The Comparison of Metronidazole, Clindamycin, and Amoxicillin Againts Streptococcus sanguinis

  • Kevin Lim Undergraduate student, Faculty of Dentistry, Trisakti University
  • Armelia Sari Widyarman Department of Microbiology, Faculty of Dentistry, Trisakti University


Introduction: Viridans streptococci group such as Streptococcus sanguinis (S. sanguinis), an anaerobic Gram-positive bacteria is a well-known for its involvement in dry socket (alveolar osteitis)-associated infection. Systemic amoxicillin, clindamycin and metronidazole have all been shown to be effective to inhibit this bacterium. However, there has been a lack of studies identifying which are the most effective amongst these antibiotics toward Streptococcus sanguinis.
Objectives: The purpose of this study is to evaluate the effectiveness of metronidazole, clindamycin, and amoxicillin in inhibiting the growth of Streptococcus sanguinis in vitro.
Methods: This effectiveness was done by using agar well diffusion methods. S. sanguinis ATCC 10556 were cultured in Brain Heart Infusion (BHI) broth at 37°C under anaerobic condition. After 48h, bacterial cells were harvested and counted using microplate reader (490 nm) to achieve optical density of 0.25-0.30 (107 CFU/mL). Subsequently, 100 μL of bacterial suspension was cultured on BHI agar and each antibiotic suspension was added into each agar well, incubated for 72h at 37°C. The inhibition zone diameters were measured with electronic caliper. All experiments were done in triplicate, and repeated two times in separated occasions. The obtained data were statistically analyzed using one-way ANOVA test. A  p<0.05 was considered as significance.
Result: The results showed that there was a significant difference in the effectiveness, clindamycin and amoxicillin in inhibiting the growth of Streptococcus sanguinis (p<0.05), compared to metronidazole. The inhibition zone diameter with mean±SD (mm) are 13.50±2.0, 34.67±2.3 and 32.67±1.7 for metronidazole, clindamycin and amoxicillin, respectively.
Conclusion: Clindamycin and amoxicillin are more effective in inhibiting the growth of Streptococcus sanguinis compared to metronidazole in this study. However, future studies are needed to confirm this result in vivo.


