[Antibiotic management in oral medicine]

Although antibiotic therapy cannot replace surgical drainage of pus and ablation of necrotic tissue, it plays an essential role in the treatment of buccodental infections by preventing vascular dissemination responsible for bacterial endocarditis and infection of cardiovascular and hip prostheses. It also prevents complications due to local spread of infection (sinus cavernosus thrombosis, osteomyelitis, maxillary sinusitis, Ludwig's angina). Bacteriology of stomatologic infections of dental origin is complex and usually reflects buccal endogenous flora. Infections due to anaerobic germs are increasing in frequency in line with streptococcal affections. The choice of effective antibacterial treatment is complicated by the difficulty in isolating responsible germs and the need for diffusion of the antibiotic into bone and tonsillar tissues. Penicillin G, ampicillin and amoxicillin, possibly combined with a betalactamase inhibitor, macrolide and imidaxole derivative, are products responding best to bacteriologic and pharmacokinetic criteria for treatment of buccodental infections.