Keberhasilan Terapi Ceftriaxone pada Angina Ludwig: Laporan Kasus dan Tinjauan Literatur tentang Faktor-Faktor yang Memengaruhi Luaran Klinis

Abstract

Ludwig's angina is a rapidly progressive deep neck space infection with the potential to cause life-threatening airway obstruction and sepsis. Ceftriaxone is widely used as an empirical antibiotic for its management; however, therapeutic success is influenced by multiple factors, including patient characteristics, causative microorganisms, antibiotic regimen, and surgical intervention. This study aimed to describe the therapeutic outcomes of ceftriaxone in a patient with Ludwig's angina and to identify factors associated with treatment success through a literature review. A case report combined with a literature review was conducted. The case report describes the patient's clinical presentation, diagnostic findings, management, and clinical outcomes, while the literature review evaluates evidence regarding host-related factors, microbial characteristics, ceftriaxone treatment regimens, surgical management, and clinical outcomes in Ludwig's angina. A 43-year-old man with a history of dental caries presented with bilateral submandibular swelling, dysphagia, trismus, and neck pain. Laboratory investigations revealed leukocytosis, and contrast-enhanced computed tomography of the neck demonstrated bilateral submandibular abscesses. The patient was treated with intravenous ceftriaxone (1 g every 12 hours) combined with metronidazole, followed by prompt incision and drainage. Gradual clinical improvement was observed, including reduced edema and improved mouth opening, swallowing, and speech, allowing discharge in stable condition. The literature review indicates that the success of ceftriaxone therapy is influenced by the patient's immune and nutritional status, antimicrobial susceptibility of the causative pathogens, the appropriateness of the antibiotic regimen particularly in combination with metronidazole and effective source control through early surgical drainage. The successful management of Ludwig's angina with ceftriaxone depends not only on the antimicrobial activity of the drug but also on host factors, microbiological characteristics, the appropriateness of antibiotic therapy, and timely surgical source control. A multidisciplinary approach involving early diagnosis, appropriate empirical antibiotic therapy, and prompt surgical drainage is essential for improving clinical outcomes in patients with Ludwig's angina.