Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Clindamycin and dentistry

Key Points

  • Absorption of clindamycin produces high bone concentrations.

  • Clindamycin has a favourable spectrum of activity against anaerobic infections.

  • Clindamycin is not the only antibiotic to be associated with acute pseudomembranous colitis.

  • The suitability of clindamycin as an effective agent for the prophylaxis of infective endocarditis has been demonstrated in the animal model.

  • The use of clindamycin in the management of endodontic infections may lead to the selection of enterococci within the root canal.

Abstract

Clindamycin is an antimicrobial agent that dentists use in the UK for infective endocarditis prophylaxis but rarely for other clinical situations that require antimicrobial intervention. This has been largely due to its association with acute pseudomembranous colitis. Up to date information on the efficacy and safety of this antimicrobial agent should be known before prescription.

Introduction

The predominant use of clindamycin in dentistry in the UK has been for the prophylaxis of infective endocarditis in patients allergic to penicillin. Although it is not licensed for use in endocarditis prophylaxis, it is currently recommended by the British Society of Antimicrobial Chemotherapy (BSAC) Endocarditis Working Party as an alternative to penicillin.1 In paediatric cases that require prophylactic cover, however, clindamycin suspension (no longer available) has been superseded by azithromycin suspension.2

The Dental Practitioner's Formulary (DPF) recommends that clindamycin should not be used routinely for the treatment of dental infections.1 The main reason for this is because of its association with acute pseudomembranous colitis (APC).3,4 Surveys have indicated that clindamycin is not frequently prescribed in the UK for the management of dentoalveolar infections.5,6 In other countries such as Canada there has been a resurgence in the prescribing popularity of clindamycin.7 The reasons for this may be related to publications in the dental literature recommending clindamycin as a first line drug in the management of odontogenic infections.8,9

The purpose of this article is to review the literature on the prophylactic and therapeutic uses of clindamycin in dentistry and to discuss the association of its use with APC.

Antimicrobial activity

Clindamycin is known to have a very favourable spectrum of activity against anaerobic infections.10,11 Its antimicrobial spectrum also includes Gram-positive cocci, Gram-positive and –negative anaerobes and certain protozoa.12 Although classed as bacteriostatic, bactericidal activity is usually achieved with the recommended doses13. The mechanism of action of clindamycin is by the inhibition of protein synthesis, acting specifically on the 50S subunit of the bacterial ribosome. Protein synthesis is inhibited primarily in early chain elongation by interference with the transpeptidation reaction.13

The treatment of bacterial infections with adjunctive antimicrobials requires adequate concentrations of the antimicrobial to be obtained at the site of infection. Serum concentrations are not always equal to the concentration in the tissue. The systemic administration of clindamycin has been shown to produce high concentrations within bone.14 In mandibular bone the concentration was found to be about a third of the alveolar serum concentration, but this level exceeded the minimum inhibitory concentration of most micro-organisms isolated from mandibular osteitis.15

An important feature of odontogenic infections is that they are typically polymicrobial in nature, with mixed faculative and anaerobic bacteria present. Strict anaerobes are usually the predominant bacteria, generally outnumbering the faculative anaerobes by a factor of three to four fold.16,17,18 It is therefore understandable that clindamycin has been considered a suitable antimicrobial for the management of odontogenic infections.

Acute Pseudomembranous Colitis

Caution regarding the use of clindamycin has always been expressed due to its potential side effects. The main concern has been its association with APC, which if left untreated can be fatal. This condition appears to be related to the proliferation of antibiotic resistant Clostridium difficile which produces metabolites toxic to the gut wall resulting in colitis. Other micro-organisms have, however, been isolated from cases of APC, but they are rare. They include Staphylococcus aureus, Clostridium perfringens type C and Salmonellae.19 APC is not exclusively a side effect of clindamycin. Other commonly used antimicrobials in dentistry such as amoxicillin, erythromycin, tetracyclines, metronidazole and the cephalosporins have all been shown to cause this disease.19 In fact Bignardi reported that clindamycin was not the primary antimicrobial that is associated with colitis but was in the middle of the spectrum. Co-amoxiclav, an antimicrobial used far more frequently for the management of dentoalveolar infections, was found to be a greater risk for APC than clindamycin.20

