Rational antibacterial therapy for toxic osteonecrosis of the jaws

Background. Toxic osteonecrosis of the jaw is a new disease of the XXI century. It develops due to the use of an artificially manufactured narcotic substance — desomorphine.

Aim. To determine the species composition of microflora and to study its sensitivity to antibiotics for toxic osteonecrosis of the jaws, depending on the phase of the inflammatory process to develop the principles of rational antibacterial therapy of this pathology.

Methods. A retrospective study was conducted for 38 patients aged from 21 to 45 years, observed in the PSMU dental clinic from 2012 to 2018, including 25 men and 13 women. They were divided into 2 groups. The first group (19 patients) were admitted for an emergency treatment in the acute phase of the inflammatory process, accompanied by the development of pyo-inflammatory complications in the maxillofacial area. The second group (19 patients) were hospitalized as planned for sequestrectomy. A bacteriological study from the pathological lesion was carried out in all the subjects with the subsequent determination of the sensitivity of the selected microflora to antibiotics.

Results. The analysis of the obtained results revealed the following differences in the composition of the predominant microflora: in the group of patients with osteonecrosis in the acute phase, the prevailing group of bacteria were staphylococci, in the group of patients with osteonecrosis in the chronic phase — streptococci. In addition, the presence of such microorganisms as enterococci and acinetobacter was noted in the first group, and bacilli and fungi were noted in the second group. The isolated microorganisms in the first group were also more susceptible to antibiotics than those in the second group. At the same time, the use of levofloxacin and gentamicin is preferable in both study groups. In addition, antibiotics of the penicillin family, cephalosporins and chloramphenicol may be used in the acute phase.

Conclusion. Our study shows that the composition of microflora in toxic osteonecrosis is diverse and depends on the phase of the inflammatory process. The study results form a basis for the prescription of a rational antibacterial therapy, which contributes to a more successful treatment of this disease, reducing the risk of developing severe purulent complications and the inflammatory process generalization.