Mamoun J. Dry socket etiology, diagnosis, and clinical treatment techniques. J Korean Assoc Oral Maxillofac Surg. 2018;44(2):52–8.
Alexander RE. Dental extraction wound management: a case against medicating postextraction sockets. J Oral Maxillofac Surg Off J Am Assoc Oral Maxillofac Surg. 2000;58(5):538–51.
Narayanan LL, Vaishnavi C. Endodontic microbiology. J Conserv Dent JCD. 2010;13(4):233–9.
Chunduri NS, Madasu K, Goteki VR, Karpe T, Reddy H. Evaluation of bacterial spectrum of orofacial infections and their antibiotic susceptibility. Ann Maxillofac Surg. 2012;2(1):46–50.
Patterson MJ. Streptococcus. In: Baron S (ed). Medical Microbiology. University of Texas Medical Branch at Galveston: Galveston (TX); 1996
Akinbami BO, Godspower T. Dry Socket: Incidence, Clinical Features, and Predisposing Factors. Int J Dent. 2014;2014. doi:10.1155/2014/796102.
Samuelson J. Why metronidazole is active against both bacteria and parasites. Antimicrob Agents Chemother . 1999;43(7):1533–41.
Heta S, Robo I. The side effects of the most commonly used group of antibiotics in periodontal treatments. Med Sci. 2018;6. doi:10.3390/medsci6010006.
Tuohy M, Washington JA. Antimicrobial susceptibility of viridans group streptococci. Diagn Microbiol Infect Dis. 1997;29(4):277–80.
Smieja M. Current indications for the use of clindamycin: A critical review. Can J Infect Dis. 1998; 9(1):22–8.
Lippincott’s guide to infectious diseases. 3rd edition. Philadelphia: LWW; 2003.
Langdon A, Crook N, Dantas G. The effects of antibiotics on the microbiome throughout development and alternative approaches for therapeutic modulation. Genome Med. 2016;8:39. doi:10.1186/s13073-016-0294-z.
Kuehn J, Ismael Z, Long PF, Barker CIS, Sharland M. Reported rates of diarrhea following oral penicillin therapy in pediatric clinical trials. J Pediatr Pharmacol Ther . 2015;20(2):90–104.
Widyarman AS, Yunita ST, Prasetyadi T. Consumption of yogurt containing probiotic Bifidobacterium lactis reduces Streptococcus mutans in orthodontic patients. Sci Dent J. 2018;2(1):19–25.
Widyarman AS, Hartono V, Marjani L, Irawan D, Luthfi L, Bachtiar BM. Lactobacillus reuteri containing probiotic lozenges consumption reduces Streptococcus mutans, Streptococcus sobrinus, Porphyromonas gingivalis, and Aggregatibacter actinomycetemcomitans in orthodontic patients. J Int Dent Med Res. 2018;11(2):628–33.
Uzlikova M, Nohynkova E. The effect of metronidazole on the cell cycle and DNA in metronidazole-susceptible and -resistant Giardia cell lines. Mol Biochem Parasitol. 2014;198:75–81.
Leitsch D. A review on metronidazole: an old warhorse in antimicrobial chemotherapy. Parasitology. 2017;23:1–12.
Morar M, Bhullar K, Hughes DW, Junop M, Wright GD. Structure and mechanism of the lincosamide antibiotic adenylyltransferase LinB. Struct Lond Engl. 2009;17(12):1649–59.
Scholar EM, Pratt WB (eds.). The antimicrobial drugs. 2nd Edition. New York: Oxford University Press; 2000.
Peedikayil FC. Antibiotics in odontogenic infections - an update. J Antimicrob Agents. 2016;2(2):1–3.
Credito KL, Lin G, Pankuch GA, Bajaksouzian S, Jacobs MR, Appelbaum PC. Susceptibilities of Haemophilus influenzae and Moraxella catarrhalis to ABT-773 compared to their susceptibilities to 11 other agents. Antimicrob Agents Chemother. 2001; 45(1):67–72.
Kohanski MA, Dwyer DJ, Collins JJ. How antibiotics kill bacteria: from targets to networks. Nat Rev Microbiol. 2010;8(6):423–35.
Zeng X, Lin J. Beta-lactamase induction and cell wall metabolism in Gram-negative bacteria. Front Microbiol. 2013;4:128.
Alcaide F, Liñares J, Pallares R, J carratala, MA Benitez, F Gudiol, et al. In vitro activities of 22 beta-lactam antibiotics against penicillin-resistant and penicillin-susceptible viridans group streptococci isolated from blood. Antimicrob Agents Chemother. 1995;39(10):2243–7.
Blum IR. Contemporary views on dry socket (alveolar osteitis): a clinical appraisal of standardization, aetiopathogenesis and management: a critical review. Int J Oral Maxillofac Surg. 2002; 31(3):309–17.
Mombelli A, Cionca N, Almaghlouth A, Cherkaoui A, Schrenzel J, Giannopoulou C. Effect of periodontal therapy with amoxicillin-metronidazole on pharyngeal carriage of penicillin- and erythromycin-resistant viridans streptococci. J Periodontol. 2016;87(5):539–47.
Mangundjaja S, Hardjawinata K. Clindamycin versus ampicillin in the treatment of odontogenic infections. Clin Ther. 1990;12(3):242–9.
Smith A, Jackson MS, Kennedy H. Antimicrobial susceptibility of viridans group streptococcal blood isolates to eight antimicrobial agents. Scand J Infect Dis. 2004;36(4):259–63.
Kupfer SR. Prevention of dry socket with clindamycin. A retrospective study. N Y State Dent J. 1995; 61(6):30–3.
How to Cite
LIM, Kevin; WIDYARMAN, Armelia Sari. The Comparison of Metronidazole, Clindamycin, and Amoxicillin Againts Streptococcus sanguinis. Journal of Indonesian Dental Association, [S.l.], v. 1, n. 1, oct. 2018. ISSN 2621-6175. Available at: <>. Date accessed: 17 july 2019. doi:
Research Article