The incidence of APC following the administration of clindamycin has been stated to range from as low as 0.01% to as high as 10%.21,22,23 This may reflect the populations studied as the main factors that predispose a person to APC include advanced age, debilitating illness and administration of multiple antimicrobials.20 Females have been suggested to be more at risk of APC, but epidemiological studies have not supported this contention.24 The incidence of reported cases of APC in the dental literature is low; in fact many authors who have done studies on the use of clindamycin have failed to note this complication.9,25,26 Only five dentally related cases of APC have been reported; three of the patients were elderly with an average age of 68.7 years.3,4,7,27,28 Previously it had been thought that prophylactic use of clindamycin would not lead to the development of APC,29 but a recent case report has contradicted this contention.7 It is difficult to know however, if this case was caused solely by clindamycin, because the week previously the patient had received a prophylactic dose of erythromycin prior to dental treatment; the patient was aged 71.

Reports of other serious problems associated with clindamycin such as anaphylaxis are low.30,31 Clindamycin, however, has been shown to have neuromuscular blocking properties that may enhance the action of other neuromuscular blocking agents.32,33 Antagonism between erythromycin and clindamycin has been demonstrated in vitro, therefore these drugs should not be administered concurrently.34 It has also been advised that caution should be aired when prescribing clindamycin in patients with a history of gastrointestinal disease, especially colitis.34

Prophylactic use

The prophylactic use of antibiotics is recommended by the BSAC for patients at risk of IE. Dentists are legally obliged to adhere to the guidelines laid down by the BSAC, which are published in each British National Formulary.1 It is unlikely that a bacteraemia following a dental procedure can be totally prevented by prior prophylaxis with oral or systemic antimicrobials. It has been shown however, that the intensity of a dentally-induced bacteraemia can be reduced by prophylactic doses of antimicrobials.35,36

During the decades before the 1990s, a high oral loading dose of erythromycin was recommended for penicillin-allergic patients for the prevention of IE. This recommendation was changed to clindamycin due to an accumulation of evidence on the unsuitability of erythromycin, together with the known problems of its side effects.37,38 Predominantly the fact is that erythromycin is the single most poorly tolerated oral antibiotic, with epigastric distress, nausea and vomiting being common. In a study on the efficacy of erythromycin stearate in the prevention of bacteraemia following dental extraction, no reduction was seen when compared with a placebo group.37 Concomitant with this latter finding came evidence of failure of erythromycin to prevent IE, with the micro-organism isolated proving to be erythromycin-resistant.38 Animal models of IE also reported erythromycin's failure as a suitable prophylactic agent.39 Despite the change in recommendation, a recent study of prophylactic antibiotic prescribing within the National Health Service found that 18.6% of general dental practitioners would use erythromycin as a prophylactic agent in patients allergic to penicillin.40

The suitability of clindamycin as an appropriate agent for the prophylaxis of IE has been demonstrated in the animal model.41,42 The protection afforded by clindamycin in these studies suggested a wide, yet theoretical, margin of safety for the use of this antimicrobial for human endocarditis prophylaxis. The American Heart Association guidelines for antibiotic prophylaxis now gives two other alternatives to clindamycin in penicillin allergic patients: azithromycin or clarithromycin are now recommended as alternatives, both as single 500mg doses.43

Therapeutic Uses

Periodontology

Conventional periodontology treatment modalities such as scaling and root planing, periodontal surgery and maintenance are effective in the management of most periodontal diseases. In some, the systemic use of antibiotics can be a powerful adjunct to mechanical debridement. The suitability of clindamycin in the management of periodontal diseases has only been investigated in a limited number of studies.28,44,45,46,47,48 These studies have all demonstrated the beneficial effects of clindamycin as an adjunct to scaling. These results, with the exception of one study44 may in part be related to the use of clindamycin only in patients whose subgingival micro flora was known to be susceptible to clindamycin.

