GuidelinesOther guideline
Ludwig’s Angina
Infection Ludwig’s angina Brief outline/clinical setting Severe cellulitis involving the floor of the mouth, that can lead to airway compromise. Most prevalent cause of Ludwig's angina is odontogenic,[9] accounting for approximately 75% to 90% of cases. Infections of the lower second and third molars are usually implicated due to their roots extending inferiorly below the mylohyoid muscle. Periap
| Infection | Ludwig’s angina |
| Brief outline/clinical setting | Severe cellulitis involving the floor of the mouth, that can lead to airway compromise. Most prevalent cause of Ludwig's angina is odontogenic,[9] accounting for approximately 75% to 90% of cases. Infections of the lower second and third molars are usually implicated due to their roots extending inferiorly below the mylohyoid muscle. Periapical abscesses of these teeth also result in lingual cortical penetration, leading to submandibular infection |
| Aetiologies/organisms | Microbiology were found to be commonly polymicrobial and anaerobic. Commonly found microbes are Viridans Streptococci, Staphylococci, Peptostreptococci, Prevotella, Porphyromonas and Fusobacterium |
| Optimal antimicrobial selection | Amoxicillin/ticarcillin with clavulanic acid ( 1,2gm IVI 8hrly ) or a Beta-lactamase resistant antibiotic such as cefoxitin, cefuroxime, imipenem or meropenem. This should be given in combination with a drug effective against anaerobes such as clindamycin or metronidazole ( 500mg ivi 8hrly) |
| Duration | 2 Weeks |
| Alternative if allergic/not available | Clindamycin 150-300 mg PO TDS for 10 days |
| Rationale | |
| Level of evidence | |
| Link to Guideline | Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America |