Systemic antibiotic treatment with sitafloxacin prevents periodontal surgery-induced stomatitis outbreak

16 August, 2018

Behçet’s disease (BD) is a systemic vasculitis of unknown aetiology – characterised by recurrent oral and genital ulceration, uveitis, and skin manifestations; epidemiologic studies have established an autoimmune process triggered by herpes simplex virus-1 and several species of Streptococcus.¹ Prophylactic oral sitafloxacin is shown to be effective in preventing periodontal surgery-induced aphthous stomatitis outbreak in a patient with BD.

A 51-year-old man with history of BD presented with swelling in the left maxillary molar region and nasal congestion; he had been treated for BD with Chinese herbal medicine that did not reduce his symptoms – including oral aphthous ulcers, skin lesions, and genital ulcers. Clinical oral examination also revealed accumulation of dental plaque and calculus, swelling and redness of the gingiva, and purulent discharge around several of his teeth. The patient was diagnosed with severe chronic periodontitis and acute odontogenic sinusitis in the left maxillary sinus.

Treatment with the anti-inflammatory colchicine was initiated prior to periodontal therapy of scaling and root planing – successfully alleviating the oral symptoms of BD by reducing the size and numbers of oral aphthous ulcers and decreasing their recurrence. The patient underwent two periodontal surgeries – both of which have induced an outbreak of oral stomatitis despite receiving oral cefdinir (300mg/day) prior to surgery. The outbreak may be due to the diffusion of periodontal pathogens that had led to a rash of aphthae.² The oral odour that often accompanies the presence of anaerobic bacteria was also present.

Oral sitafloxacin has been previously demonstrated to be effective in infection control in elderly patients receiving periodontal therapy.³ The patient in this case report received sitafloxacin at 50 mg twice daily for five days to treat the acute infection – which resolved within only three days – eliminating the stomatitis and bacterial odour. Prior to the subsequent periodontal surgery, the patient received prophylactic sitafloxacin – which prevented the recurrence of acute stomatitis altogether.

The current case report therefore demonstrated a twofold outcome: first, comprehensive periodontal therapy improves overall periodontal condition, and is useful in decreasing the oral signs and symptoms of BD – particularly their recurrence. Second, oral sitafloxacin treatment is not only effective in eliminating oral stomatitis, but also prevents its outbreak when administered preoperatively.