Delayed Clinical Response of Deep Facial Infections Due to Prior Unregulated Antibiotics Use Assessed By CRP Levels In A Tertiary Care Hospital
DOI:
https://doi.org/10.37762/jgmds.12-4.734Keywords:
Antibiotics, Infection, Facial Spaces, CRP, Clinical ResponseAbstract
OBJECTIVES
This study aimed to assess the efficacy of serum CRP levels as monitoring tools for patients with fascial space infections who had a delayed clinical response to initial treatment, as per guidelines, due to prior unregulated antibiotics.
METHODOLOGY
This case series study was conducted at Lady Reading Hospital’s Department of Oral and Maxillofacial Surgery and Ophthalmology from January 2024 to March 2025, with ethics approval and informed consent obtained from 35 participants with fascial space infections requiring hospitalization and prior antibiotic use. Those with recurrent infections, trauma, or chronic conditions were excluded. Diagnosis involved a comprehensive history, clinical examination, and imaging studies (OPG for odontogenic infections and CT for non-odontogenic infections). Infection severity was tracked through C-reactive protein (CRP) levels measured at admission, day three, and discharge. Initial treatment followed clinical guidelines, utilizing first-line antibiotics and incision and drainage. If CRP levels did not decrease, the antibiotic regimen was adjusted, leading to improved outcomes. Data were analyzed using SPSS.
RESULTS
The most commonly involved space was the submandibular space (31%), followed by unilateral and bilateral submandibular, sublingual, and submental spaces (20%). Orbital cellulitis was observed in 17% of patients. When asked about the prior unregulated use of antibiotics, 65.7% of patients admitted to having used them. The Mean CRP on the day of admission was 15.46 mg/dl with a SD of 6.42. The follow-up means CRP on the 3rd day of admission was 15.17mg/dl with SD 9.77, showing a poor response to initial treatment in 54.3% of the patients. The mean CRP on the day of discharge and after the change of antibiotic was markedly reduced, with a mean of 3.2mg/dl and SD of 3.7, showing resolution of infection.
CONCLUSION
Delays in infection resolution lead to longer hospital stays and increased antibiotic resistance. Urgent action is needed to establish national antibiotic programs, implement public awareness campaigns, and enforce stricter regulations on antibiotic use to improve outcomes and reduce antibiotic resistance.
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