amoxicillin-potassium-clavulanate-combination and Maxillary-Diseases

Multiple myeloma (MM) and breast cancer (BC) are the two most common diseases associated with bisphosphonates-related osteonecrosis of the jaws (BRONJ), for which different therapeutical approaches have been proposed. The aim of this study was to compare the clinical behaviour of BRONJ in patients with MM vs. BC and the time of healing in terms of clinical and symptomatological remission, following a standardized therapeutic protocol.. Twenty-six BRONJ patients (13 men with MM and 13 women with BC) were prospectively enroled and treated with a specific systemic and topical antibiotic therapy. Several predictors of outcome were also evaluated.. Nine patients (69.2%) with BC and 10 patients (76.9%) with MM progressed towards a complete clinical remission (CR) in a mean healing time of 183.3 days [SD: 113.7; 95% confidence interval (CI): 95.95-207.7] and 372.0 days (SD: 308.0; 95% CI: 151.7-592.3) (P = 0.776), respectively. The clinical improvement was statistically significant (P = 0.0013 and P = 0.0014), as well as the assessment of pain (P = 0.0015 and P = 0.0015), in MM and BC group, respectively. Cox regression analysis revealed that just triggering events (P = 0.036) were found to be significant predictors of outcome of BRONJ healing.. Both groups of cancer patients experienced clinical and symptomatological remission regardless their malignancy, but BC patients earlier than MM patients.

Topics: Aged; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Bisphosphonate-Associated Osteonecrosis of the Jaw; Bone Density Conservation Agents; Breast Neoplasms; Diphosphonates; Female; Follow-Up Studies; Forecasting; Humans; Imidazoles; Male; Mandibular Diseases; Maxillary Diseases; Middle Aged; Multiple Myeloma; Pain Measurement; Proportional Hazards Models; Prospective Studies; Remission Induction; Treatment Outcome; Wound Healing; Zoledronic Acid

Bisphosphonates (BPs) are widely used as bone-stabilizers, but side effects of BP therapy include bisphosphonate-related osteonecrosis of the jaw (BRONJ), which is resistant to therapy. The aim of this study was to evaluate the outcome of maxillary BRONJ involving sinusitis maxillaris. 21 patients presenting with maxillary BRONJ, from 2005 to 2008, were included in the study. In 18 cases BP had been administered for carcinoma and in 3 cases for osteoporosis, with an average exposure time of 47.4 months. 12 patients spontaneously developed BRONJ. The 10 patients diagnosed with stage III BRONJ presented with concomitant sinusitis maxillaris. Despite treatment, there were six recurrences of BRONJ, four of them with additional sinusitis maxillaris. Whether BRONJ occurred spontaneously or after extraction there was no difference in the outcome. Patients with advanced maxillary BRONJ often suffer from sinusitis maxillaris, both of which are frequently resistant to therapy.

Topics: Aged; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bone Density Conservation Agents; Carcinoma; Chronic Disease; Debridement; Diphosphonates; Female; Follow-Up Studies; Humans; Imidazoles; Injections, Intravenous; Male; Maxillary Diseases; Maxillary Sinusitis; Middle Aged; Osteonecrosis; Osteoporosis; Osteotomy; Recurrence; Risk Factors; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Zoledronic Acid

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Antineoplastic Combined Chemotherapy Protocols; Bone Density Conservation Agents; Diphosphonates; Female; Follow-Up Studies; Humans; Imidazoles; Maxillary Diseases; Multiple Myeloma; Oroantral Fistula; Osteonecrosis; Zoledronic Acid

We report a patient with bisphosphonate-associated osteonecrosis of the jaws who developed pathological fractures of the upper and lower extremities after the suspension of treatment with bisphosphonates. Temporary discontinuation of the drugs does not alter the clinical course of the disease, and could result in the recurrence of bone pain and the progression of metastases or osteolytic lesions.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Infective Agents, Local; Bone Density Conservation Agents; Bone Neoplasms; Chlorhexidine; Debridement; Diphosphonates; Female; Humans; Hydrogen Peroxide; Imidazoles; Maxillary Diseases; Middle Aged; Mouthwashes; Multiple Myeloma; Oroantral Fistula; Osteonecrosis; Tooth Extraction; Zoledronic Acid