Antibiotics in Endodontics


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The use of antibiotics in Endodontics

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  • Antibiotics in Endodontics

    1. 1. Lecturer of Endodontics<br />Al-Azhar University<br />Ashraf<br />Refai<br />BDS MSc DD HMD<br /><br />AshrafSamirRefai<br /><br />+20101434323<br />
    2. 2. Antibiotics in Endodontics<br />AMDA (Arab Microdentistry Association) <br />Advanced Endodontic <br />Training Crouse<br />30/11/2010<br />
    3. 3. What Do We Know About Antibiotics??<br />One of Greatest Medical Advances<br />1935 Sulfanilamide & Penicillin<br />The Single Most Abused Drug in Medicine<br />
    4. 4. Myths About Antibiotics…<br />Myth #1:<br />Antibiotics Cure Patients<br />
    5. 5. Myths About Antibiotics…<br />Myth #2:<br />Antibiotics Are Substitutes for Surgical Drainage<br />
    6. 6. Myths About Antibiotics…<br />Myth #3:<br />60% of Infections Resolve<br />by Host Defesnses<br />The Most Important Decision is Which Antibiotic to Use<br />
    7. 7. Myths About Antibiotics…<br />Myth #4:<br />Culture & Sensitivity Testing Are Required<br />
    8. 8. Myths About Antibiotics…<br />Myth #5:<br />Tetracyclinesvs Beta Lactams<br />Antibiotics Increase the Hosts Defense<br />
    9. 9. Myths About Antibiotics…<br />Myth #6:<br /> ADRs Microbial Resistance<br />Expensive Antagonistic Effects <br />Multiple Antibiotics Are Superior to Single Antibiotics<br />
    10. 10. Myths About Antibiotics…<br />Myth #7:<br />Antibiotics Prophylaxis is Usually Effective<br />
    11. 11. Myths About Antibiotics…<br />Myth #8:<br />Drug Resistant Bacteria<br />Antibiotics are Effective Against Chronic Infections<br />
    12. 12. Myths About Antibiotics…<br />Myth #9:<br />Prolonged Antibiotics Kill Resistant Infections<br />Prolonged Antibiotics are Necessary to Prevent Rebound Infections (Remove the Cause)<br />What Works for One Specialty Should not be Extrapolated to Another (2-7 Day Infections)<br />Infections Require a Complete Course<br />
    13. 13. Nosocomial Infections“Hospital BornInfections”<br />
    14. 14. 5 Million Treated for Infections / Year3 Million Come in With One2 Million Get One at the Hospital<br />
    15. 15. 5-6% of Patients in HospitalsGet a Nosocomial Infection6-8% Mortality Rate<br />
    16. 16. 45-65% of Antibiotic Prescriptions are Inappropriate<br />
    17. 17. What About inEgypt???<br />3rd World Countries are a Major Source of Resistant Infections<br />
    18. 18. Some Reasons Why Antibiotic Therapy Fails…<br />Inappropriate Choice of Antibiotics<br />Too Low Blood Concentration (Improper Dosing)<br />Poor Penetration (Abscess)<br />Limited Vascularity & High Acidity in the Affected Area<br />
    19. 19. Some Reasons Why Antibiotic Therapy Fails…<br />Antibiotic Antagonism (Multiple Antibiotics)<br />Resistant Organisms<br />Failure to Take Antibiotics (Patients Fault)<br />Failure to Eradicate Infection<br />
    20. 20. The Bacterial Mix…<br />Initially Pulpal Infections<br />are Mixed in Nature<br />After Oxygen Depletion<br />Facultative & Anaerobic<br />Bacteria Predominate<br />
    21. 21. When to Use Antibiotics???<br />When there is a Reasonable Chance that<br />the Infection may Spread Beyond the<br />Periapex<br />
    22. 22. Type of Antibiotics…<br />Bactericidal<br />(Fast Killing) <br />Bacteriostatic<br />(Slow Killing)<br />
    23. 23. Penicillins<br />Incorporates Beta-Lactam in Structure<br />Bactericidal<br />Short Half Life (Regular Doses)<br />Accumulates in the Kidney<br />Least Toxic Antibiotic<br />
    24. 24. Cephalosporins<br />Similar to Penicillins in Chemical Structure<br />Also Incorporates Beta-Lactam in Structure<br />Bactericidal<br />Wide Spectrum<br />1st , 2nd, 3rd,4th & 5th Generations<br />
    25. 25. Considerations When Using Pennicilin & Cephalosporins<br />Severe Allergic Reactions are Rare with these Groups<br />If you are Allergic to One then you Could be Allergic to the Other<br />
    26. 26. Considerations When Using Pennicilin & Cephalosporins<br />Ressistance to this Group May Happen<br />Beta-Lactamase Enzyme Neutralizes them<br />Some Antibiotics Incorporate Clauvanic Acid which Makes it Resistant to the Enzyme<br />
    27. 27. Metronidazole<br />Bactericidal<br />Mainly Affects Only Anearobic Bacteria<br />Used in Combination with Other Antibiotics like (Augmentin)<br />Causes Stomach Upset<br />Darkened Urine<br />
    28. 28. Macrolides (Erythromycin)<br />Bacteriostatic<br />Kills Same Range of Bacteria Like Penicillin<br />Drug of Choice with Penicillin Allergy<br />Has Serious Drug Interactions with Certain Antihistaminic & Bronchodialators<br />
    29. 29. Clindamycin<br />Bacteriostatic<br />Wide Spectrum of Action<br />Can Cause Pseudomembranous Colitis<br />Over Growth of Clostridium difficile<br />Penetrates well into Abscesses<br />
    30. 30. Tetracycline (Doxycycline)<br />Bacteriostatic<br />Kills the Broadest Spectrum of Bacteria<br />Excellent for Endo-Perio Lesions<br />Not to be Given to Children, Pregnant or Lactating Women<br />May Causes Photosensitivity <br />
    31. 31. Antibiotic Prophylaxis<br />The Purpose<br />To Prevent Clinical Infection by Helping Destroy Small<br />Numbers of Bacteria Present Before or Introduced<br />During Treatment<br />
    32. 32. Viridans Streptococcus<br />Alpha Hemolytic<br />Stores Energy by Forming Intra & Extra Cellular Polysaccharides(Sticky Vegetation)<br />Colonies Form and Trap Fibrin & Blood Cells<br />
    33. 33.
    34. 34. When to Use Prophylaxis???<br />Lets Look at the Handouts!!<br />
    35. 35. Review<br />Myths Surrounding Antibiotics<br />Some Stastics Around the Abuse of Antibiotics<br />Nosocomial Infections<br />Bactericidal vsBacteriostatic<br />The Different Types of Antibiotics<br />When to use Antibiotic Prophylaxis<br />