antibiotics for dental student

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Clinical Microbiology
Fifth Year

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antibiotics for dental student

  1. 1. Antibiotic Use in Orofacial Dental Infection VGH-TPE
  2. 2. INTRODUCTION  This presentation will review the evaluation and management of orofacial infections with emphasis on: ■ ■ ■ Antibiotic Therapy Indications for Prophylaxis Antifungal Agents VGH-TPE
  3. 3. ASSESSMENT  Requires a complete medical history and exam of the head and neck region with awareness to systemic factors as part of a comprehensive dental examination  Identify local and/or systemic signs and symptoms to support the diagnosis of infection: < erythema, warmth, swelling, and pain > < malaise, fever ( >38 c), chills >  Loss of function < dysphagia, trismus, dyspnea > VGH-TPE
  4. 4. DIAGNOSIS: Infection  Determine etiology > odontogenic > trauma wound, animal bite > TB, fungi, viral, actinomycoses VGH-TPE
  5. 5. DIAGNOSIS (CON’T)  Determine cellulitis versus abscess VGH-TPE
  6. 6. TREATMENT of INFECTION  Remove the cause of infection, most important of all, drain the pus by either spontaneously or surgically  Antibiotics are merely an adjunctive therapy. Drainage Host defense VGH-TPE Antibiotics
  7. 7. INDICATION for ANTIBIOTICS 1. Severity of the infection  Acute onset  Diffuse swelling involves fascial spaces 2. Adequacy of removing the source of infection  When drainage can’t be established immediately 3. The state of patients’ host defense  When the patient is febrile  Compromised host defenses  For prophylaxis VGH-TPE
  8. 8. MICROBIOLOGY  Most oral infections are mixed in origin consisting of aerobic and anaerobic Gram positive and Gram negative organisms  Anaerobes predominant (75%) VGH-TPE
  9. 9. COMMONLY USED A/B  Mechanism of the antibiotics
  10. 10. COMMONLY USED A/B 1. Groups of Penicillin  First choice for odontogenic infection  G(+) cocci and rod, spirochetes, anaerobes  0.7~10% hypersensitivity  Nature: penicillin G (IV), penicillin V (Oral)  Penicillinase-resistant: oxacillin, dicloxacillin  Extended spectrum: ampicillin, amoxicillin  Combine β-lactamase inhibitor: augmentin VGH-TPE
  11. 11. 2. Cephalosporin  More resistance to penicillinase  G(+) cocci, many G(-) rods  Third generation: Pseudomonas aeruginosa  Second choice (less effect for anaerobes) First generation Cefazolin U-SAVE-A Tydine Second generation Keflor Ucefaxim Third generation Claforan VGH-TPE Forth generation Cefepime
  12. 12. 3. Clindamycin  G(+) cocci  Bacteriostatic -> bactericidal  Second-line drug: should be held in reserve to treat those infections caused by anaerobes resistant to other antibiotics VGH-TPE
  13. 13. 4. Aminoglycoside  G(-) aerobes, some G(+) aerobes eg S. aureus  Poorly absorbed from GI tract  Adjustment of dosage in renal dysfunction  Drugs: Gentamicin, Amikacin, Amikin  Combined with penicillin or cephalosporin VGH-TPE
  14. 14. 5. Metronidazole*  Only for obligate anaerobes  Can cross blood-brain barrier  To treat serious infections caused by anaerobic bacteria, combined with β-lactam A/B  Effective against Bacteroides species, esp. in periodontal infections  Drugs: Anegyn, Flagyne  Avoid in pregnant women VGH-TPE
  15. 15. 6. Vancomycin  G(+), most anaerobes, some G(-) cocci (Neisseria)  Given intravenously, BP should be monitored  Adjustment of dosage in renal dysfunction  Use as a substitute for penicillin in the prophylaxis of the heart valve patient VGH-TPE
  16. 16. 7. Chloramphenicol  Wide spectrum, highly active against anaerobes  Limited to severe odontogenic infection threatening to the eye or brain  Severe toxicity VGH-TPE
  17. 17. ` 8. Erythromycin  G(+) cocci, oral anaerobes  Bacteriostatic  Second choice for odontogenic infections  Indication for out-patients with mild infection  Drug resistence: 50% of S. aureus, Strep. viridans, VGH-TPE
  18. 18. 9. Tetracycline*  Only against anaerobes  Contraindications: pregnant women, children <12  Limited usefulness in orofacial infection  Use as adjunctive therapy for refractory periodontitis VGH-TPE
  19. 19. SELECTION of A/B  Use Empiric therapy routinely  Use the narrowest spectrum antibiotics  Use the antibiotics with the lowest toxicity and side effects  Use bactericidal antibiotics if possible  Be aware of the cost of antibiotics VGH-TPE
  20. 20.  Empiric Antibiotics in Oro-Facial Infection ■ First-line Penicillin 3MU IVA q6h -> Cefazolin 1000mg q6h Gentamycin 60-80mg IVA q8h-q12h ■ Second line (3A) Augmentin 1200mg q8h + Amikin 375mg q12h + Anegyn ■ Mild infection Amoxicillin 250mg #2 PO q8h Clindamycin 300mg PO q6h VGH-TPE
  21. 21.  Side Effect of Commonly Used Antibiotics 1. Penicillin hypersensitivity 2. Cephalosporin hypersensitivity 3. Clindamycin diarrhea, pseudomembrane colitis 4. Aminoglycoside damage to kidney, 8th neurotoxicity 5. Metronidazole* GI disturbance, seizures 6. Vancomycin 8th neurotoxicity, thrombophlebitis 7. Chloramphenicol bone marrow suppression 8. Erythromycin mild GI disturbance 9. Tetracyclin* tooth discoloration, photosensitivity VGH-TPE
  22. 22. PROPHYLAXIS  Indications
  23. 23. PROPHYLAXIS (CON’T)  Dental procedures recommended for prophylaxis
  24. 24. PROPHYLAXIS (CON’T)  Regimen
  25. 25. ANTIFUNGAL AGENT  Most of fungal infection are from candida  Commonly used drugs: (1) Nystatin (Mycostatin)= PO 4-600,000 U qid (2) Amphotericin B= IV for severe systemic infec. (3) Fluconazole, Ketoconazole VGH-TPE
  26. 26. Parmason Gargle  0.2% Chlorhexidine gluconate  Against G(+), G(-)  Reduce pain and inflammation, enhance healing  Indication: immunocompromised patient, C/T R/T (prophylaxis mouthrinse reduce oral mucositis)  Use: 2-3 times daily,10-20cc/ time, 20-30sec.
  27. 27. Anti-Virals used in dentistry  Topical Acyclovir is useful for recurrent herpetic infections, but must be started early in the prodromal phase to have a worthwhile effect.  Oral Acyclovir, Valacyclovir and Famciclovir are efficacious and safe for the treatment of the first episode and recurrent genital herpes VGH-TPE
  28. 28.  FOSCARNET - Class: Non-nucleoside DNA Polymerase Inhibitors Indications: "HSV, CMV Treatment of acyclovir resistant HSV infections in AIDS patients Acyclovir resistant VZV MOA/PCOL: Blocks the pyrophosphate binding site on viral DNA polymerase Adverse Effects/Other: "Not a purine or pyrimidine analog, Phosphono formate analog Toxic: renal impairment, CNS disturbance, leukopenia, liver dysfunction VGH-TPE

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