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DENT 319 - Pharmacology > Antibiotics Specific to Dentistry > Flashcards

Antibiotics Specific to Dentistry Flashcards

1
Q

4 general considerations before prescribing antibiotic

A
  • Determine if there is a clear indication for antibacterial therapy
  • Patient’s health status
  • Select best antibiotic
  • Decide on dosage of regimen and overall duration of therapy
    • Is the infection life-threatening?
    • Will pt be compliant?
    • Can they afford medication?
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2
Q

3 considerations to determine if there is a clear indication for antibacterial therapy

A
  • Systemic symptoms
  • Signs and symptoms that may progress to systemic levels
  • Oral soft tissue swelling appears to be spreading into surrounding tissues
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3
Q

5 systemic symptoms

A
  • Malaise
  • Fever
  • Chills
  • Swelling
  • Erythema of the skin
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4
Q

3 considerations for the patient’s health status prior to prescribing antibiotic

A
  • Systemic considerations (diabetes, immunosuppression, renal failure, liver failure, pregnancy)
  • History of adverse drug reactions
  • Potential drug-drug interactions
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5
Q

4 things to consider in order to select best antibiotic

A
  • Narrow spectrum
  • Low toxicity
  • Cost
  • Selection based on micobiological culture and sensitivity tests when available (if in hospital setting)
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6
Q

6 signs/symptoms for which one should go to the hospital emergency

A
  • Can not swallow liquids (dehydration)
  • Can not swallow pills
  • Vomiting (loss of medication)
  • Difficulty breathing (airway obstruction)
  • Decreased level of consciousness (not oriented to time and day)
  • Rapidly spreading infection
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7
Q

4 things to check at follow-up appoointment in 48 - 72 hours

A
  • Determine if pt is getting better
  • Measure temperature
  • Assess level of consciousness
  • Monitor for adverse drug effects (skin rash, diarrhea)
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8
Q

First choice for treatment of odontogenic infections

A

Penicillin unless allergy

  • Penicillin V (potassium) –> APO-PENVK or PEN VEE K
  • 300 or 600 mg q6h for 5-10 days
  • NOTE: may use loading dose of 600 mg
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9
Q

Dosage form of penicillin V available

A

300 mg tabs

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10
Q

Treatment of severe odontogenic infection with penicillin V

A

600 mg q6h x7 days

NOTE: caution for elderly or frail pt –> 300 mg may be safer

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11
Q

Alternative for treatment of odontogenic infection if compliance to penicillin dosing regimen is an issue (2nd choice antibiotic)

A

Amoxicillin 500 mg q8h 7-10 days

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12
Q

Available dosage form of amoxicillin

A

250 mg or 500 mg caps

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13
Q

Contraindication for amoxicillin prescription

A

Penicillin allergy

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14
Q

Antibiotic regimen for resistant odontogenic infections (not usually prescribed in private practice without culture and sensitivity results)

A
  • Amoxicillin/clavulanic acid (CLAVULIN)
  • 250/125 mg q8h OR
  • 500/125 q12h x 7-10 days
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15
Q

CLAVULIN regimen for more severe resistant odontogenic infections

A

500/125mg q8h or 875/125 q12h x 7-10 days

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16
Q

3 things to do if no signifiant improvement in patient’s odontogenic infection symptoms in 48-72 hours

A
  • Refer patient to hospital
  • Consider adding an additional antibiotic (metronidazole)
  • Do not stop penicillin or amoxicillin
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17
Q

When to prescribe metronidazole for odontogenic infections

A

If no significant improvement noted in 48-71 hours

NOTE: add to penicillin or amoxicillin. good for management of chronic infections with obligate anaerobic bacteria

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18
Q

Metronidazole prescription for treatment of odontogenic infection

A
  • Metronidazole
  • 250 mg q6h x 7 days

NOTE:if added to amoxicillin, prescription would be q8h

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19
Q

Dosage form available for metronidazole

A

250 mg tabs

20
Q

Indication for clindamycin

A

Serious infections, including possiblity of osteomyelitis

21
Q

Clindamycin prescription for serious dental infections

A
  • Clindamycin 300 mg q6h x 7 days
  • May be prescribed for 10 days and dose may vary from 150-450 mg
22
Q

