'Grandmother penicillin' - Not in vogue, but clinically still effective

Abstract

Although dental health in the developed world is improving, patients with acute dentoalveolar or odontogenic abscesses still present frequently at dental surgeries or emergency units.1 Following its discovery by Fleming in 1928,2 penicillin has long been recognized as an effective standard therapy in patients with orofacial infections. However, penicillin is no longer in favour3 due to the more frequent isolation of resistant bacteria from abscesses of odontogenic origin.4,5 Therefore, alternative antibiotics such as erythromycin, clindamycin, tetracycline and levofloxacin have been considered and recommended for patients with failure of penicillin regimen or allergy.4,6 Newer studies recommend levofloxacin or moxifloxacin, modern 8-methoxyquinolone antibiotics, as potential rational choices for odontogenic infections, due to high in vitro activity against oral pathogens.7 Therefore, we are ascending the ladder of our antibiotic weaponry, unfortunately simultaneously increasing the risk of further resistance to these additional classes of drugs. But do these in vitro investigations correlate with common day-to-day clinical experience?