Medication Summary
None of the agents listed below has been systematically evaluated.
Immunomodulatory agents are tried as follows:
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Nonsteroidal anti-inflammatory agents (NSAIDs)
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Mast cell stabilizers [41]
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Clofazimine [50]
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Methotrexate [51]
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Tacrolimus
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Biologics such as infliximab [52]
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Dapsone
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Triamcinolone and dapsone injections [53]
Antimicrobials are as follows:
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Tetracycline (used for anti-inflammatory activity)
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Azithromycin [54]
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Minocycline [55]
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Roxithromycin [56]
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Antibiotic treatment of dental abscess - Resulted in remission in anecdotal cases
Intralesional corticosteroid (triamcinolone) injections may reduce swelling. Systemic corticosteroids are rarely indicated and not all patients respond. Clofazimine, dapsone, tacrolimus, thalidomide, or antitumor necrosis factor biologics may be needed. [36] No large randomized, controlled trials have been recorded with potential therapies such as tacrolimus, thalidomide, or infliximab.
Antibiotics, Other
Class Summary
Therapy must be comprehensive and should cover all likely pathogens in the clinical setting.
Azithromycin (Zithromax, Zmax)
Azithromycin inhibits bacterial growth by binding to the 50S subunit of bacterial ribosome, preventing assembly of the ribosome complex and inhibiting translation during protein synthesis.
Clofazimine (Lamprene)
Clofazimine inhibits mycobacterial growth, binding preferentially to mycobacterial deoxyribonucleic acid (DNA). It has antimicrobial properties, but the mechanism of action is unknown.
Dapsone
Dapsone is bactericidal and bacteriostatic against mycobacteria. Its mechanism of action is similar to that of sulfonamides in which competitive antagonists of para-aminobenzoic acid (PABA) prevent the formation of folic acid, inhibiting bacterial growth.
Metronidazole (Flagyl, Flagyl ER, Flagyl IV RTU)
Metronidazole is used to treat a number of microbial infections, exerting is greatest effects in reducing cellular environments. Reduction of its nitro group results in the creation of cytotoxic intermediates that inhibit deoxyribonucleic acid synthesis.
Penicillin G (Pfizerpen)
Penicillin G interferes with the synthesis of cell wall mucopeptide during active multiplication, resulting in bactericidal activity against susceptible microorganisms.
Doxycycline (Doryx, Adoxa, Ocudox, Vibramycin, Oraxyl)
Doxycycline is a broad-spectrum, synthetically derived bacteriostatic antibiotic in the tetracycline class. It is almost completely absorbed, concentrates in bile, and is excreted in urine and feces as a biologically active metabolite in high concentrations.
Doxycycline inhibits protein synthesis and, thus, bacterial growth by binding to 30S and possibly the 50S ribosomal subunits of susceptible bacteria. It may block dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest.
Erythromycin (E.E.S., Ery-Tab, Erythrocin, PCE, EryPed)
Erythromycin covers most potential etiologic agents, including Mycoplasma species. The oral regimen may be insufficient to adequately treat Legionella species, and this agent is less active against Haemophilus influenzae. Although the standard course of treatment is 10 days, treatment until the patient has been afebrile for 3-5 days seems a more rational approach. Erythromycin therapy may result in GI upset, causing some clinicians to prescribe an alternative macrolide or change to a thrice-daily dosing.
Erythromycin is a macrolide that inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest.
Mast Cell Stabilizers
Class Summary
Mast cell stabilizers inhibit the degeneration of sensitized mast cells when exposed to specific antigens by inhibiting the release of mediators from the mast cells. These agents block calcium ions from entering the mast cell.
Ketotifen, ophthalmic
Ketotifen is an H1-receptor antagonist and mast cell stabilizer. This agent inhibits the release of mediators from cells involved in hypersensitivity reactions.
Salicylates
Class Summary
These agents decrease inflammatory responses and systemically interfere with events leading to inflammation.
Sulfasalazine (Azulfidine)
Sulfasalazine decreases the inflammatory response and systemically inhibits prostaglandin synthesis.
Corticosteroids
Class Summary
These agents have anti-inflammatory properties and cause profound and varied metabolic effects. In addition, these agents modify the body's immune response to diverse stimuli.
Triamcinolone (Aristospan, Kenalog)
Triamcinolone is used to treat inflammatory dermatosis that is responsive to steroids. It decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing capillary permeability.
Immunosuppressants
Class Summary
These agents inhibit key factors that mediate immune reactions, which, in turn, decrease inflammatory responses.
Azathioprine (Imuran, Azasan)
Azathioprine antagonizes purine metabolism and inhibits the synthesis of DNA, ribonucleic acid (RNA), and proteins. It may decrease the proliferation of immune cells, which results in lower autoimmune activity.
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Orofacial granulomatosis in a patient with Crohn disease showing showing lip and gingival swelling.
