Antibiotic 3: oral bacterial and skin

Question 1

1) If the oral infection fail to respond to antibacterial treatment, how long should we wait before we change antibacterials?
2) which combination of antibiotics may sometimes be helpful for the treatment of severe oral infections ?

Answer 1

1) of no response within 48 hours the antibacterial should be changed, preferably on the basis of bacteriological investigation
2) penicillin (or a macrolide) with metronidazole

Question 2

Which antibiotic can be used for dentoalveolar abscess?

Answer 2

Phenoxymethylpenicillin is effective

Question 3

Discuss the use of penicillins for the treatment of oral infections.

Answer 3

1) Amoxicillin as effective as phenoxymethylpenicillin but is better absorbe. However it may encourage resistance.
2) Co-amoxiclav is active against beta-lactamase-that are resistant to amoxicillin. Co-amoxiclav may be used for severe dental infection with spreading cellulitis or dental infection not responding to first-line treatment.
3) Amoxicillin may be useful for short course oral regimens.

Question 4

Discuss the use of cephalosporins for the treatment of oral infections.

Answer 4

1) offer little advantage over the penicillins and they are less active against anaerobes
2) infections due to oral streptococci resistant to penicillin are usually resistant to cephalosporins.

Question 5

Discuss the use of tetracyclines for the treatment of oral infections.

Answer 5

1) In adults can be effective against oral anaerobes resistance has reduced their usefulness for oral infections
2) Doxycycline has a longer duration of action than tetracycline or oxytetracycline -once daily

Question 6

Discuss the use of macrolides for the treatment of oral infections.

Answer 6

1) macrolides are an alternative for oral infections in penicillin-allergic patients or where a beta-lactamase producing organism is involved.
2) many organisms are now resistant to macrolides so use is limited to short courses.

Question 7

Discuss the use of Clindamycin for the treatment of oral infections.

Answer 7

1) Clindamycin should not be used routinely as no more effective than penicillins against anaerobes
2) may be cross-resistance with erythromycin-resistant bacteria.
3) Clindamycin: of dentoalveolar abscess that has not responded to penicillin or to metronidazole.

Question 8

Discuss the use of Metronidazole and tinidazole for the treatment of oral infections.

Answer 8

1) Metronidazole alternative to a penicillin, useful if penicillin allergic or due to beta-lactamase anaerobes.
2) It is the drug of first choice for the treatment of acute necrotising ulcerative gingivitis and pericoronitis. For these purposes metronidazole for 3 days is sufficient
3) Tinidazole is licensed for acute ulcerative gingivitis.

Question 9

outline the treatment for Impetigo if small areas of skin are infected

Answer 9

1) Topical fusidic acid 7 days (max. 10 days)

2) If MRSA topical mupirocin 7 days (max. 10 days)

Question 10

how is a widespread infection of Impetigo treated?

Answer 10

1) Flucloxacillin , if streptococci suspected in severe infection, add phenoxymethylpenicillin- 7 days.
2) if penicillin-allergic, oral clarithromycin- 7 days

Question 11

Treatment for Erysipelas?
( Erysipelas is a skin infection. It is a form of cellulitis, but unlike cellulitis, which affects deeper tissue, erysipelas only affects the upper layers of the skin.)

Answer 11

1) Phenoxymethylpenicillin or benzylpenicillin sodium

2) if severe switch to high-dose flucloxacillin

Question 12

what is the treatment for Cellulitis?

Answer 12

1) Flucloxacillin (high-dose)
↳ If streptococcal infection confirmed, replace flucloxacillin with penicillin V or benzylpenicillin
2) If penicillin-allergic, clindamycin or clarithromycin

Question 13

treatment for Animal and human bites?

Answer 13

1) Co-amoxiclav
↳ If penicillin-allergic: doxycycline + metronidazole
2) Cleanse wound thoroughly- For tetanus-prone wound, give human tetanus immunoglobulin
3) Consider rabies prophylaxis for bites from animals in endemic countries
4) Assess risk of blood-borne viruses

Question 14

How should mastitis during breast-feeding be managed?

Answer 14

1) Treat if severe, if systemically unwell, if nipple fissure present, if symptoms do not improve after 12–24 hours of effective milk removal, or if culture indicates infection.
2) Continue breast-feeding or expressing milk during treatment.

Question 15

what antibacterial treatment is used to treat mastitis during breast-feeding ?

Answer 15

1) Flucloxacillin- 10–14 days

2) if penicillin-allergic, erythromycin- 10–14 days.