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Oral and Maxillofacial Surgery

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01-06-2020 | Ampicillin | Original Article

Treatment of odontogenic abscesses: comparison of primary and secondary removal of the odontogenic focus and antibiotic therapy

Authors: Sven Holger Baum, An-Khoa Ha-Phuoc, Christopher Mohr

Published in: Oral and Maxillofacial Surgery | Issue 2/2020

Abstract

Purpose

To examine the time of removal of the odontogenic focus, antibiotic therapy and risk factors in odontogenic abscesses.

Patients

From January 2012 to December 2015, inpatients undergoing incision due to odontogenic abscesses were identified in a retrospective study. All the patients were evaluated for time of removal of the odontogenic focus, antibiotic therapy, germ spectrum, complications and risk factors.

Results

Two hundred ten patients completed the study. In 89 cases (42.4%), the odontogenic focus was removed as part of the abscess treatment (group A). In 121 cases (57.6%), the focus was secondarily removed (group B). On average, 2 ± 4 teeth were removed in group A, and 6 ± 5 teeth in group B (p < 0.0001). An average of 1.2 ± 0.4 surgical interventions were performed in group A, and 2 ± 0.2 operations in group B (p < 0.0001). Microbiological examination was positive in one-third of the cases (70 cases). Most commonly, streptococci (27%) were isolated. A resistance screening was possible in 57 of the detected germs (68.7%). In 89% of these patients, the combination of ampicillin-sulbactam was effective. The hospital stay was 4.8 ± 2 days for group A and 7.6 ± 3 days for group B (p < 0.0001). The clinical evaluation revealed 12 intermediate (5.7%) and three long-term (1.4%) complications. The long-term complications included a recurrence in two cases (1%) and an osteomyelitis in one case (0.5%). A logistic regression analysis identified no significant risk factor in relation to these complications.

Conclusion

The study shows that a primary removal of the odontogenic focus may have advantages over a secondary removal: (1) fewer operations, (2) shorter hospital stay and (3) shorter antibiotic therapy. Broad-spectrum penicillins in combination with beta-lactamase inhibitors are a possible, sufficient antibiotic regimen. Long-term complications are rare. No risk factors are identified in relation to these complications.

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Title: Treatment of odontogenic abscesses: comparison of primary and secondary removal of the odontogenic focus and antibiotic therapy
Authors: Sven Holger Baum
An-Khoa Ha-Phuoc
Christopher Mohr
Publication date: 01-06-2020
Publisher: Springer Berlin Heidelberg
Keywords: Ampicillin
Antibiotic
Published in: Oral and Maxillofacial Surgery / Issue 2/2020
Print ISSN: 1865-1550
Electronic ISSN: 1865-1569
DOI: https://doi.org/10.1007/s10006-020-00835-w

At a glance: The STEP trials

Springer Medicine

Treatment of odontogenic abscesses: comparison of primary and secondary removal of the odontogenic focus and antibiotic therapy

Abstract

Purpose

Patients

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Patients

Results

Conclusion

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