The efficacy of clindamycin as an adjunctive agent in the treatment of rapidly progressive periodontitis (RPP) was compared with that of metronidazole and tetracycline.44 The metronidazole and clindamycin groups showed a significant reduction in sulcus bleeding scores, probing depths and a significant gain in clinical attachment. Less favourable results were found in the doxycline and placebo groups. It was concluded by the authors of this study that both metronidazole and clindamycin are effective antimicrobials when used adjunctively. All these studies indicate that clindamycin could be used as a useful periodontal adjunctive agent. Although the latest European Federation of Periodontology review, which used evidence based reviews and meta-analysis on several subject areas concluded that conclusive evidence for adjunctive benefits was only available for metronidazole and amoxicillin in combination and for spiromycin.49

Endodontics

The treatment of acute and chronic infections of endodontic origin primarily requires operative intervention and therefore the adjunctive use of antimicrobials are not usually indicated in the healthy patient. When intervention is not possible then systemic antimicrobials are indicated to limit local spread and bring about symptomatic relief, but ultimately definitive treatment will be required.50

Due to the predominance of anaerobic species in acute periapical infections, it was thought that clindamycin would be an appropriate adjunctive agent in the management of these infections.16 In fact interest in the micro-flora of root canals has largely been focused on anaerobic bacteria due to their predominance in untreated canals.17,51,52 Enterococci, which are seldom found in these circumstances, have been isolated from teeth undergoing endodontic treatment and previously root treated teeth.53,54,55,56 In a study of root filled teeth with apical periodontitis 69% of the bacterial strains recovered from the root canals were faculative anaerobes.53,54 Enterococci were isolated in 50% of the infective cases and were the most frequently isolated. A later study on the susceptibility of enterococci isolated from root canals to various antibiotics found that 25 out of 29 strains were resistant to clindamycin.57 These results are similar to an earlier study in which enterococci isolated were found to be completely or partially resistant to clindamycin.58 Clindamycin has also been investigated as a topical intra-canal medicament.59,60 When applied as an intra-canal paste (clindamycin dissolved in saline), it was found to confer no advantage over conventional root canal dressings.60 Another study used ethylene vinyl acetate (EVA) fibres impregnated with clindamycin. Although they were effective in significantly reducing growth of Prevotella intermedia, Fusobacterium nucleatum and Streptococcus intermedia in extracted teeth, enterococci were not tested.59

The use of clindamycin in the management of endodontic infections may lead to the selection of enterococci within the canal. Empirical prescribing of systemic clindamycin may therefore not be appropriate. Culture and susceptibility testing, however, is not routinely recommended for endodontic procedures due to the risk of sample contamination.50

Control of post-operative infection

Clindamycin has been compared with penicillin and other antibiotics for the prophylaxis of post-operative complications following third molar surgery. Clindamycin was compared with azidocillin, erythromycin and doxycycline in a double blind randomised control trial.61 This study showed that systemically administered antimicrobials offered only slight advantages in routine operations of impacted third mandibular molars. With the exception of doxycycline, these antimicrobials showed little reduction in postoperative swelling. In a similar investigation that compared penicillin with clindamycin, penicillin was seen to be marginally superior in the early post-operative period.62 In a more recent study, however, clindamycin treatment was found to significantly reduce the number of infections following third molar surgery as compared with amoxicillin. A combination of amoxicillin and metronidazole did produce an efficacy comparable to that of clindamycin.63 The infection rate, however, following routine exodontia and dentoalveolar surgery including endodontic surgery is very low. Most dentoalveolar surgical procedures should, therefore, not require antimicrobial prophylaxis in the healthy individual to prevent infection.64

Management of dentoalveolar abscesses

Acute dentoalveolar infections are best dealt with by establishing surgical drainage. This is not always possible or the patient may present with signs and symptoms of systemic effect. These circumstances require the use of systemic antimicrobials. Penicillin or amoxicillin, and erythromycin for penicillin allergic patients, have been regarded as antimicrobials of choice.65

