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  1. 1. Antibiotics in DentistryIyad Abou Rabii DDS, OMFS, MRes, PhD QASSIM UNIVERSITY
  2. 2. Antibiotics in Dentistry Iyad Abou Rabii DDS, OMFS, MRes, PhDAntibiotic is a a chemical substance derivable from a mold or bacterium that can killmicroorganisms and cure bacterial infectionsBest use of AntibioticsCardinal Rules: 1. Use the right drug. 2. Use the right dose. 3. Use the correct dosing schedule. 4. Correct duration. 5. Use a loading dose to rapidly achieve therapeutic blood levels. 6. Avoid combinations of bacteriostatic and bacteriocidal drugs.Chose well 1. Narrow Spectrum? 2. Extended/Broad Spectrum? 3. Designer Antibiotics? 4. Anaerobes? Consider if the infection is present > 3days or if no improvementKnow your enemy (bateria) 1. Gram Positive? 2. Gram Negative? 3. Mixed Infection? 4. Anaerobes?Identify your weapon 1. Specific for the pathogen. 2. Fewer disturbances of non-pathogenic bacteria. 3. Fewer side effects. 4. Rapid response for sensitive organisms. Ex: Pen VK, Pen G, Erythromycin 5. Affects both Gram + and Gram - bacteria, better for mixed infections. [ ‫ا ر‬ 6. May give up some effectiveness for Gram + to gain effectiveness for Gram Examples: Amoxicillin, Ampicillin ‫ | ]ا‬Antibiotics in DentistryIdentify you patients 1. Age, allergies, compliance, pregnancy risk 2. Patient function 3. Renal, hepatic, immunosuppresion, route applicability 4. Cost Brand name, length of course, alternatives? 1
  3. 3. Prophylactic antibiotic The goal of antibiotic prophylaxis in Odontology is to prevent the onset of infections through the entrance way provided by the therapeutic action, therefore it is indicated provided there is a considerable risk of infection, either because of the characteristics of the operation itself or the patient’s local or general condition. The physician’s criterion for choosing antibiotic prophylaxis or not must be based on the benefit and the cost of the risk. In the last instance, the prophylaxis decision is the choice of the physician, who will use the equation: risk = degree of damage x probability of experiencing it. To that aim, patients could be classified as: a)healthy patients, b) patients with local or systemic infection risk factors, and c) patients with post-bacteraemia focal infection risk factors. In healthy subjects, prophylaxis is based exclusively on the risk of the procedure. Topical Antibiotics Pharmaceutical Forms Some topical antibiotics are available without a prescription and are sold in many forms, including creams, ointments, powders, and sprays. Some widely used topical antibiotics are bacitracin, neomycin, mupirocin, and polymyxin B. Among the products that contain one or more of these ingredients are Bactroban (a prescription item), Neosporin, Polysporin, and Triple Antibiotic Ointment or Cream. Antibiotic mouthwash can be prepared by the patient by dissolving the contents of 250 mg tetracycline capsule in 10 ml of water to give a 2% solution. It may be more effective to add glycerol to the solution as a demulcent, this must be done by pharmacist. Advantages The value of topical antibiotics overweighs such risks in some cases. Tetracycline is a useful topical antibiotics. As at 2% solution it’s often effective in reducing secondary infection (and thus the discomfort) in cases of aphtous stomaitis, primary herpetic stomaitis, and all oral ulcerative conditions. Use of topical antibiotics is also seen to be helpful in acute chronic gingivitis treatment.[ ‫ا ر‬ Disadvantages There are inherent disadvantages associated with the use of topical antibiotics‫ | ]ا‬Antibiotics in Dentistry because of the possibilities of selection for resistant strains and inducing hypersensitivity reaction at the patient. Use of Topical Antibitics Indication2
  4. 4. Topical antibiotics help prevent infections caused by bacteria that get into minorcuts, scrapes, and burns. Treating minor wounds with antibiotics allows quickerhealing.They are always used to prevent secondary infection (ulcers)DurationThe use of topical antibiotics cannot normally be practiced as long- termtreatment, it is better to be reserved for acute episodes. Otherwise, there will bethe risk of overgrowth of resistant organisms, although a candidal infection mayoccur. However, in some rare cases a prolonged topical antibiotic treatment isjustified (Patients with severe and persistent oral lesions), in that case atetracycline with triamcinolone combination is preferredTopical antifungal treatmentAntifungal drugsThe polyene antifungal agents, nystatin and amphotericin B, are wellestablished and relatively free from side-effects when used locally. They areavailable in various forms, such as lozenges, pastilles, creams, and suspensions.Unfortunately, patient compliance is often poor with these preparations, whichmay take a while to dissolve in the mouth (for example, pastilles and lozenges)and have a a distinctive taste.The newer azoles have very useful properties, although resistance is rather morecommonly met and may be problematic in the future, particularly in theimmunocompromised patient. (C. krusei and and C. glabrata are usually resistantto fluconazole.) The locally active agent, miconazole is available as an oral gel orcream.Pharmaceutical FormsConventionalIn order to assure topic application of antifungal agents, conventional lozenge,mouthwash, or gel would be the simplest dosage forms for the delivery of drugsin the buccal cavity, but these conventional dosage forms had the disadvantageof an initial burst of salivary concentration followed by a rapid decrease. Alozenge produced effective salivary drug levels for more than one hour butrepeated administration was restricted due to systemic toxicity coming from thelarge quantity of ingested drug. The action of mouthwashes was even moretransient than that of lozenges, and gels/pastes were difficult to retain in the [ ‫ا ر‬mouth .Sustained Release forms ‫ | ]ا‬Antibiotics in DentistryIn case of oral fungal infections, a prolonged therapy with antifungal agent wasrequired, and some papers documented prolonged release of antifungal agentfrom buccal devices in the form of an adhesive tablets.I.Abou Rabii et al (2004, France) has developped a Miconazole musoadhesivetablette which has been given higher concentration of Miconazole in Saliva(Over the IMC for more than 9h).Topical antifungal therapy 3
  5. 5. Pseudomembranous, erythematous hyperplastic candidosis Amphotericin lozenges (10 mg) Nystatin pastilles (100 000 units) Dissolve slowly in mouth, after meals; use 4 times daily; Candida-associated denture stomatitis Amphotericin or nystatin (as above) and remove dentures Miconazole gel applied to palatal surface of denture 4 times daily for 1 to 4 weeks Chlorhexidine 0.2% rinse, 4 times daily (do not use with nystatin) Candida-associated angular cheilitis Nystatin cream; apply to corners of mouth 3 to 4 times daily, until resolution Miconazole cream (or gel); apply 3 to 4 times daily to angles[ ‫ا ر‬‫ | ]ا‬Antibiotics in Dentistry4