Antimicrobial chemotherapy of patients with lymphadenitis and adenophlegmon of the maxillofacial region

Relevance. Patients with maxillofacial lymphadenitis account for 3.09 % of the total number of hospitalized in specialized departments of maxillofacial surgery, and 5.7% of the number of patients with various inflammatory processes of the maxillofacial region.
Aim. Microbiological substantiation of the algorithm of antimicrobial chemotherapy for lymphadenitis and adenophlegmon of the maxillofacial region.
Materials and methods. The analysis of the results of microbiological studies and determination of the sensitivity of isolated microorganisms to antibiotics of the material from inflammatory foci in lymphadenitis and adenophlegmon of the maxillofacial region was carried out using a standard protocol of laboratory microbiological studies. Anaerobic bacteria were cultured in the HiAnaerobic System Mark III anaerostat, identification was carried out using Biochemical Identification Test Kits (Himedia Labs).
Results. The results of determining the sensitivity of the main pathogens of limphadenitis and adenophlegmon to the most commonly used antibiotics: groups of beta- lactam drugs, macrolides, lincosamides, imidazoles, teracyclines and fluoroquinolones are presented. The priorities of prescribing different treatment regimens are determined, taking into account the international classification of antibiotics AWaRe, adopted by WHO in 2018.
Conclusions. Recommended drugs of choice for various forms of lymphadenitis and adenoflegmon include combinations of amoxicillin with clavulanic acid, lincosamides (preferably clindamycin) and fluoroquinolones (ciprofloxacin), which should be combined with imidazoles in odontogenic limphadenitis and adenophlegmon (for example, tinidazole as part of the complex drug Tsifran ST).

1. Dregalkina A. A., Kostina I. N., Shimova M. E., Schneider O. L. Inflammatory diseases of the maxillofacial region. Modern features of the clinical course, principles of diagnosis and treatment: Textbook. Yekaterinburg: Publishing House "CIRCULATION"; 2020: 108.

2. Ushakov R. V., Tsarev V. N. The use of antibiotics in dentistry. Textbook. M: FGBOU DPO RMANPO; 2018: 185.

3. A. A. Kulakova, T. G. Robustovoy, A. I. Erobeeva editors. Surgical dentistry and maxillofacial surgery : National manual. - Moscow: GEOTAR-Media; 2015: 928.

4. Sandor G. K., Low D. E., Judd P. L., Davidson R. J.. Antimicrobial treatment options in the management of odontogenic infections. J Can Dent Assoc. 1998 Jul-Aug; 64 (7): 508-14. PMID: 9737082.

5. Tsarev V. N., Ushakov R. V., Pozharskaya V. O., Ippolitov E. V. Principles of Antibacterial and Immunomodulatory Therapy in Dentistry. In: Microbiology, virology and oral immunology. V. N. Tsarev editor. M.: GEOTAR-Media; 2013: 273-335.

6. Kohli M., Mathur A., Kohli M., Siddiqui S. R.. In vitro evaluation of microbiological flora of orofacial infections. J Maxillofac Oral Surg. 2009 Dec; 8 (4): 329-33.

7. Shakya N., Sharma D., Newaskar V., Agrawal D., Shrivastava S., Yadav R. Epidemiology, Microbiology and Antibiotic Sensitivity of Odontogenic Space Infections in Central India. J Maxillofac Oral Surg. 2018 Sep; 17 (3): 324-331.

8. Goldberg M. H. The changing biologic nature of acute dental infection. J Am Dent Assoc. 1970 May; 80 (5): 1048-51.

9. Quayle A. A., Russell C., Hearn B. Organisms isolated from severe odontogenic soft tissue infections: their sensitivities to cefotetan and seven other antibiotics, and im plications for therapy and prophylaxis. Br J Oral Maxillofac Surg. 1987 Feb; 25 (1): 34-44.

10. Poeschl P. W., Crepaz V., Russmueller G., Seemann R., Hirschl A. M., Ewers R. Endodontic pathogens causing deep neck space infections: clinical impact of different sampling techniques and antibiotic susceptibility. J Endod. 2011 Sep; 37 (9): 1201-5.

11. Bahl R., Sandhu S., Singh K., Sahai N., Gupta M. Odontogenic infections: Microbiology and management. Contemp Clin Dent. 2014 Jul; 5 (3): 307-11.

12. Bogacz M., Morawiec T., Smieszek-Wilczewska J., Janowska-Bogacz K., Bubifek-Bogacz A., Roj R., Pinocy K., Mertas A. Evaluation of Drug Susceptibility of Microorganisms in Odontogenic Inflammations and Dental Surgery Procedures Performed on an Outpatient Basis. Biomed Res Int. 2019 Oct 7; 2019: 2010453.

13. T. G. Robustova editor / Odontogenic inflammatory diseases. - M.: JSC "Publishing House Medicine"; 2006: 664.

14. Tsarev V. N., Nikolaeva E. N., Ippolitov E. V. Microbiota and immune processes in periodontal diseases. In the book: Microbiology, virology and immunology of the oral cavity.V. N. Tsarev editor. - M .: GEOTAR-Media; 2019: 489-563.

15. Afanasyev V. V. Surgical dentistry. textbook.V. V. Afanasyev editor. GEOTAR-Media; 2016: 400.