antibiotics in dentistry

1. ANTIBIOTICS IN
DENTISTRY
By, Lt M (Dr) Tengku Natasha Eleena
3015206

2. PRINCIPLES OF SURGICAL AND
ANTIMICROBIAL INFECTION MANAGEMENT
■Principles of Therapy
■Principles for Choosing The
Appropriate Antibiotic
■Principles of Antibiotic Administration
■Patient Monitoring

3. 1. PRINCIPLES OF THERAPY
■PRESENCE OF INFECTION
■STATE OF HOST DEFENSES
■SURGICAL DRAINAGE AND
INCISION
■THE DECISION TO USE ANTIBIOTIC
THERAPY

4. 2. PRINCIPLES FOR CHOOSING THE
APPROPRIATE ANTIBIOTIC
■ Identification of the Causative Organism
■ Determination of Antibiotic Sensitivity
■ Use of Specific, Narrow-Spectrum Antibiotic
■ Use the Least Toxic Antibiotic
■ Patient Drug History
■ Use of Bactericidal > Bacteriostatic Drug
■ Use of the Antibiotic with Proven History of
Success
■ Cost

5. 3. PRINCIPLES OF ANTIBIOTIC
ADMINISTRATION
■Proper Dose
■Proper Time Interval
■Proper Route of Administration
■Consistency in Route
Administration
■Combination Antibiotic Therapy

6. 4. PATIENT MONITORING
■Response to Treatment
■Development of Adverse Reactions
■Superinfection and Recurrent
Infection

7. ANTIBIOTIC PHARMACOLOGY FOR
MAXILLOFACIAL INECTIONS
■ß-LACTAMS
■TETRACYCLINS, VANCOMYCIN,
CHLORAMPHENICOL
■MACROLIDES
■NITROIMIDAZOLES
■QUINOLONES

8. 1. ß-LACTAMS
■ Inhibit replication of bacteria by breaking down the cell
wall
■ Five general categories :
a) Pencillins
b) Cephalosporins
c) Monobactams
d) Carbapenems
e) Combination of drugs that are formulated with ß-
lactamase inhibitors

9. a) Pencillins
• FIVE major group of penicillin
• Cephalosporins and other ß-lactams can be used in
patients who are penicillin allergic

10. b) Cephalosporins

11. ■ 1st
generation to a lesser degree , provide good
coverage
■ 1st
generation  greatest gram-positive activity
■ As the generation number increases, greater gram-
negative activity and resistance to ß-lactamase
■ Earlier generation  better killing anaerobes
■ 1st
gen  maxillofacial infections and prophylaxis
■ 2nd
gen  sinusitis
■ 3rd
gen  sinusitis and skin infections

12. c) Monobactams
■ Only one monobactam is approved for use in the US ->
Aztreonam (Azactam)
■ It has no activity against gram-positive organisms
■ Useful for Pseudomonas and Proteus infections

13. d) Carbapenems
■ Their spectrum is extremely broad
■ The available for use in the US are Imipenem
and Meropenem
■ Administered parenterally

14. 2. Tetracyclines, Vancomycin,
Chloramphenicol
A) Tetracyclines
■ Inhibiting bacterial protein synthesis
■ Side effects  GI disturbance, discoloration of
bone and teeth, contraindicate in pregnant
patients and children
■ Should be used with caution in conjunction with
phenytoin, carbamazepine, oral anticoagulants
and patients with renal insufficiency

15. b) Vancomycin
■ Treatment of methicillin-resistant
staphylococci
■ Inhibiting peptidoglycan synthesis
■ Administered via IV but requires slow infusion
 “red man syndrome”
■ Tosix effects  nephrotoxicity when using with
other nephrotoxic drugs

16. c) Chloramphenicol
■Inhibits bacterial protein synthesis
■Broad spectrum  anaerobic infections
■Good agent for brain abscess and
meningitis

17. 3. Macrolides
• Interfere with protein synthesis
• Neutralizes the bacteria

18. a) Erythromycin
■ Gram-positive antibacterial
■ Can cause GI upset
■ Preferred in cases of penicillin allergy

19. b) Clindamycin (Cleocin)
■ use for serious infection  osteomyelitis
■ Aerobic gram-positive, facultative and strict
anaerobic bacteria

