Antibiotic Prophylaxis

Question 1

Metastatic Infection

Answer 1

Caused by surgical manipulation, transient bacteremia, distant susceptible site and infection

Question 2

Subacute Bacterial EndoCardities (SBE)

Answer 2

Extraction produces bactermia -> Agglutinating antibodies bind bacteria -> clumped AB/Bacteria complex circulates -> Infect sterile thrombus on dz tissue or prosthetic material -> infection

Question 3

Cardiac Conditions at Risk for SBE (pre-2007 guideline = antibiotic prophylaxis)

Answer 3

Always give antibiotic prophylaxis, not needed!
Prosthetic valve
Previous BE
Congenital (high flow) or acquired defect
RHD
Atherosclerotic Valve

Question 4

Cardiac Conditions at Risk for SBE After 2007

Answer 4

Antibiotic prophylaxis given to only highest cardiac risk

Prosthetic Cardiac Valve
Previous Infective Endocarditis
Cardiac Transplant patients w/ valve defects

Question 5

SBE and dentistry

Answer 5

13% of all SBE

97. 5 streptococcal
98. 5 after extractions

Question 6

Situations Requiring Prophylaxis

Answer 6

Extraction
Root scaling/planing 
Dental prophy (bleed)
Implant surgery
Endodontic therapy beyond apex
Retraction cord placement (Fixed)
Ortho bands (not brackets)
Intraligament injection (not IAN block or infiltrations)

Question 7

SItuations not needed

Answer 7

Restorative Dentistry
Rubber Dam placement
Local anesthesia
Intracanal endo
Suture removal
IMpressions
Fluoride treatment
Radiographs
Shedding decidious teeth

Question 8

Prophalyxis Regimen

Answer 8

Amoxicillin 2gm (50 mg/kg) per 1 hour pre-op

Question 9

Why amoxicillin

Answer 9

More effective = same dose = high blood levels = longer half life = slower excretion

All to do with PK not spectrum

Question 10

Allergy to PCN

Answer 10

Clindamycin 600mg (20mg/kg) 1 hour pre-op

Go to drug

Sometimes bad GI problems = Clarithromycin

Question 11

Special Situations

Answer 11

Already on antibiotics = use different class of drug(if PCN, use clindamycin)

Non-coronary vascular grafts = wait until after 6 months

Question 12

Special Situations Ctd

Answer 12

Heart transplant
Ventricular Shunt
AV dialysis Shunt
Other implantable cardiac devices
Forgot prophylaxis = wait 2 hrs

Question 13

Total Joint Replacement

Answer 13

Chronic infection usually lead to bacteria emboli that can lead to infection.

Immunocompromised
Type 1 diabetics

Question 14

AAOS Guidelines

Answer 14

Recommended prophylaxis for all patients w/ TJR undergoing any invasive dental procedure

In 2015 - prophylatic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection

Question 15

TJR Prophylaxis Regiment

Answer 15

Amoxicillin or Cehpalexin 2 gm

Clindamycin 600mg PO or IV

Question 16

Wound Infection Prophylaxis

Answer 16

Be best surgical technique

Asepsis
Gentle tissue handling
Good hemostasis
No dead space
Limit necrotic tissue
Limit foreign body

Clean wound infection rate is important quality indicator

Question 17

WI Prophylaxis Principles

Answer 17

Most dental procedures dont have significant risk

Time antibiotic correctly - First dose before surgery, repeat dose at 1/2 therapeutic interval

Use 2x therapeutic dose!!

Question 18

WI Prohpylaxis Principles

Answer 18

Correct antibiotic - effective against likely organism, least toxic, cidal drug

Use shortest effective exposure - 1 dose pre-op, repeat intra-op at half therapeutic interval (if long procedure), final dose after surgery

Question 19

All you need to know about Antibiotic Prophylaxis

Answer 19

Significant risk
Choose correct antibiotic
Adequate Dose
Give before surgery
Stop immediately after surgery

Question 20

Prevention of Dry socket (happens 7% of time)

Answer 20

Topical CHG rinses

Topical antibiotic within socket

Question 21

Prophylaxis for Dentoalveolar Surgery

Answer 21

Poorly controlled metabolic dz
Immunosuppressed
Surgery longer than 3 hours
Contaminated wound
Insertion of major foreign body
Surgery adjacent to sinus (implant placement)
Bony impactions
Same regimen as SBE prophylaxis