Antibiotics, Prophylaxis, & Other meds Flashcards
Does doxycycline use always cause tooth discolouration?
NO.
Not if short term <21 days use, even in children under 7 years of age
What is the appropriate time frame for antibiotic prophylaxis?
Before: 30-60min
After: up to 2hours after
You have a 5 year old patient with who as been taking Amoxicillin for an ear infection that requires SBE prophylaxis. What are appropriate oral antibiotics (name 3)?
Azithromycin
Doxycycline
Not cephalexin since its a beta lactam
Acetaminophen Dosage for children <12yrs
10-15mg/kg every 4-6hrs
Acetaminophen max dosage for children <12yrs
75mg/kg (do not exceed 4000mg/24hrs)
Acetaminophen Dosage for children/adolescents >12yrs
325-650 mg every 4-6 hours
OR
1000mg 3-4x daily
Acetaminophen max dosage for children/adolescents >12yrs
4000mg per day
Ibuprofen Dosage for children <12yrs
4-10mg/kg/dose 6-8hrs
Ibuprofen Dosage for children/adolescents >12yrs
200-400mg 4-6hrs
3200mg per day
Amoxicillin dosage child <40kg
20-40 mg/kg/day every 8hrs
500mg max per dose
Amoxicillin dosage child >40kg
250-500mg every 8hrs
Amoxicillin dosage for SBE
50mg/kg 30-60min before procedure
2g max dose (children/adults >40kg)
Azithromycin dosage child and adolescents
SINGLE DOSE EACH DAY
10-12mg/kg on day 1 (max 500mg)
5-6mg/kg days 2-5 (max 250mg)
Azithromycin dosage adults/children >40kg
500mg day 1; 250mg days 2-5
Azithromycin dosage SBE
15mg/kg (max 500mg) 30-60min before procedure
Risk of azithromycin
can cause cardiac arrhythmias in pts with pre-exiting cardiac conduction defects
Cephalexin dosage children/adolescents
25-50mg/kg/day
divided into 6-12hrs
Cephalexin max dosage children/adolescents
2000mg maximum daily dose
Cephalexin dosage and maximum dosage adults
250-1000mg every 6hrs
4000mg maximum daily dose
Cephalexin SBE dosage
50mg/kg 30-60min before
2000mg max dose
identical to amoxicillin
Cephalexin contraindications
history of anaphylaxis, angioedema with penicillin/ampicillin
Doxycycline dosage children (and what age is cut off)
children >8yrs old: 2.2mg/kg/dose every 12hrs
100mg = max dose
Doxycycline dosage adults
100-200mg/day 1x daily OR 2x daily 12hrs
Metronidazole dosage in children for oral infections
NOT RECOMMENDED
Metronidazole dosage in adolescents/adult for oral infections
500mg every 8hrs with penicillin
What antibiotics are used for periodontal disease in children?
Amoxicillin and/or Metronidazole
Azithromycin if penicillin allergy
0.12% Chlorhexidine gluconate indications and dosages
gingivitis/periodontitis
off-label for stomatitis
Children >8yrs = Rinse with 15mL 2x daily for 30s and spit out
Fluconazole dosage infants, children, adolescents
6-12mg/kg/dose ONCE daily for 7-14 days
Fluconazole Adult dose
200mg day 1, 100-200mg ONCE daily 7-14 days
Fluconazole contraindications
Fluconazole is a hepatic enzyme inhibitor
risky for pts with other meds metabolized by cytochrome P450 enymes
Nystatin dose infants
2mL 4x daily 7-14 days
1/2 dose placed in each side of mouth
Nystatin dose children/adolescents/adults
swish 4-6mL 4x daily for 7-14 days
continue for 48hrs after symptoms resolve
NPO 30min
Acyclovir for primary herpetic gingivostomatitis in children
20mg/kg/dose 4x daily for 5-7 days
800mg max dose
Acyclovir for herpes labialis in children and adolescents
Children: 20mg/kg/dose 4x daily until clinical resolution or 7-10 days
400mg max dose
Adolescents/adults: 400mg up to 3x daily until resolution or 7-10 days
Topical Corticosteroid indications
non-infectious ulcers, mucocutaneous lesions
i.e. aphthous ulcers, localized allergic reactions, symptomatic benign migratory glossitis
Triamcinolone acetonide (medium potency corticosteroid) application
apply paste to ulcers 2-4x daily, after meals and at bedtime
DO NOT EXCEED 14 DAYS
NPO 30min
Clobetasol (super-high potency corticosteroid) application
apply thin amount to ulcers 2-4x daily, after meals and at bedtime
DO NOT EXCEED 14 DAYS
What sort of dental procedures require antibiotic prophylaxis for subacute bacterial endocarditis (SBE)?
Manipulation of:
1) Gingival tissues (prophy, scaling)
2) Periapical region of teeth (EXT, Endo)
OR
3) Perforation of oral mucosa (BUT! Local through non-infected tissue is ok… lol)
You have a patient presenting in the ED with
1) Hx of mitral valve prolapse
2) Torn lip
Do they need SBE?
NO.
SBE not recommended for mitral valve prolapse, or
bleeding from trauma to the lip or oral mucosa
What are Cardiac indications for subacute bacterial endocarditis antibiotic prophylaxis (SBE)?
1) History of Infective Endocarditis (Previous, relapse, or recurrent)
2) Congenital heart defect that is:
- Unrepaired & Cyanotic (palliative shunt is NOT a repair)
- Repaired in the past 6 months
- Repaired with Residual Defects
3) Cardiac transplant patient WITH cardiac valvulopathy
4) Patient has prosthetic heart valve OR Left Ventricular Assisting Device (LVAD)
What is the appropriate SBE dosage for Clindamycin?
SIKE.
AAPD 2022 guidelines do not recommend Clindamycin for SBE due to frequent & severe reactions such as C. Difficile infections
Which dental procedures DO NOT require SBE?
1) Radiographs
2) Ortho brackets, bands, etc.
3) Bleeding from trauma to LIP or ORAL Mucosa
4) Local injections through “non infected tissue” lol
Which cardiac conditions DO NOT require SBE?
1) Patient has a hx of septal defect that is COMPLETLY closed (ASD, VSD)
2) Patient has a coronary artery stent
3) Patient has a ventriculoatrial shunt (brain to atria)
4) Patient has a ventriculoperitoneal (VP) shunt
Some immuncompromised patients will require antibiotic prophylaxis after consultation with physicians. “Yellow Flag” conditions include:
1) Neutropenic patients (Chediak Higashi)
2) Cancer patients undergoing chemo/radiation
3) Sickle Cell anemia
4) Asplenic patients
5) Severe autoimmune disease (lupus, juvenile arthritis)
6) Kidney failure: hemodialysis patients
7) Uncontrolled diabetes mellitus
8) Chronic high-dose steroid use
Scully & Vinson like Cefdinir for odontogenic infections. What’s the dosage?
Cefdinir (Omnicef): 7mg/kg every 12h
Maximum (adult) 300 mg/dose
What are your anaerobic “Heavy hitters” for odontogenic infections?
1) Clindamycin
Child: 20-30mg/day into 3 doses q8h
Adult: 300-450mg every 6-8h (max 1800mg)
2) additional Metronidazole
Child: NOPE
Adult: add on 500mg q8h to penecillin/cephalosporin
Clindamycin dosage kids
20-30mg/kg/day 3 doses q8h (max single dose 450mg)
Clindamycin dosage adults
300-450mg q8h (max daily dose 1800mg)
