Endodontia

TEE ADDITION OF A FUNGICIDE TO AN ANTIBIOTIC

MIXTURE FOR USE IN ENDODONTICS

SAMUEL SELTZER, D.D.S., AND I. B. BENDER, D.D.S., PHILADELPHIA, PA.

NVESTIGATIONS of the use of antibiotics in the treatment of infected

I pulpless teeth have led to the conclusion that, until now, only a combination
of antibiotics is capable of killing all the organisms which may be encountered in
the root canal with the exception of fungi.
The most successful combination which has been developed thus far consists
of 300,000 units of aqueous suspension of procaine penicillin G to which has been
added 250 mg. each of streptomycin and chloramphenicol (chloromycetin) .
All bacteria encountered in an infected root canal are readily eliminated in
one sterilization treatment. However, if fungi are present, they grqw luxuriantly
since the bacteria are destroyed and do not interfere with fungal growth. On
this basis, a culture medium for fungi containing streptomycin has been developed
by Litman.l The streptomycin inhibits the growth of both gram-positive and
gram-negative bacteria, thus permitting three times as many colonies of fungi
to grow as could on Sabourauds agar.
Recent report+ 3 attest to the fact t.hat the problem of elimination of fungi
is one which will become increasingly evident as various diseasesare treated wit,h
antibiotics. Until an antifungal antibiotic is developed, some other method of
dealing with this problem must be sought.
Fungi have been detected in infected root canals long before the use of anti-
biotics. However, they were found in small numbers and were considered to be
either contaminants or of doubtful pathogenicity. Since the advent of the use
of antibiotics in endodontics, however? their presence can no longer be dismissed
as inconsequential. We have demonstrated that fungi are present in about
20 per cent of the casesof infected pulpless teet,h.4 An antifungal agent must
be added to the combination of antibiotics, therefore, which is effective against
the fungi and which is also compatible with the antibiotics used. The present
report deals with this problem.
Antifungal Antibiotics
Recent tests against a strain of Candida a&cans isolated from the root canal
were made with all antibiotics available at the time. Among the antibiotics tested
were penicillin, streptomycin, bacitracin. actidione, and tyrothricin.* The only
one which was effective against the test organisms was tyrothricin. This anti-
biotic, however, had many undesirable properties which contraindicated its clini-
cal use. Among these were poor solubility, low rate of diffusion, inherent toxic-
ity, and inactivation by blood, pus, and serum.5 The effective component of
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