Is cefuroxime (Cefuroxime) effective in treating Vincent's stomatitis (also known as acute necrotizing ulcerative gingivitis)?

Cefuroxime for Vincent's Stomatitis (Acute Necrotizing Ulcerative Gingivitis)

Cefuroxime is not the first-line antibiotic for Vincent's stomatitis (acute necrotizing ulcerative gingivitis/ANUG), though it can be used as a second-line agent when first-line treatments fail or are contraindicated.

Primary Treatment Approach

Vincent's stomatitis (ANUG) is caused primarily by fusiform bacilli, spirochetes, Bacteroides species, and Selenomonas species 1. The infection requires both mechanical debridement and antimicrobial therapy targeting these anaerobic organisms.

First-Line Antibiotic Choices

• Metronidazole is the preferred first-line agent for ANUG due to its excellent activity against the causative anaerobic organisms (fusiform bacilli and spirochetes) 2
• Amoxicillin-clavulanate (Augmentin) is also appropriate as first-line therapy, providing coverage against the mixed anaerobic flora 2
• Penicillin combined with metronidazole represents another effective first-line regimen 2

Role of Cefuroxime

Cefuroxime can be considered as a second-line option when first-line agents fail or in penicillin-allergic patients who cannot tolerate other alternatives 2. However, it has important limitations:

• Cefuroxime has broad-spectrum activity against gram-positive and gram-negative aerobes but lacks optimal coverage against the anaerobic organisms (particularly Bacteroides fragilis) that are central to ANUG pathogenesis 3, 4
• The drug is specifically noted to have no effect against B. fragilis, a key pathogen in periodontal infections 3
• When used for odontogenic infections, cefuroxime is recommended only in combination with metronidazole to provide adequate anaerobic coverage 2

Treatment Algorithm

1. Initial therapy: Start with metronidazole alone OR amoxicillin-clavulanate as monotherapy 2

2. If no improvement within 2-3 days: Switch to second-line regimens including:

   • Amoxicillin-clavulanate (if not used initially)
   • Cefuroxime PLUS metronidazole (combination required for adequate anaerobic coverage) 2
   • Penicillin plus metronidazole 2

3. For penicillin-allergic patients: Clindamycin is preferred over macrolides or cephalosporins due to superior anaerobic coverage 2

Critical Caveats

• Never use cefuroxime as monotherapy for ANUG—it must be combined with metronidazole to cover anaerobic pathogens 2
• Antibiotic therapy alone is insufficient; mechanical debridement, scaling, and curettage of infected tissue are essential components of treatment 2, 1
• Address predisposing factors including stress (which increases cortisol and compromises immune function), smoking, and poor oral hygiene 1
• The fusiform-spirochete nature of ANUG requires agents with specific anaerobic activity, making metronidazole-containing regimens superior to cefuroxime alone 1