Abstract & Commentary

Moxifloxacin for Odontogenic Infection

By Dean L. Winslow, MD, FACP, FIDSA, Chief, Division of AIDS Medicine, Santa Clara Valley Medical Center; Clinical Professor, Stanford University School of Medicine, is Associate Editor for Infectious Disease Alert.

Synopsis: In a randomized, double-blind clinical trial, treatment with moxifloxacin was as effective as clindamycin in the treatment of dental abscess and superior to clindamycin in the treatment of odontogenic inflammatory infiltrates.

Source: Cachovan G, et al. Comparative efficacy and safety of moxifloxacin and clindamycin in the treatment of odontogenic abscesses and inflammatory infiltrates: A phase II, double-blind, randomized trial. Antimicrob Agents Chemother 2011;55:1142-1147.

Outpatients with a diagnosis of either dentoalveolar or periodontal abscess or a diagnosis of gingival inflammatory infiltrates were randomized to receive either moxifloxacin 400 mg daily or clindamycin 300 mg QID, both for 5 days, in a prospective, randomized, placebo-controlled, double-dummy clinical trial design. The primary efficacy endpoint was percent reduction in pain on a visual analogue scale (VAS) at days 2-3 from baseline. (This endpoint has been shown historically to be a useful endpoint for dental intervention studies.)

Among gingival infiltrate patients, the 21 patients randomized to moxifloxacin (MXF) experienced a 61% median reduction in pain at days 2-3 vs. 23% in the 19 patients receiving clindamycin (CLI) (P = 0.006). Among abscess patients, the 15 patients receiving MXF had a 56% reduction in pain vs. 43% in the 16 patients receiving CLI (P = 0.358). Objective evidence of infiltrate and abscess resolution by day 5-7 of treatment also favored MXF.

While not reaching statistical significance, MXF appeared to be better tolerated than CLI with lower incidence of diarrhea and nausea (1 in the MXF arm vs. 8 in the CLI arm).

Commentary

Clindamycin is commonly prescribed for treatment of odontogenic infection in both the inpatient and outpatient setting. While generally effective, clindamycin requires TID or QID dosing and is commonly associated with diarrhea (including Clostridium difficile colitis). Moxifloxacin, while also occasionally associated with C. difficile disease, is generally well-tolerated, has the advantage of once daily dosing, and has in vitro activity against most of the pathogens implicated in odontogenic infections.

This study nicely demonstrates that MXF is superior to CLI for treatment of dental inflammatory infiltrates and at least equal to CLI as adjunctive treatment of odontogenic abscess. MXF appeared to have fewer side effects than CLI.