Antibiotic Premedication Exam 3 Flashcards
Standard General prophylaxis:
Amoxicillin
- Adults: 2 gm orally 1 hr before procedure
If unable to take standard general prophylaxis:
Ampicillin
- Adults: 2 gm IM or IV within 30 min before procedure
If allergic to penicillin, what four things are prescribed for prophylaxis;
- clindamycin (Cleocin)
- cephalexin (Keflex)
- azithromycin (Zithromax)
- clarithromycin (Biaxin)
When allergic to penicillin, how do you prescribe clindamycin (Cleocin)
Adults:
- 600 mg orally 1 hr before procedure
When allergic to penicillin, how do you prescribe cephalexin (Keflex)
Adults:
- 2 gm orally 1 hr before procedure
When allergic to penicillin, how do you prescribe azithromycin (Zithromax)
Adults:
- 500 mg orally 1 hr before procedure
When allergic to penicillin, how do you prescribe clarithromycin (Biaxin)
Adults:
- 500 mg orally 1 hr before procedure
What is prescribed if allergic to penicillin and unable to take oral medications for prophylaxis:
Clindamyin
Cefazolin (Ancef, Kefzol, Zolicef)
ceftriaxone (Rocephin)
When allergic to penicillin and unable to take oral medications, how do you prescribe Clindamycin
Adults:
- 600 mg IV within 30 min before procedure
When allergic to penicillin and unable to take oral medications, how do you prescribe cefazolin (Ancef, Kefzol, Zolicef)
Adults:
- 1 gm IM or IV within 30 min before procedure
When allergic to penicillin and unable to take oral medications, how do you prescribe ceftriaxone (Rocephin)
Adults:
- 1 gm IM or IV within 30 min before procedure
Describe risk factors that assist with identification of patients who are most likely to develop a prosthetic joint infection caused by microorganisms found in the oral cavity
- Prior joint surgery
- Failure to give antimicrobial prophylaxis during surgery
- Immunosuppression
- Preoperative wound complications
- High ASA score (higher score = more problems)
- Prolonged operative time
- History of prosthetic joint infection
The big four used to identify patients with prosthetic devices who require antibiotic premedication prior to receiving dental treatment in prevention of bacterial endocarditis?
- Prosthetic cardiac valve
- Previous history of infective endocarditis
- Congenital heart disease (CHD)
- Cardiac transplantation
When talking about congenital heart disease as an indication for antibiotic premedication, what all is involved in this category
- Unprepared 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
- Transposition of the great arteries
T or F, Cardiac shunt is not the same as AV shunt
True
Under ADA guidelines of 2003, consider premed all of the time for the following patients:
- Immunocompromised/immunosuppressed
- Previous prosthetic joint infections
- Malnourishment
- Hemophilia
- HIV infection
- Insulin-dependent (Type I) diabetes
- Malignancy
Describe risk factors that assist with the identification of patients who are most likely to develop a prosthetic joint infection independent of dental procedures
- wound drainage or wound hematoma after arthroplasty
- Postoperative urinary tract infection
- Prior operation/arthroplasty on index joint
- Diabetes mellitus
- Immunocompromised
Is Premed needed for one with Diabetes Mellitus
Yes
Is Premed needed for Postoperative urinary tract infection
Yes
Is Premed needed for Penile implant
Maybe..
Is Premed needed for coronary stents
No
Is Premed needed for History of Fen-Phen
Yes
Is Premed needed for Breast, dental or corneal implants
No
Is Premed needed for pacemakers, defibrillators
No
Is Premed needed for pins, plates, screws
No
Is Premed needed for Organ transplant patients
Yes
How do you configure a pediatric dose for premedication?
1 g = 1000mg
1 lb =2.2kg
(Weight of child/150) x Adult dose = pediatric dose
If patient is allergic to penicillin which is mild or in distant past, what is recommended for premedication
Cephalosporin (6-8 % chance of cross-allergy)
If patient had full blown Type I hypersensitivity anaphylaxis, what is recommended for premedication
Use clindamycin
Also azithromycin & clarithromycin
(20% chance of cross-allergy with cephalosporin)
What is recommended for patients requiring antibiotic premedication for those who are already taking tetracycline
- Macrolides (Azithromycin & Clarithromycin)
- Must be bacteriostatic antibiotic
Why don’t you use clindamycin for a patient’s premed if already taking tetracycline?
because premed dose of clindamycin is bactericidal
T or F, Strep are rarely implicated in bacteremia following dental procedures
False, Staph
What is most common cause of transient bacteremia after dental procedures that result in trauma to gingiva or oral mucosa
Viridans-group Strep
T or F, Cumulative exposure to transient bacteremia through daily activities is several times higher than following a single exposure during a dental procedure
True
Other factors indicating use of Premeds
- History of IV drug abuse if valve damage
- Dialysis
- PICC line, hickman catheter, Portacath, CSF shunts
- History of Fen-Phen
- Decreased WBC
- Organ transplant patients