Some studies have suggested that the antimicrobial activity of penicillins have decreased against the causative bacteria related to orofacial odontogenic infections, such as streptococci and oral anaerobes. This has led to the continuing debate over whether penicillins remain adequate as the antimicrobials of choice for odontogenic infections.8,66,67,68,69 Clindamycin has been proposed as an alternative regime for patients with penicillin allergies or for patients for whom penicillin therapy has failed.8,16,69

Concerns have also been raised about the suitability of erythromycin in the management of severe odontogenic infections.16 Erythromycin is not effective against Fusobacterium species and oral streptococci, which are more frequently isolated from severe odontogenic infections than milder infections.16,70,71,72

A number of clinical trials have demonstrated clindamycin's efficacy in treating odontogenic infections. Three studies reported comparable findings when clindamycin was compared with penicillin for the management of orofacial infections.25,27,73 All three concluded that clindamycin would be a suitable alternative to penicillin. In a recent study into the bacteriological features and antimicrobial susceptibilities of bacteria isolated from orofacial odontogenic infections penicillin was found to be effective against most major pathogens involved.16 Although clindamycin was also found to be a suitable agent, it was suggested that clindamycin be reserved for those cases in which penicillin therapy had failed.

Conclusions

Clindamycin has good antimicrobial properties for the management of most dentoalveolar infections. These include a favourable spectrum of activity against anaerobic infections and the ability to concentrate highly in bone. Animal models support the suitability of clindamycin as a prophylactic agent and therefore it should be used in accordance with the guidelines produced by the BSAC.

The risk of developing APC with clindamycin appears low and to be no greater than many of the other antimicrobial agents frequently prescribed in general dental practice. In the elderly or those with debilitating illnesses, however, clindamycin should not be considered a first line drug in the management of odontogenic infections.

There are few data to support the empirical prescription of clindamycin for the adjunctive management of periodontal diseases at present. Further randomised controlled studies will be required to compare its adjunctive efficacy with other antimicrobials. The potential for the selection of enterococci, following the adjunctive use of systemic clindamycin in the management of endodontic infections should be taken seriously. Enterococci are more frequently found in previously treated endodontic cases. The empirical prescription of systemic clindamycin for the management of such cases cannot be recommended.

In the management of the dentoalveolar abscess clindamycin shows comparable efficacy with penicillin. It should therefore be considered as an alternative to penicillin in penicillin allergic patients or for those cases that do not respond to penicillin.

References

  1. Dental Practitioner's Formulary 2002-2004 British National Formulary No 44. London: The Royal Pharmaceutical Society of Great Britain and the British Medical Society, 2002.

  2. Littler WA . Clindamycin suspension and endocarditis prophylaxis. Br Dent J 2001; 190: 407.

    PubMed  Google Scholar 

  3. Williams M . Clindamycin and dentists. Lancet 1990; 335: 787.

    PubMed  Article  Google Scholar 

  4. Rippon R . Clindamycin and dentists. Br Dent J 1990; 168: 348.

    PubMed  Article  Google Scholar 

  5. Palmer N, Martin M . An investigation of antibiotic prescribing by general dental practitioners: a pilot study. Prim Dent Care 1998; 5: 11–14.

    PubMed  Google Scholar 

  6. Thomas DW, Satterthwaite J, Absi EG, Lewis MA, Shepherd JP . Antibiotic prescription for acute dental conditions in the primary care setting. Br Dent J 1996; 181: 401–404.

    PubMed  Article  Google Scholar 

  7. Bombassaro AM, Wetmore SJ, John MA . Clostridium difficile colitis following antibiotic prophylaxis for dental procedures. J Can Dent Assoc 2001; 67: 20–22.

    PubMed  Google Scholar 

  8. Sandor GK, Low DE, Judd PL, Davidson RJ . Antimicrobial treatment options in the management of odontogenic infections. J Can Dent Assoc 1998; 64: 508–514.

