SYMPOSIUM ON MAXILLOFACIAL INFECTIONS Presented on Saturday, September 24, 2005, 1:00 pm—3:00 pm Moderator: Raymond P. White, Jr, DDS, PhD, Chapel Hill, NC
Pharmacology Update on Antimicrobial Agents Thomas R. Flynn, DMD, Boston, MA The development of new antibiotics slowed down in the 1990’s, possibly due to an oversupply of new antibiotics, largely cephalosporins. At the same time, new mechanisms of antibiotic resistance were developing among pathogenic bacteria. This decade saw the emergence of such highly resistant organisms as VISA, VRE, and Pseudomonas. In response to increased antimicrobial resistance, researchers have developed entire new families of antibiotics, such as the ketolides and the oxazolidinones, which are targeted primarily to highly antibiotic resistant Gram positive cocci, such as Staphylococcus aureus. In addition, established antibiotic families have been joined by new drugs with enhanced spectra, such as moxifloxacin and levofloxacin, among the fluoroquinolones. Side effects and drug interactions remain a problem for the antibiotics, however. The safety profile of the carbapenems has been improved by meropenem. Similarly, Azithromycin is a safer macrolide that has been shown to be effective in orofacial infections. The promise of even newer yet to be released antibiotics is tempered by their cost, by competition with other more profitable types of drugs, and by the amazing ability of bacteria of respond to the pressures of survival. References Flynn TR, Halpern LR: Antibiotic selection in head and neck infections. Oral Maxillofac Surg Clin North Am 15:17, 2003 File TM: Overview of resistance in the 1990s. Chest 115:3S, 1999 (suppl) Kuriyama T, Karasawa T, Nakagawa K, et al: Bacteriologic features and antimicrobial susceptibility in isolates from orofacial odontogenic infections. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 90:600, 2000
Infections in Immunocompromised Patients Thomas B. Dodson, DMD, MPH, Boston, MA The overall purpose of this presentation will be to review issues regarding the management of immunocompromised patients in the setting of oral and maxillofacial surgical practice. The specific aims of the presentation will be to: 1. Review primary and secondary immunodefiAAOMS • 2005
ciency states with an emphasis on the more common immunodeficiency states, eg, neutropenia following chemotherapy, HIV infection, diabetes, and chronic steroid therapy, Discuss the effect of immunodeficiency on wound healing, Review new or unusual pathogens associated with infections in immunocompromised subjects, Review the principles of management of immunocompromised subjects presenting for the evaluation and management of more common oral and maxillofacial surgical problems, and Discuss concepts for preventing postoperative complications in the immunocompromised patient. References
Dodson TB: Hematologic disorders, in Bennett JD, Rosenberg MB (eds): Medical Emergencies in Dentistry. Philadelphia, PA, Saunders, 2002, pp 389-208 Dodson TB: HIV status and the risk of post extraction complications. J Dental Res 76:1644, 1997 Dodson TB: Prediction of post extraction complications in HIVpositive patients. Oral Surg Oral Med Oral Pathol 84:474, 1997
Fungal Head and Neck Infections Alan A. Miyake, DDS, MD, Oklahoma City, OK Please see page 76.
Management of Antibiotic Resistant Organisms David W. Hecht, MD, Maywood, IL Antibiotic resistance among bacteria causing or associated with maxillofacial infections can result in failures to some empiric regimens. Maxillofacial infections often involve a mixture of aerobic, facultative anaerobic, and anaerobic bacteria with varied and increasing resistance to empiric antibiotic therapy. Key aerobic bacteria include Viridans and other streptococcal species, Actinobacillus, and spirochetes, which by and large remain sensitive to penicillin and other commonly used antibiotics. However, resistance to erythromycin and tetracycline for some organisms is now sufficiently prevalent that these agents are not generally recommended. Among some of the key anaerobic pathogens including Porphyromonas sp, Prevotella sp, Peptostreptococ21