Update on antibiotics used to treat orofacial infections

Odontogenic infections are most often composed of many different bacteria. The pathogenesis of odontogenic infections depends on the relationship between anaerobic and aerobic bacteria within the infection. Historically, penicillins have been used to treat odontogenic infections. With the ever-increasing bacterial resistance to penicillin-based antibiotics with dental pathogens and concurrent clinical failures with penicillins, other agents have become increasingly attractive. Clindamycin has more recently become a drug of choice for the management of odontogenic infections because of the bacterial susceptibility to this drug, great oral absorption, low emergence of bacterial resistance and good antibiotic levels in bone. Newer macrolides, such as azithromycin, also have significant clinical efficacy for the management of dental infections and have additional benefits of reduced dosing, which increases patient compliance. Tables 1 and 2 provide additional information for a summary of antibiotics discussed in this article and general oral prescribing information for the adult patient. The general dentist should consider these additional choices of antibiotics to successfully manage odontogenic infections. [table: see text]