    PubMed  Google Scholar 

  9. Mangundjaja S, Hardjawinata K . Clindamycin versus ampicillin in the treatment of odontogenic infections. Clin Ther 1990; 12: 242–249.

    PubMed  Google Scholar 

  10. von Konow L, Nord CE, Nordenram A . Anaerobic bacteria in dentoalveolar infections. Int J Oral Surg 1981; 10: 313–322.

    PubMed  Article  Google Scholar 

  11. Phillips L, Fernandes R, Warren C . In-vitro comparison of erythromycin, lincomycin, and clindamycin. Br Med J 1970; 2: 89–90.

    PubMed  PubMed Central  Article  Google Scholar 

  12. Dhawan VK, Thadepalli H . Clindamycin: a review of fifteen years of experience. Rev Infect Dis 1982; 4: 1133–1153.

    PubMed  Article  Google Scholar 

  13. Steigbigel N . Macrolides and Clindamycin. In Mandell, Douglas and Bennett's Principles and Practice of Infectious Diseases. 4th ed. pp 366–382. New York: Churchill Livingstone, 1995.

    Google Scholar 

  14. Nicholas P, Meyers BR, Levy RN, Hirschman SZ . Concentration of clindamycin in human bone. Antimicrob Agents Chemother 1975; 8: 220–221.

    PubMed  PubMed Central  Article  Google Scholar 

  15. Bystedt H, A DA, Dornbusch K, Nord CE . Concentrations of azidocillin, erythromycin, doxycycline and clindamycin in human mandibular bone. Int J Oral Surg 1978; 7: 442–449.

    PubMed  Article  Google Scholar 

  16. Kuriyama T, Karasawa T, Nakagawa K, Saiki Y, Yamamoto E, Nakamura S . Bacteriologic features and antimicrobial susceptibility in isolates from orofacial odontogenic infections. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000; 90: 600–608.

    PubMed  Article  Google Scholar 

  17. Brook I, Frazier EH, Gher ME . Aerobic and anaerobic microbiology of periapical abscess. Oral Microbiol Immunol 1991; 6: 123–125.

    PubMed  Article  Google Scholar 

  18. Lewis MA, MacFarlane TW, McGowan DA . Quantitative bacteriology of acute dento-alveolar abscesses. J Med Microbiol 1986; 21: 101–104.

    PubMed  Article  Google Scholar 

  19. Theilman N . Antibiotic-associated Colitis. In Mandell, Douglas and Bennett's Principles and Practice of Infectious Diseases. 4th ed. pp 111–1126. New York: Churchill Livingtone, 1995.

    Google Scholar 

  20. Bignardi GE . Risk factors for Clostriddium difficile infection. J Hosp Infect 1998; 40: 1–15.

    PubMed  Article  Google Scholar 

  21. Zehnder D, Kunzi UP, Maibach R, Zoppi M, Halter F, Neftel KA, et al. Frequency of antibiotics-associated colitis in hospitalized patients in 1974-1991. In Bern/St. Gallen. Comprehensive hospital drug monitoring. Schweiz Med Wochenschr 1995; 125: 676–683.

    Google Scholar 

  22. Lusk RH, Fekety FR Jr, Silva J Jr, Bodendorfer T, Devine BJ, Kawanishi H, et al. Gastrointestinal side effects of clindamycin and ampicillin therapy. J Infect Dis 1977; 135 Suppl: S111–119.

    PubMed  Article  Google Scholar 

  23. Gurwith MJ, Rabin HR, Love K . Diarrhoea associated with clindamycin and ampicillin therapy: preliminary results of a cooperative study. J Infect Dis 1977; 135 Suppl: S104–110.

    PubMed  Article  Google Scholar 

  24. Borriello SP, Larson HE . Antibiotic and pseudomembranous colitis. J Antimicrob Chemother 1981; 7 Suppl A: 53–65.

    PubMed  Article  Google Scholar 

  25. Schuen NJ, Panzer JD, Atkinson WH . A comparison of clindamycin and penicillin V in the treatment of oral infections. J Oral Surg 1974; 32: 503–505.

