiotic prophylaxis. His knee had become inflamed 48 hours after extraction and he was started on ibuprofen and steroid treatment (prescribed by his primary health care doctor). With a provisional diagnosis of septic arthritis, synovial fluid was taken for study. Antimicrobial therapy was commenced with amoxicillin/clavulanic acid and the patient progressed satisfactorily.Prevotella loescheii was identified by anaerobic culture. A site of origin for the infection was never found. Joint infection is generally secondary to haematogenous dissemination of bacteria from habitual sites such as odontogenic locations. We suggest that patients with inflammatory arthropathies should be considered as candidates for antibiotic prophylaxis in oral surgery and invasive dental procedures. We suggest, in these cases, the use of antibiotic with spectrum against aerobic and anaerobic bacteria (AU)

Piomiositis lumbar por Finegoldia magna (Peptostreptococcus magnus) en paciente con hepatitis C / Lumbar pyomiositis caused by Finegoldia magna (Peptostreptococcus magnus) in a patient with hepatitis C virus infection

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Antimicrobial prophylaxis in oral surgery and dental procedures.

Transient bacteraemia is a known risk factor following oral surgery and invasive dental procedures in patients with altered immune system response and those with a susceptible site of infection (patients with heart valve prostheses or recent joint replacements, etc.) The most commonly isolated aerobic bacteria in postoperative bacteraemia are Streptococcus Viridans. However, other periodontal pathogenic anaerobic bacteria are found in up to 64% in blood cultures (mixed bacteria or anaerobic bacteria alone). Dental pathogenic bacteria do not appear to be covered by standard amoxicillin or clindamycin prophylactic regimens. This is partly due to the fact that these anaerobic bacteria often produce beta lactamase and also in view of results of antimicrobial sensitivity tests observed in recent studies. A personal history of exposure to dental pathogenic bacteria may have an impact on the patient s global health, not only because of classical local or systemic infectious complications, but also because dental pathogenic bacteria have been found in atheromatous plaques in coronary and carotid arteries. This finding, along with epidemiological data, suggests that such bacteria may contribute to the progression of vascular arteriosclerotic lesions and the occurrence of cardiovascular and/or cerebrovascular accidents, although the pathogenic mechanisms involved are not yet well known. Taking these facts into consideration, and in view of antimicrobial sensitivity data available at present, we believe that the use of amoxicillin/clavulanic acid is the most appropriate option for prophylaxis of all infectious risks associated with bacteraemia of oral origin, due to its broader cover of dental pathogenic bacteria and its pharmacokinetic profile.

Antimicrobial prophylaxis in oral surgery and dental procedures

Tras la cirugía oral y los procedimientos odontológicos invasivos, la bacteriemia transitoria es un factor de riesgo conocido para los pacientes que sufren alteraciones del sistema inmune y para aquellos que presentan focalidad susceptible (pacientes con prótesis valvulares cardiacas o prótesis articulares recientes, entre otros). Los Streptococcus viridans son las bacterias aerobias aisladas con mayor frecuencia en las bacteriemias postquirúrgicas orales; no obstante otras bacterias odontopatógenas anaerobias se encuentran por hemocultivo hasta en el 64 por ciento de los casos (tratándose en estos casos de bacteriemias mixtas o exclusivamente anaerobias). Las bacterias odontopatógenas no parecen bien cubiertas con el régimen profiláctico estándar de amoxicilina o clindamicina, debido, entre otras causas, a la frecuente producción de betalactamasas por dichas bacterias anaerobias y a los resultados de las pruebas de sensibilidad antimicrobiana observados en estudios recientes. La historia personal de exposición a bacterias odontopatógenas puede repercutir en la salud global del individuo, no sólo por las complicaciones infecciosas clásicas: locales o sistémicas, sino por el hecho de haber sido encontradas bacterias odontopatógenas en placas de ateroma de arterias coronarias y carótidas; sugiriendose con este hallazgo, y por los datos epidemiológicos, que puedan contribuir (por mecanismos patogénicos aún no bien conocidos) a la progresión de lesiones vasculares arterioescleróticas y a la aparición de accidentes cardiovasculares y/o cerebrovasculares. Tomando en consideración estos hechos y los datos de sensibilidad antimicrobiana disponibles, el empleo de amoxicilina/clavulánico nos parece la opción más adecuada como profilaxis de todos los riesgos infecciosos asociados con la bacteriemia de origen oral, por su mayor cobertura frente a las bacterias odontopatógenas y su mejor perfil farmacocinético

