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17 April 2019

Maxillary sinus lift and infectious complications: which antibiotic should we choose?

Lara Figini

Maxillary sinus elevation has been shown to be a safe and effective means of creating adequate vital bone formation for implant placement in pneumatized sinuses,. However, it can sometimes involved intra- and post-operative complications, such as infection, that can affect surgical outcomes. Infection may occur in two ways: infection of the graft situated below the elevated sinus and infection of the sinus itself. When infection appears, antibiotic administration is necessary. What kind of antibiotic to prescribe in these cases?
An antibiogram of the bacterial flora present in the maxillary sinus will provide specific information on which to base effective antibiotic treatment.         

In a study published in Clinical Oral Implants Research in November 2018, the authors used antibiogram to determine a specific and effective antibiotic in each case. in patients undergoing maxillary sinus augmentation surgery. A total of 174 patients (90 women and 84 men) with a mean age of 55.92 years underwent 227 breast augmentation surgeries. As the membrane was lifted, a sample was collected from the maxillary sinus floor with a cotton swab and placed on a blood agar and chocolate agar culture to incubate for 48 h at 37°; the samples then underwent microbiological analysis. The antibiograms were performed for each positive culture to identify the most sensitive antibiotic. Antibiotics have been grouped according to their mechanism of action in: 

  • beta-lactams (penicillins), 
  • beta-lactams (cephalosporins),
  • macrolides
  • quinolones,
  • fosfomycin,
  • aminoglycosides or trimethoprim-sulfamethoxazole.    

Of 227 cultures, 18.1% were bacteria-positive. Of the germs, 45% were of the Streptococcus genus, most of which belonged to the Streptococcus viridans group (61.1%). The germs studied showed greater resistance to macrolides and greater sensitivity to penicillins, cephalosporins, and ciprofloxacin. The antibiotics that showed the greatest efficacy were as follows: ampicillin, amoxicillin–clavulanate, and ciprofloxacin.      

Based on the antibiograms performed in this study, the most effective antibiotics against possible infectious complications in maxillary sinus lift are as follows: ampicillin, amoxicillin- clavulanic acid, and ciprofloxacin. 

For additional informations: 
The antibiotic of choice by antibiogram in maxillary sinus Elevation surgery: a clinical study.

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