The use of topical oral antibiotics in head and neck prophylaxis: is it justified?

Systemic antibiotic therapy is widely used for prophylaxis in major head and neck surgery, but the efficacy of topical oral antibiotic therapy has not been adequately investigated. A pilot, placebo-controlled, double-blind crossover study using six healthy adult male volunteers was performed to assess the influence of topical clindamycin on oral flora. Samples of saliva were cultured for aerobic and anaerobic bacteria immediately before, and at 1- and 4-hour intervals after, rinsing the mouth with a solution of either placebo or clindamycin. Quantitative analysis demonstrated significantly reduced levels of both aerobic and anaerobic bacteria after use of the topical antibiotic at both the 1- and 4-hour intervals. It is postulated that topical clindamycin, by reducing concentrations of oral flora, may also reduce the incidence of regional infection following major upper aerodigestive tract surgery.