Changes

*'''Chronic [[stomatitis]]'''<br><br>

*'''Chronic [[stomatitis]]'''<br><br>

The choice of prophylactic antibiotic and protocol remains controversial. A wide variety of microorganisms is found in the flora of the mouth and saliva. Antibiotic prophylaxis requires a drug with antimicrobial activity against '''Gram-positive and Gram-negative aerobes and anaerobes'''. The timing of administration of antibiotics is critical. It is generally accepted that antibiotics should be administered '''within 2 hours of the surgery''' and '''not continued for more than 4 hours after the procedure''' <ref name="Peterson">Peterson, L.J. (1994) '''Principles of antibiotic therapy.''' In:Topazian, R.G. & Goldberg, M.H. (eds) ''Oral and Maxillofacial Infections'', 3rd edn. Philadelphia:W.B.Saunders, p. 160-197.</ref>

The choice of prophylactic antibiotic and protocol remains controversial. A wide variety of microorganisms is found in the flora of the mouth and saliva. Antibiotic prophylaxis requires a drug with antimicrobial activity against '''Gram-positive and Gram-negative aerobes and anaerobes'''. The timing of administration of antibiotics is critical. It is generally accepted that antibiotics should be administered '''within 2 hours of the surgery''' and '''not continued for more than 4 hours after the procedure''' <ref name="Peterson">Peterson, L.J. (1994) '''Principles of antibiotic therapy.''' In:Topazian, R.G. & Goldberg, M.H. (eds) ''Oral and Maxillofacial Infections'', 3rd edn. Philadelphia:W.B.Saunders, p. 160-197.</ref>

<ref name="Callender">Callender, D.L. (1999) '''Antibiotic prophylaxis in head and neck oncologic surgery: the role of Gram- negative coverage.''''' International Journal of Antimicrobial Agents'' 12 (Suppl. 1): S21–S25.</ref>. In addition, antibiotics must be given at a '''high enough dose''' to reach a tissue level four times higher than the MIC of the causative organisms. A number of studies have shown that ampicillin, amoxicillin-clavulanic acid, certain [[cephalosporins]] and [[Macrolides and Lincosamides|clindamycin]] meet the above requirements in dogs, cats and humans <font color="red">(Callender, 1999; Johnson et al, 1997; Harvey et al, 1995a; Harvey et al, 1995b; Mueller et al, 1999).</font color>

<ref name="Callender">Callender, D.L. (1999) '''Antibiotic prophylaxis in head and neck oncologic surgery: the role of Gram- negative coverage.''''' International Journal of Antimicrobial Agents'' 12 (Suppl. 1): S21–S25.</ref>. In addition, antibiotics must be given at a '''high enough dose''' to reach a tissue level four times higher than the MIC of the causative organisms. A number of studies have shown that ampicillin, amoxicillin-clavulanic acid, certain [[cephalosporins]] and [[Macrolides and Lincosamides|clindamycin]] meet the above requirements in dogs, cats and humans <ref name="Callender" /><ref>Johnson, J.T., Kachman, K., Wagner, R.L. et al (1997) '''Comparison of ampicillin/sulbactam versus clindamycin in the prevention of infection in patients undergoing head and neck surgery.''''' Head Neck'' 19: 367–371.</ref><ref>Harvey, C.E., Thornsberry, C., Miller, B.R., Shafer, F.S. (1995a) '''Antimicrobial susceptibility of subgingival bacterial flora in dogs with gingivitis. '''''Journal of Veterinary Dentistry'' 12(4): 151–155.</ref><ref>Harvey, C.E., Thornsberry, C., Miller, B.R., Shafer, F.S.(1995b)''' Antimicrobial susceptibility of subgingival bacterial flora in cats with gingivitis. '''''Journal of Veterinary Dentistry'' 12(4): 157–160.</ref><ref>Mueller, S.C., Henkel, K.O., Neumann, J. et al (1999) '''Perioperative antibiotic prophylaxis in maxillofacial surgery: penetration of clindamycin into various tissues.''''' Journal of craniomaxillofacial surgery ''27: 172-176</ref>

A standard protocol often consists of ampicillin prior to surgery (at the time of catheter placement for anaesthesia), repeated after 6 hours if the catheter is still in place. Metronidazole is given intravenously in addition to ampicillin in the presence of severe infection to ensure a wider anaerobic spectrum.

A standard protocol often consists of ampicillin prior to surgery (at the time of catheter placement for anaesthesia), repeated after 6 hours if the catheter is still in place. Metronidazole is given intravenously in addition to ampicillin in the presence of severe infection to ensure a wider anaerobic spectrum.