    PubMed  Google Scholar 

  26. De Marco TJ, Kluth EV . The use of cleocin in post-surgical periodontal patients. J Periodontol 1972; 43: 381–385.

    PubMed  Article  Google Scholar 

  27. Gilmore WC, Jacobus NV, Gorbach SL, Doku HC, Tally FP . A prospective double-blind evaluation of penicillin versus clindamycin in the treatment of odontogenic infections. J Oral Maxillofac Surg 1988; 46: 1065–1070.

    PubMed  Article  Google Scholar 

  28. Gordon J, Walker C, Lamster I, West T, Socransky S, Seiger M, et al. Efficacy of clindamycin hydrochloride in refractory periodontitis. 12-month results. J Periodontol 1985; 56 (11 Suppl): 75–80.

    PubMed  Article  Google Scholar 

  29. C Scully, R Cawson . Medical Problems in Dentistry. 3rd ed. Oxford: Wright, 1993.

    Google Scholar 

  30. Raab W . Acute side effects of erythromycin, lincomycin and clindamycin. Int J Clin Pharmacol Biopharm 1977; 15: 90–97.

    PubMed  Google Scholar 

  31. Lochmann O, Kohout P, Vymola F . Anaphylactic shock following the administration of clindamycin. J Hyg Epidemiol Microbiol Immunol 1977; 21: 441–447.

    PubMed  Google Scholar 

  32. Al Ahdal O, Bevan DR . Clindamycin-induced neuromuscular blockade. Can J Anaesth 1995; 42: 614–617.

    PubMed  Article  Google Scholar 

  33. Becker LD, Miller RD . Clindamycin enhances a nondepolarizing neuromuscular blockade. Anesthesiology 1976; 45: 84–87.

    PubMed  Article  Google Scholar 

  34. Compendium of Data Sheets and Summaries of Product Characteristics 1999-2000. London: Datapharm Publications Limited, 1999.

  35. Shanson DC, Akash S, Harris M, Tadayon M . Erythromycin stearate, 1.5 g, for the oral prophylaxis of streptococcal bacteraemia in patients undergoing dental extraction: efficacy and tolerance. J Antimicrob Chemother 1985; 15: 83–90.

    PubMed  Article  Google Scholar 

  36. Shanson DC, Cannon P, Wilks M . Amoxycillin compared with penicillin V for the prophylaxis of dental bacteraemia. J Antimicrob Chemother 1978; 4: 431–436.

    PubMed  Article  Google Scholar 

  37. Sefton AM, Maskell JP, Kerawala C, Cannell H, Seymour A, Sun ZM, et al. Comparative efficacy and tolerance of erythromycin and josamycin in the prevention of bacteraemia following dental extraction. J Antimicrob Chemother 1990; 25: 975–984.

    PubMed  Article  Google Scholar 

  38. Eng RH, Wolff M, Smith SM . Failure of erythromycin in preventing bacterial endocarditis. Arch Intern Med 1982; 142: 1958–1959.

    PubMed  Article  Google Scholar 

  39. Durack DT, Petersdorf RG . Chemotherapy of experimental streptococcal endocarditis. I. Comparison of commonly recommended prophylactic regimens. J Clin Invest 1973; 52: 592–598.

    PubMed  PubMed Central  Article  Google Scholar 

  40. Palmer NA, Pealing R, Ireland RS, Martin MV . A study of prophylactic antibiotic prescribing in National Health Service general dental practice in England. Br Dent J 2000; 189: 43–46.

    PubMed  Article  Google Scholar 

  41. Glauser MP, Francioli P . Successful prophylaxis against experimental streptococcal endocarditis with bacteriostatic antibiotics. J Infect Dis 1982; 146: 806–810.