Transient bacteraemia is a known risk factor following oral surgery and invasive dental procedures in patients with altered immune system response and those with a susceptible site of infection (patients with heart valve prostheses or recent joint replacements, etc.) The most commonly isolated aerobic bacteria in postoperative bacteraemia are Streptococcus Viridans. However, other periodontal pathogenic anaerobic bacteria are found in up to 64 percents in blood cultures (mixed bacteria or anaerobic bacteria alone). Dental pathogenic bacteria do not appear to be covered by standard amoxicillin or clindamycin prophylactic regimens. This is partly due to the fact that these anaerobic bacteria often produce beta lactamase and also in view of results of antimicrobial sensitivity tests observed in recent studies. A personal history of exposure to dental pathogenic bacteria may have an impact on the patient’s global health, not only because of classical local or systemic infectious complications, but also because dental pathogenic bacteria have been found in atheromatous plaques in coronary and carotid arteries. This finding, along with epidemiological data, suggests that such bacteria may contribute to the progression of vascular arteriosclerotic lesions and the occurrence of cardiovascular and/or cerebrovascular accidents, although the pathogenic mechanisms involved are not yet well known. Taking these facts into consideration, and in view of antimicrobial sensitivity data available at present, we believe that the use of amoxicillin/clavulanic acid is the most appropriate option for prophylaxis of all infectious risks associated with bacteraemia of oral origin, due to its broader cover of dental pathogenic bacteria and its pharmacokinetic profile

Consensus statement on antimicrobial treatment of odontogenic bacterial infections.

The infection of the oral cavity is a common public health problem and constant cause for antibiotic prescription, with 10% of antibiotics used to treat this problem. However, few studies have so far aimed to determine its incidence. Added to this, its relationship with certain sytemic diseases (cardiac, endocrine, etc) confers this pathology vital importance. In spite of the frequency and importance of odontogenic infection, the current dispersion in criteria regarding key aspects in classification, terminology and therapeutic recommendations is noticeable. The main objective of this document, compiled as a consensus statement by specialists in microbiology and odontology, is to establish useful recommendations for all of those involved in the clinical management of this pathology. Special attention has been placed on the rise in bacterial resistance observed over the last years, specifically the proliferation of betalactamase producing strains. Another important factor causing the resistance to appear is lack of therapeutic compliance, specially what regards dosage and treatment duration. Therefore, this pathology constitutes a complex problem which requires the instauration of broad spectrum antimicrobials, well tolerated and a convenient posology so that patients receive the adequate dose over the necessary period. High doses of amoxicillin/clavulanate (2000 mg/125 mg) have showed good results and power to overcome resistance. Other agents such as metronidazole and clindamycin, followed by de claritromycin and azithromycin have also proved to be active against most of microorganisms responsible for odontogenic infection.

Treatment options in odontogenic infection.

Most infections of the oral cavity are primary, odontogenic infections, with dental caries, gingivitis, and periodontitis the most common. Treating these infections will encompass odontologic, antimicrobial, surgical or combined treatment. Antimicrobial treatment includes the use of betalactams, macrolydes, tetracyclins, metronidazole, clindamycin, or combined treatment. The most commonly used ones are administered orally. PK/ PD parameters predict THE clinical and microbiological efficacy of the antibiotic. The three indices that are generally used to measure clinical efficacy are: T >MIC (time during which the concentration is above the minimum inhibitory concentration), Cmax/ MIC (ratio between peak concentration and the minimum inhibitory concentration) and AUC/ MIC (ratio between the area under the curve and the minimum inhibitory concentration). Amoxicillin/ clavulanic acid is one of the antibiotics recommended for the treatment of odontogenic infections due to its wide spectrum, low incidence of resistance, pharmacokinetic profile, tolerance and dosage.

Documento de consenso sobre el tratamiento antimicrobiano de las infecciones bacterianas odontogénicas / Consensus statement on antimicrobial treatment of odontogenic bacterial infections