20. c) Azithromycin (Zithromax)
■ Broad spectrum including gram-positive nd gram-
negative aerobes, strict anaerobes
■ Actinobacillus Actinomycetemcomitans and
Porphyromonas Gingivalis

21. d) Clarithromycin (Biaxin)
■ Usually in combination with other drugs
■ Treatment Helicobacter pylori

22. e) Aminoglycosides
■ Gram-negative bacteria
■ Limited coverage for gram-positive or
anaerobic bacteria

23. 4. Nitroimidazoles
a) Metronidazoles (Flagyl)
■ Kill susceptible bacteria
■ Strict anaerobic bacteria
■ Can be useful adjunct to antibiotics with an aerobic
spectrum in mixed aerobic and anaerobic infection
■ Can increase the action of anticoagulants  nausea,
headache, metallic tatse
■ Should not be used in pregnant patients

24. 5. Quinolones
• Gram-positive and gram-negative aerobes, not useful
for strict anaerobes
• Interfere DNA transcription
• Useful for Streptococcus pneumoniae
• Ciprofloxacin, Moxifloxacin

25. SUMMARY
Bactericidal Antibiotics Bacteriostatic Antibiotics
Penicillin Tetracyclines
Cephalosporin Erythromycin
Aminoglycosides Clarithromycin
Vancomycin Arithromycin
Metronidazole Clindamycin
Imipenem Sulfa
Fluoroquinalones

26. Maxillofacial Therapy Drugs of choice
Abscess Penicillin
Acute Pericoronitis Penicillin
Osteomyelitis Penicillin + Metronidazole
Clindamycin
Clindamycin + Metronidazole
Fractures Penicillin
Soft Tissue Wounds Amoxicillin + Clavulanic Acid

28. ANTIBIOTIC PROPHYLAXIS
■ Infective endocarditis is an uncommon but life-
threatening complication resulting from
bacteremia
■ Viridans group streptococci, Staphylococcus
aureus, enterococcus, pseudomonas, serratia,
and candida
■ When procedures involve infected tissues or
are performed on a patient with a
compromised host response, additional doses
or a prescribed postoperative regimen of
antibiotics may be necessary

29. a) Patients With Cardiac Conditions
■ Prosthetic cardiac valve or prosthetic material used for cardiac valve
repair
■ Previous infective endocarditis
■ Congenital heart disease (CHD)*
• Unrepaired cyanotic CHD, including palliative shunts and conduits
• Completely repaired congenital heart defect with prosthetic
material or device, whether placed by surgery or by catheter
intervention, during the first six months after the procedure
• Repaired CHD with residual defects at the site or adjacent to the
site of a prosthetic patch or prosthetic device (which inhibit
endothelialization)
■ Cardiac transplantation recipients who develop cardiac valvulopathy

31. b) Patients with compromised immunity
■ Patients with a compromised immune system may not be able to tolerate a
transient bacteremia following invasive dental procedures.
■ Medical conditions such as;
• Immunosuppression secondary to: human immunodeficiency virus (HIV);
severe combined immunodeficiency (SCIDS); neutropenia; cancer
chemotherapy; and hematopoietic stem cell or solid organ
transplantation.
• Head and neck radiotherapy.
• Autoimmune disease (eg, juvenile arthritis, systemic lupus
erythematosus).
• Sickle cell anemia.
• Asplenism or status post splenectomy.
• Chronic steroid usage.
• Diabetes.
• Bisphosphenate therapy

32. c) Patients with shunts, indwelling
vascular catheters, or medical devices
■ antibiotic prophylaxis is indicated only at the time of placement of
these devices in order to prevent surgical site infection.
■ The AHA found no convincing evidence that microorganisms
associated with dental procedures cause infection of CIED and
nonvalvular devices at any time after implantation.
■ Ventriculoatrial (VA), ventriculocardiac (VC), or ventriculovenus (VV)
shunts for hydrocephalus are at risk of bacteremia-induced infections
due to their vascular access.
■ ventriculoperitoneal (VP) shunts do not involve any vascular structures
and, consequently, do not require

33. d) Patients with prosthetic joints
■antibiotic prophylaxis is not indicated for
dental patients with pins, plates, screws,
or other hardware that is not within a
synovial joint nor is it indicated routinely
for most dental patients with total joint
replacements.

34. Prescription

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