    PubMed  Article  Google Scholar 

  42. Vermot D, Entenza JM, Vouillamoz J, Glauser MP, Moreillon P . Efficacy of clarithromycin versus that of clindamycin for single-dose prophylaxis of experimental streptococcal endocarditis. Antimicrob Agents Chemother 1996; 40: 809–811.

    PubMed  PubMed Central  Article  Google Scholar 

  43. Dajani AS, Taubert KA, Wilson W, Bolger AF, Bayer A, Ferrieri P, et al. Prevention of bacterial endocarditis: recommendations by the American Heart Association. Clin Infect Dis 1997; 25: 1448–1458.

    PubMed  Article  Google Scholar 

  44. Sigusch B, Beier M, Klinger G, Pfister W, Glockmann E . A 2-step non-surgical procedure and systemic antibiotics in the treatment of rapidly progressive periodontitis. J Periodontol 2001; 72: 275–283.

    PubMed  Article  Google Scholar 

  45. Gordon J, Walker C, Hovliaras C, Socransky S . Efficacy of clindamycin hydrochloride in refractory periodontitis: 24-month results. J Periodontol 1990; 61: 686–691.

    PubMed  Article  Google Scholar 

  46. Magnusson I, Low SB, McArthur WP, Marks RG, Walker CB, Maruniak J, et al. Treatment of subjects with refractory periodontal disease. J Clin Periodontol 1994; 21: 628–637.

    PubMed  Article  Google Scholar 

  47. Walker CB, Gordon JM, Socransky SS . Antibiotic susceptibility testing of subgingival plaque samples. J Clin Periodontol 1983; 10: 422–432.

    PubMed  Article  Google Scholar 

  48. Walker C, Gordon J . The effect of clindamycin on the microbiota associated with refractory periodontitis. J Periodontol 1990; 61: 692–698.

    PubMed  Article  Google Scholar 

  49. Herrera D, Sanz M, Jepsen S, Needleman I, Roldan S . A systematic review on the effect of systemic antimicrobials as an adjunct to scaling and root planing in periodontitis patients. J Clin Periodontol 2002; 29 (Suppl 3): 136–159.

    PubMed  Article  Google Scholar 

  50. Longman LP, Preston AJ, Martin MV, Wilson NH . Endodontics in the adult patient: the role of antibiotics. J Dent 2000; 28: 539–548

    PubMed  Article  Google Scholar 

  51. Wasfy MO, McMahon KT, Minah GE, Falkler WA Jr . Microbiological evaluation of periapical infections in Egypt. Oral Microbiol Immunol 1992; 7: 100–105.

    PubMed  Article  Google Scholar 

  52. Sundqvist G . Associations between microbial species in dental root canal infections. Oral Microbiol Immunol 1992; 7: 257–262.

    PubMed  Article  Google Scholar 

  53. Molander A, Reit C, Dahlen G, Kvist T . Microbiological status of root-filled teeth with apical periodontitis. Int Endod J 1998; 31: 1–7.

    PubMed  Article  Google Scholar 

  54. Sundqvist G, Figdor D, Persson S, Sjogren U . Microbiologic analysis of teeth with failed endodontic treatment and the outcome of conservative re-treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998; 85: 86–93.

    PubMed  Article  Google Scholar 

  55. Peciuliene V, Reynaud AH, Balciuniene I, Haapasalo M . Isolation of yeasts and enteric bacteria in root-filled teeth with chronic apical periodontitis. Int Endod J 2001; 34: 429–434.

    PubMed  Article  Google Scholar 

  56. Peciuliene V, Balciuniene I, Eriksen HM, Haapasalo M . Isolation of Enterococcus faecalis in previously root-filled canals in a Lithuanian population. J Endod 2000; 26: 593–595.

    PubMed  Article  Google Scholar 

  57. Dahlen G, Samuelsson W, Molander A, Reit C . Identification and antimicrobial susceptibility of enterococci isolated from the root canal. Oral Microbiol Immunol 2000; 15: 309–312.

