Pharmacoeconomic analysis of antibiotic therapy in maxillofacial surgery.

OBJECTIVES/AIMS: The aim of this study was to investigate the microbial cultures collected in the years 2013-2014 at the craniomaxillofacial department and outpatient clinic to analyse optimisation of the treatment cost of the bacterial infections and present the results. DESIGN AND SETTING: We analysed 485 cultures from 263 patients, of which 77.28% consisted of Gram-positive bacteria. On the basis of the antibiotic efficacy, antibiotic price and the cost of entire treatment during hospitalisation, the most useful antimicrobial agents for the most common pathogens were selected. RESULTS: The most frequently collected material was pus. The most common pathogens were found to be the Staphylococcus epidermidis (18%), Streptococcus mitis and Str. oralis (14%) and S. aureus (6.5%). DISCUSSION: The most frequently isolated bacteria in other studies were the Streptococcus strain. Other authors showed that ceftriaxone is the most cost efficient agent. The use of postoperative antibiotic prophylaxis remains controversial. CONCLUSION: The results of this study suggest that the most useful antibiotics for therapy, from the perspective of the cost minimisation, were gentamycin, trimethoprim with sulfamethoxazole and vancomycin.

Antibiotic therapies in maxillofacial surgery in the context of prophylaxis.

OBJECTIVES: There is no single pattern for preventive action as to the duration and type of antibiotic therapy in maxillofacial surgery. In these circumstances, it appears reasonable to set relevant standards for prophylactic procedures after such surgeries. METHODS: Retrospective analysis of bacteriological tests has been carried out as well as a susceptibility evaluation of cultured bacterial and fungal strains to antibiotics over a five-year period in subjects treated at the Cranio-Maxillo-Facial Clinic in Katowice. A total of 726 bacterial and fungal strains were cultured in 484 patients (200 women and 284 males). The age of the patients was 40.2 on average. RESULTS: The most frequent bacteria isolated from the patients were Gram-positive 541 (74.5%). Gram-negative bacteria were present in 177 (24.4%) cases. Fungi of the Candida genus were isolated in eight cases (1.1%). CONCLUSIONS: The most often isolated bacteria were Streptococcus mitis and Streptococcus oralis, whose number has grown over the last two years. Empiric therapies should be based on ciprofloxacin and gentamicin. It has been observed that all the Gram-positive bacteria are becoming more resistant to all antibiotics. Ampicillin and imipenem were antibiotics with the steepest resistance reduction while vancomycin showed the lowest resistance drop.