Download Lecture Antibiotics in Dentistry File

ANTIBIOTICS IN DENTISTRY
BDS 5 ORAL SURGERY
DR KANTARA TIIM
CMNHS, FNU
Usage in Dentistry
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Antibiotic Prophylaxis
Medical Prophylaxis
Surgical Prophylaxis
Antibiotic Therapeutic
Acute Odontogenic Infections
Osteomyelitis
Antibiotic Prophylaxis
• Prescription of A/B to minimise the risk of
bacterial infection
• Indicated when risk of infection is high:
• Infection can be at:
1. Distant site: usu Heart (endocarditis)
2.Around an implanted foreign body (eg joint
prosthesis)
3. Oral surgical site eg dentoalveolar procedure
1. Antibiotic Prophylaxis
• Medical Prophylaxis
Prescription of A/B to prevent infection at a
distant site, usually the heart (eg endocarditis)
• Surgical Prophylaxis
Use of A/B to prevent surgical site infection +
in some cases, bacteraemia
Medical Prophylaxis – Prevention of
Infective Endocarditis
• Based on current international practice
• Risks are different depending on cardiac
condition + dental procedure
• Need to discuss relative risks with patient
Current Antibiotic Prophylactic
Protocol - IE
• Procedures requiring antibiotic prophylactic cover:
All dental procedures involving manipulation of gingival tissue or
the periapical region of teeth or perforation of the oral mucosa
Includes all procedures except:
– Routine LA through non-infected tissue
– Taking dental X-Rays
– Placement of removable dentures or orthodontic appliances
– Shedding of deciduous teeth & bleeding from trauma to lips or oral
mucosa
Cardiac conditions for prophylactic
antibiotic cover required:
•Prosthetic heart valves (bio or mechanical)
•Rheumatic valvular heart disease
•Previous IE
•Unrepaired cyanotic congenital heart disease
(includes palliative shunts/conduits)
•Surgical or catheter repair of congenital heart
disease within 6 mnths of repair
Antibiotic regimens for a dental
procedure
• Amoxycillin 2g (child 50mg/kg up to 2 g), administered
- Orally, 1 hr b4 procedure
- IV, just before the procedure
- IM, 30 mins before
• Penicillin allergy
- Clindamycin 600mg (child: 15mg/kg up to 600mg),
administered orally, 1 hr b4
- IV, over at least 20mins, just before procedure
- IM, 30mins b4
or
• Clarithromycin 500mg (child: 15mg/kg, up to 500mg) orally, 1 hr
before procedure
Reference for antibiotic prophylaxis for the
Prevention of Infective Endocarditis
• National Heart Foundation of New Zealand
(Dec 2008), Guideline for the Prevention of
Infective Endocarditis Associated with Dental
and Other Medical Interventions
Surgical Prophylaxis
Indications:
1. Surgical removal of bone-impacted tooth or
2. Periapical surgery in patient with recurrent
infections
3. Immunocompromised patients
Surgical Prophylaxis
• Not recommended for:
1. Simple extraction
Incidence of wound infection following simple extractions is
negligible
Incidence following removal of bone-impacted wisdom in fit
healthy pats is LOW (3% to 5%)
Such low incidence of infection, A/B prophylaxis is not
recommended or required
2. Dry socket
Not a bacterial infection but a wound healing problem
Hence A/B are of no value
Immunocompromised Patients
• Diabetes
• Steroid therapy eg corticosteroids for mx of
severe asthma, dermatological conditions
• Chemotherapy
• AIDS
• Taking immunosuppressants for organ transplants
or malignancy
Consider antibiotic prophylaxis if undergoing at risk
dental procedures
2. Antibiotic Therapeutic
Principles of treating disease:
• Identify dis + its cause ( ie Make Dx)
• Remove cause
• Remove effect of disease
• Restore tissues to normal function
• Monitor healing
• Observe stability of area over time
• Prevent recurrence of disease
Principles of Use of Antibiotics
1. General principles
2. Therapy choice
3. Prophylaxis
General Principles
• Use A/B only where Benefits are scientifically
demonstrable + substantial
• Use narrowest spectrum
• Use single drug unless proven combination
therapy required to ensure efficacy
• Use dose high enough to ensure efficacy +
minimise resistance selection
• Use dose that is low enough to minimise risk
of dose related toxicity
Therapy Principles
• Base choice of therapy on either known common
pathogens (Empirical therapy)
• Or culture + susceptibilty test results (Directed
therapy). Need to review empirical regimen when
culture results have identified m.o present +
susceptibilty to A/B
• Duration of use should be as short as possible +
not exceed 7 days unless there is proof that this
duration is inadequate
• Most odontogenic infections 5 days is sufficient
Prophylaxis Principles
• Base choice of antimicrobial on known or
likely target pathogens
• Duration should be as short as possible
• Single dose A/B is required for surgical
prophylaxis if req’d for dental procedures
“MIND ME”
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Microbiology guides tx
Indications should be evidenced-based
Narrowest spectrum required
Dosage appropriate to site + type of infection
Minimise duration of tx - 5days
Ensure monotherapy in most situations
Microbial Tx should include:
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Most effective
Least toxic
Narrowest spectrum drug available
Reduces problems with broad-spectrum A/B
ie selection of + superinfection with resistant
m.o
• Most cost-effective
Empirical Antibiotic Choices for
Odontogenic Infections
Outpatient: mild-mod
• Amoxycillin
• + Metronidazole (modsevere)
Penicillin allergy:
• Clindamycin
• Azithromycin
Inpatient: severe
• Ampicillin +
metronidazole
• +/- Gentamicin
Penicillin allergy:
• Clindamycin
• Ceftriaxone
Oral Antibiotics - Dosages
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Amoxycillin – 500mg PO, 8 hourly x 5/7
Clindamycin – 300mg PO, 8 hourly x 5/7
Metronidazole – 400mg PO, 8 hourly x 5/7
Azithromycin – 500mg PO, once daily x 5/7
IV Antibiotics - Dosages
• Ampicillin 1 g IV, 6 hourly
• Clindamycin 450 mg IV, 8 hourly
• Azithromycin 500 mg IV x2/7 followed by
500mg oral for another 5-8 days
• Metronidazole 500 mg IV, 8 hourly
Children’s dosages: Common
antibiotics
• Amoxycillin
10-25mg/kg/day IV or Oral , 8 hourly
• Metronidazole
10-15mg/kg/day (max 1 g) IV or Oral, 8 hourly
• Erythromycin
10-25 mg/kg/day IV or Oral, 6 hourly
• Clindamycin
10-15 mg/kg/day IV or Oral, 8 hourly
References
• Dr Sunia’s Notes
• Peterson's Principles of Oral and Maxillofacial
Surgery
• National Heart Foundation of New Zealand
(Dec 2008), Guideline for the Prevention of
Infective Endocarditis Associated with Dental
and Other Medical Interventions