Pooyan Sadr Eshkevari, DDS, MD
University of Louisville
Oral versus Intravenous Antibiotics for the Management of the Osteomyelitis of the Jaws: An Open-Label Non-Inferiority Controlled Clinical Trial
Dr. Eshkevari is currently a fifth year resident in the six year Oral and Maxillofacial Surgery program at the University of Louisville in Kentucky. He obtained his first DDS degree from Tehran Azad School of Dentistry, his second DDS from the University of California, Los Angeles, and his MD from University of Louisville School of Medicine. He has worked for a year as a research fellow in Germany on a grant funded by Forschungsgemeinschaft Dental e.V. before immigrating to the States. Dr. Eshkevari’s research interests include evidence based oral and maxillofacial surgery, research methodology, head and neck cancer and reconstruction, and hard and soft tissue regeneration.
Abstract:
The standard treatment of the Osteomyelitis of the Jaw (OMJ) includes removal of the infection through surgical intervention followed by a course of broad-spectrum antibiotic therapy which may or not be narrowed down based on the sensitivity results of bone specimen cultures obtained at the time of surgery. Currently, the antibiotic therapy for OMJ cases in need of debridement often involves the placement of a Peripherally Inserted Central Catheter (PICC) and outpatient intravenous antibiotic injections. The preference for IV antibiotics reflects a broadly held belief that parenteral therapy is inherently superior to oral therapy, largely based on an influential 1970 article. However, there has been emerging evidence refuting this notion throughout the last two decades. Despite these “hints,” no clinical trials in the field of Oral and Maxillofacial Surgery (OMFS) have addressed this clinically significant question. This is an important topic because outpatient IV therapy has many associated risks, costs, and inconvenience to patients. Patient needs to stay longer in the hospital and receive a PICC. PICCs carry the risk of vein thrombosis, infection, and potential abuse. Before discharge, patients need to be signed up with a local facility where they can receive their IV antibiotic doses or arrangement must be made for the patient to receive IV antibiotics at home. This involves significant additional cost and risk compared to potential PO antibiotics which are rather cheap and much less invasive. We have designed a study to compare the oral antibiotics to the IV for the treatment of OMJ. If oral antibiotics are truly non-inferior to the IV form, we can avoid the costly, time-consuming process of receiving outpatient IV injections.