    PubMed  Article  Google Scholar 

  58. Heintz CE, Deblinger R, Oliet S . Antibiotic sensitivities of enterococci isolated from treated root canals. J Endod 1975; 1: 373–376.

    PubMed  Article  Google Scholar 

  59. Gilad JZ, Teles R, Goodson M, White RR, Stashenko P . Development of a clindamycin-impregnated fiber as an intracanal medication in endodontic therapy. J Endod 1999; 25: 722–727.

    PubMed  Article  Google Scholar 

  60. Molander A, Reit C, Dahlen G . Microbiological evaluation of clindamycin as a root canal dressing in teeth with apical periodontitis. Int Endod J 1990; 23: 113–118.

    PubMed  Article  Google Scholar 

  61. Bystedt H, Nord CE, Nordenram A . Effect of azidocillin, erythromycin, clindamycin and doxycycline on postoperative complications after surgical removal of impacted mandibular third molars. Int J Oral Surg 1980; 9: 157–165.

    PubMed  Article  Google Scholar 

  62. Laird WR, Stenhouse D, Macfarlane TW . Control of post-operative infection. A comparative evaluation of clindamycin and phenoxymethylpenicillin. Br Dent J 1972; 133: 106–109.

    PubMed  Article  Google Scholar 

  63. Abu-Mowais M, Abdul-Amire R, El-Mosteky M . The clinical safety and efficacy of antibiotic prophylaxis after surgical removal of third molars. J Kuwait Med Assoc 1990; 24: 57–59.

    Google Scholar 

  64. Longman LP, Martin MV . The use of antibiotics in the prevention of post operative infection: a re-appraisal. Br Dent J 1991; 170: 257–262

    PubMed  Article  Google Scholar 

  65. Lewis MA, Meechan C, MacFarlane TW, Lamey PJ, Kay E . Presentation and antimicrobial treatment of acute orofacial infections in general dental practice. Br Dent J 1989; 166: 41–45.

    PubMed  Article  Google Scholar 

  66. Gill Y, Scully C . Orofacial odontogenic infections: review of microbiology and current treatment. Oral Surg Oral Med Oral Pathol 1990; 70: 155–158.

    PubMed  Article  Google Scholar 

  67. Heimdahl A, Nord CE . Treatment of orofacial infections of odontogenic origin. Scand J Infect Dis Suppl 1985; 46: 101–105.

    PubMed  Google Scholar 

  68. Kuriyama T, Nakagawa K, Karasawa T, Saiki Y, Yamamoto E, Nakamura S . Past administration of beta-lactam antibiotics and increase in the emergence of beta-lactamase-producing bacteria in patients with orofacial odontogenic infections. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000; 89: 186–192.

    PubMed  Article  Google Scholar 

  69. Baker KA, Fotos PG . The management of odontogenic infections. A rationale for appropriate chemotherapy. Dent Clin North Am 1994; 38: 689–706.

    PubMed  Google Scholar 

  70. Heimdahl A, von Konow L, Satoh T, Nord CE . Clinical appearance of orofacial infections of odontogenic origin in relation to microbiological findings. J Clin Microbiol 1985; 22: 299–302.

    PubMed  PubMed Central  Article  Google Scholar 

  71. Peterson L . Microbiology of Head and Neck Infections. Philadelphia: WB Saunders, 1991.

  72. Finegold SM, Jousimies-Somer H . Recently described clinically important anaerobic bacteria: medical aspects. Clin Infect Dis 1997; 25 Suppl 2: S88–93.

    PubMed  Article  Google Scholar 

  73. Kannangara DW, Thadepalli H, McQuirter JL . Bacteriology and treatment of dental infections. Oral Surg Oral Med Oral Pathol 1980; 50: 103–109.

    PubMed  Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to L D Addy.

Additional information

Refereed Paper

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Addy, L., Martin, M. Clindamycin and dentistry. Br Dent J 199, 23–26 (2005). https://doi.org/10.1038/sj.bdj.4812535

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.bdj.4812535

Further reading

Search

Quick links