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Moxifloxacin is more effective than clindamycin in the treatment of odontogenic abscesses and inflammatory infiltrates

Odontogenic infections are mainly associated with necrotic pulpitis or a bacterial invasion of periodontal tissue. These are usually mixed infections, mainly entering the soft tissue and bones of the upper jaw and face, causing submucosal infiltrates and abscesses.

The aim of a prospective, randomized, double-blind, phase II study was to establish the efficacy of moxifloxacin in the treatment of odontogenic infections compared to clindamycin, using a reduction in the severity of pain, determined by a visual analog scale, as the main evaluation criterion. The secondary endpoints were clinical efficacy, drug tolerance and microbiological data.

The main inclusion criteria were the age of over 18, the diagnosis of odontogenic abscess or inflammatory gum infiltrate. The main exclusion criteria were a history of allergic reactions to moxifloxacin (fluoroquinolones) or clindamycin (lincosamides), pregnancy, arrhythmias, diabetes mellitus, HIV infection, electrolyte disturbances, renal failure or hepatic. It should be noted that patients who needed parenteral antibiotics were not included in the study.

In accordance with the study protocol, a separate primary randomization was carried out in groups of infiltrates / abscesses who received either moxifloxacin (n = 21/15, mean age 43.6 / 45.0 years, men - 57 / 60%, respectively), or clindamycin (n = 19/16, average age 45.4 / 38.4 years; men - 68/69%, respectively). A clinical evaluation was carried out in a population of patients to be treated (n = 71), on days 2 or 3 and after treatment on day 5. A subsequent observation was made on the 6th or 7th day after the end of the antibiotic therapy.

Daily therapy included 5 tablets. Patients in the moxifloxacin group received 1 tablet containing 400 mg moxifloxacin and 4 mimicking clindamycin; Clindamycin patients received 4 x 300 mg clindamycin tablets and 1 tablet mimicking moxifloxacin.

The primary endpoint was assessed for 2 to 3 days and reflected the average percentage reduction in pain severity according to the visual analog scale. In the infiltrated group, treatment with moxifloxacin showed statistically significant advantages over clindamycin (61% vs 23.4%) with significant differences of 37.6% (confidence interval (95% CI 11.6- 63.8%, p = 0.006). Although patients with abscesses showed a significant decrease in the severity of pain in the two groups, there was no significant difference between moxifloxacin (55.8%) and clindamycin (42.7% ) (13.1%, 95% CI -15.5% -41.7%, p = 0.358). These effects persisted until the drug was stopped on day 5.

The clinical efficacy of the therapy has been defined as recovery, improvement, ineffectiveness or relapse. The following parameters were used as criteria to assess the effectiveness / ineffectiveness of the treatment: reduction of the infiltrate area, reduction of the severity of the swelling, pus, need for surgical treatment in a group of patients infiltrated, width of the patient able to open the mouth.

Thus, in the group of undercover patients treated with moxifloxacin, there was no case of ineffectiveness of the treatment and a significant advantage was shown compared to those receiving clindamycin both on the 2nd - 3rd day ( p = 0.003) and the 5th day (p = 0.001). However, despite the cases of failure and the greater number of patients who recovered when using moxifloxacin compared to clindamycin, in general, there were no significant differences at day 2-3 ( p = 0.372) or on day 5 (p = 0.450).

In the study of the tolerability of the treatment options compared, a smaller number of patients with moderate serious adverse drug reactions were shown in the groups of infiltrators / abscesses who received moxifloxacin (9.5 / 13, 3%, respectively), compared to clindamycin (36.8 / 25.0%, respectively), and the differences in the infiltrate group were statistically significant (p = 0.042) and were more pronounced in relation to diarrhea ( 4.8 / 6.7% vs 31.6 / 12.5%, respectively) and nausea (0/0% vs 10.5 / 6.3 %, respectively).

The results of the study indicate that in patients with odontogenic inflammatory infiltrates, moxifloxacin is indeed more effective in reducing the severity of pain and demonstrates a higher clinical efficacy than clindamycin. There was no significant difference in the treatment of patients with odontogenic abscesses.