Las infecciones de la cavidad bucal son un problema de salud pública frecuente y motivo constante de prescripción antibiótica; el 10% de los antibióticos se emplean para tratar este problema. Sin embargo, hasta la fecha son pocos los estudios realizados para determinar su incidencia. Asímismo, su relación con ciertas enfermedades sistémicas (cardiacas, endocrinas, etc...) confiere a estas patologías una importancia vital. A pesar de la reconocida frecuencia e importancia de las infecciones odontogénicas, llama la atención la actual dispersión de criterio en varios aspectos referentes a su clasificación, terminología y recomendaciones terapéuticas. El objetivo principal de este documento, realizado con el consenso de especialistas en microbiología y odontología, es establecer unas recomendaciones útiles para todos los profesionales implicados en el manejo clínico de estas patologías. Recibe especial atención el aumento de la prevalencia de resistencias bacterianas observado durante los últimos años y, en concreto, la proliferación de cepas productoras de betalactamasas. Otro factor causal importante de la aparición de resistencias es la falta de cumplimiento terapéutico, en especial en lo que respecta a la dosis y a la duración del tratamiento. Así pues, estas patologías constituyen un problema complejo cuyo abordaje requiere la instauración de antimicrobianos de amplio espectro, con adecuados parámetros farmacocinéticos, con buena tolerancia y una posología cómoda que permita que el paciente reciba la dosis adecuada durante el tiempo necesario. Amoxicilina/ácido clavulánico a dosis altas (2000mg/ 125mg) ha demostrado buenos resultados y capacidad para superar resistencias. Otros agentes como metronidazol y clindamicina, seguidos de claritromicina y azitromicina han demostrado también ser activos frente a la mayoría de los microorganismos responsables de las infecciones odontogénicas (AU)

The infection of the oral cavity is a common public health problem and constant cause for antibiotic prescription, with 10% of antibiotics used to treat this problem. However, few studies have so far aimed to determine its incidence. Added to this, its relationship with certain sytemic diseases (cardiac, endocrine, etc…) confers this pathology vital importance. In spite of the frequency and importance of odontogenic infection, the current dispersion in criteria regarding key aspects in classification, terminology and therapeutic recommendations is noticeable. The main objective of this document, compiled as a consensus statement by specialists in microbiology and odontology, is to establish useful recommendations for all of those involved in the clinical management of this pathology. Special attention has been placed on the rise in bacterial resistance observed over the last years, specifically the proliferation of betalactamase producing strains. Another important factor causing the resistance to appear is lack of therapeutic compliance, specially what regards dosage and treatment duration. Therefore, this pathology constitutes a complex problem which requires the instauration of broad spectrum antimicrobials, well tolerated and a convenient posology so that patients receive the adequate dose over the necessary period. High doses of amoxicillin/clavulanate (2000 mg / 125 mg) have showed good results and power to overcome resistance. Other agents such as metronidazole and clindamycin, followed by de claritromycin and azithromycin have also proved to be active against most of microorganisms responsible for odontogenic infection (AU)

Opciones terapéuticas en la infección de origen odontogénico / Treatment options in odontogenic infection

La mayor parte de las infecciones de la cavidad oral son odontógenas y primarias, siendo las más frecuentes la caries dental, la gingivitis y la periodontitis. El manejo terapéutico de estas infecciones comprenderá el tratamiento odontológico, antimicrobiano, quirúrgico o combinado. En el tratamiento antimicrobiano disponemos de los betalactámicos, macrólidos, tetraciclinas, metronidazol y clindamicina o su utilización combinada. Los más utilizados son los administrados por vía oral. Los parámetros FC/FD predicen la eficacia clínica y microbiológica de un antibiótico. Los tres índices que se suelen utilizar para medir la eficacia clínica son: T >CMI (tiempo que la concentración se encuentra por encima de la concentración mínima inhibitoria), Cmax/CMI (cociente entre la concentración pico y la concentración mínima inhibitoria) y ABC/CMI (cociente entre el área bajo la curva y la concentración mínima inhibitoria). Amoxicilina/clavulánico, es uno de los antibióticos recomendados para el tratamiento de infecciones odontógenas por su amplio espectro, escasez de resistencias, perfil farmacocinético, tolerancia y posología (AU)

Most infections of the oral cavity are primary, odontogenic infections, with dental caries, gingivitis, and periodontitis the most common. Treating these infections will encompass odontologic, antimicrobial, surgical or combined treatment. Antimicrobial treatment includes the use of betalactams, macrolydes, tetracyclins, metronidazole, clindamycin, or combined treatment. The most commonly used ones are administered orally. PK/ PD parameters predict THE clinical and microbiological efficacy of the antibiotic. The three indices that are generally used to measure clinical efficacy are: T > MIC (time during which the concentration is above the minimum inhibitory concentration), Cmax/ MIC (ratio between peak concentration and the minimum inhibitory concentration) and AUC/ MIC (ratio between the area under the curve and the minimum inhibitory concentration). Amoxicillin/ clavulanic acid is one of the antibiotics recommended for the treatment of odontogenic infections due to its wide spectrum, low incidence of resistance, pharmacokinetic profile, tolerance and dosage (AU)