Antibiotic prophylaxis in dentistry Flashcards
Describe the three types of antimicrobial treatment option.
Prophylactic therapy:
• The term “prophylactic antibiotics” refers to antibiotics that are given to prevent serious infection rather than treat infections
• Prophylactic antibiotics areavoided whenever possible in healthcare due to the promotion of antibiotic resistance
• Narrow spectrum therapy is used
Empirical therapy:
• In hospitals, microbiology diagnostics is encouraged in most patients, but the time to isolate and identify of the pathogen varies from 12 hours to several days
• Thus, if a patient present as a microbial emergency, then the prescription of antimicrobial treatment is done based off a clinician’s experience
• Typically broad spectrum antimicrobials are used
Definitive therapy:
• Antimicrobial treatment given once the results of the causative agents is known
• Based on cultures, antigen tests results
• Narrow spectrum, directed at the pathogens
Describe infective endocarditis in terms of:
- What activities mostly caused by
- Which bacteria is usually targeted for IE dental prophylaxis
What activities could cause IE:
• More likely to result from bacteriaemia associated with daily activates than from specific dental procedures. Maintenance of good oral health is more important than antibiotics
Which bacteria is targeted:
• Viridans group streptococci
List the indications for antibiotic prophylaxis for IE (6)
- Rheumatic heart disease in high risk patients (Indigenous Australians and low SES people)
- Prosthetic cardiac valve or prosthetic material used for cardiac valve repair
- Previous infective endocarditis
Congenital heart disease but only if it involves:
• Unrepaired cyanotic defects
• Completely repaired defects with prosthetic material or devices during the first 6 months
• Repaired defects with residual defects
For dental prophylaxis, state:
- Who needs dental antibiotic prophylaxis the most
- State why general dental antibiotic prophylaxis is needed
- What type of dental procedure would require it
- How it is done
State who needs dental antibiotic prophylaxis the most:
· Immunocompromised patients (eg, RA or poorly controlled diabetes, taking immunosuppressive Tx for organ transplants or malignancy, taking systemic corticosteroids)
· Patients with a cardiac condition associated with a risk of endocarditis from dental procedures
Why general dental antibiotic prophylaxis is needed:
• Only indicated when the risk of infection is HIGH and is given just before the procedure
• Purpose: prevent endocarditis and/ or dentoalveolar surgical site infections
• NOT used for impact wisdom teeth removal
What type of dental procedure would require it:
• Surgical removal of a bone-impacted tooth
• Periapical surgery in a patient with a Hx of recurrent infections
How it is done:
• A single dose is given to achieve high plasma and tissue concentrations at the time contaminations is most likely
• The time contamination is most likely is 4 hours following entry of organisms into a wound
List the 4 instances in a dental setting where antibiotic prophylaxis is a MUST
- Extraction
- Periodontal procedures (surgery, SRP)
- Replanting avulsed teeth
- Surgical procedures
List the 9 instances in a dental setting where antibiotic prophylaxis could be considered
May be required if multiple procedures are being conducted or prolonged or periodontal disease is present
• Full periodontal probing
• Interdental wedges placement
• Intraligamentary and intraosseous LA injection
• Supragingival cleaning
• Rubber dam placement with clamps
• Matrix band placement
• Endodontics beyond the apical foramen
• Orthodontic bands placement
• Subgingival placement of retraction cords, antibiotic strips
Is dry socket prevented with antibiotic prophylaxis?
No, dry socket is a wound healing issue
List 8 medical instances that serve as indications for preventing infection (8)
- Recurrent rheumatic fever
- Meningitis chemoprophylaxis
- Asplenic and hyposplenic patients
- Cirrhosis
- Post-sexual assault antimicrobial prophylaxis
- Postexposure prophylaxis against bloodborne viruses
- Obstetric patients
- Immunocompromised patients
Explain how Amoxycillin is used for prophylaxis:
Adult: 2 g
Child: 50mg/kg up to 2 g
Orally, 1 hour before the procedure
Explain when and how Clindamycin is used for prophylaxis:
Adult: 600 mg
Child: 50 mg/ kg up to 600 mg
- Used for patients hypersensitive to penicillin
* 1 hour before the procedure
Explain how I.V Lincomycin is used for prophylaxis:
Adult: 600 mg
Child: 15 mg/ kg up to 600 mg
- For patients who are unable to swallow clindamycin capsules
- 1 hour before the procedure