Dosage forms available for clindamycin

A

150 or 300 mg caps

23
Q

3rd choice for treatment of odontogenic infections (allergy to penicillin with relatively mild infection)

A

Other macrolides:

  • Azythromycin (ZITHROMAX)
    • 500 mg (single dose) day 1;
    • then 250 mg qd x 4 days
  • Clarithromycin (BIAXIN)
    • 250-500 mg bid x 7 days
24
Q

Dosage form available for azithromycin

A

250 mg tabs

25
Q

Dosage form available for clarithromycin

A

250 mg tabs

26
Q

6 options for treating periodontitis w/ antibiotics

A
  1. Local delivery immediately following debridement of:
    • Docycycline hyclae subgingival Gel 44 mg/unit
    • Minocycline subgingival controlled-release microspheres 1mg/cartridge
  2. Amoxicillin 500 mg q8h x 7 days OR amoxicillin/clavulanic acid 500/125 mg q8h x 7 days (better option)
  3. Metronidazole 500 mg q8h x 8 days
  4. Metronidazole 250 mg q8h x 7 days added to amoxicillin
  5. Clindamycin 300 mg q6h x 8 days (useful in some cases)
  6. Doxycylcine 100-200 mg qd x 21 days
27
Q

Indication for local delivery of doxycycline hyclate subgingival gel in treating periodontitis

A

Treatment of chronic adult periodontitis for gain in clinical attachment, reduction in probing depth, and reduction in BOP

28
Q

Indication of local delivery of minocycline subgingival controlled-release microscpheres in the treatment of periodontitis

A

Adjunct to SRP procedures to decrease pocket depth in adult patients with chronic periodontitis

29
Q

Indication for metronidazole 500 mg q8h x 8 days regarding periodontitis

A

Refractory periodontitis

30
Q

Indication for metronidazole 250 mg q8h x 7 days added to amoxicillin regarding periodontitis

A

Extremely aggressive disease

31
Q

Indication for doxycycline 100-200 mg qd x 21 days regarding periodontitis

A

Treatment of A. actinomycetemcomitans

32
Q

2 options for treating aggressive periodontitis in children older than 8 years old

A
  1. Tetracycline HCl 250 mg q6h x 2 weeks
  2. Metronidazole (FLAGYL) 250 mg q6h x 10 days alone, BUT better used in combo with:
    1. Amoxicillin 375 mg q6h x 10 days
33
Q

Time limit for chronic use of doxycycline hyclate (PERIOSTAT)

A

PERIOSTAT 20 mg bid up to 9 months (max safety reported up to 12 months, max efficacy at 9 months)

34
Q

4 conditions for which endocarditis prophylaxis is recommended

A

High risk category only:

  • Prosthetic cardiac valves
  • Previous infective endocarditis
  • Congenital heart disease (refer to another card for specific diseases)
  • Cardiac transplantation with subsequent cardiac valvulopathy
35
Q

3 congenital heart diseases meriting endocarditis prophylaxis

A
  • Unrepaired cyanotic congenital heart disease including palliative shunts and conduits
  • Completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during first 6 months after procedure
  • Repaired congenital heart disease with residual defects at the sit or adjacent to the site of a prosthetic patch or device
36
Q

8 procedures for which endocarditis prophylaxis is recommended (if indicated)

A
  • Dental exo
  • Perio procedures including surgery, SRP, probing and recall maintenance
  • Dental implant placement + reimplantation of avulsed teeth
  • Endodontic (RCT) instrumentation or surgery only beyond apex
  • Subgingival placement of antibiotic fibers or strips
  • Initial placement of orthodontic bands but not brackets
  • Intraligamentary local anesthetic injections
  • Prophylactic cleaning or teeth or implants where bleeding is anticipated
37
Q

Standard general prophylaxis for infective endocarditis

A

Amoxicillin

  • Adults 2.0 g
  • Children 50 mg/kg

Orally 1 h before procedure

38
Q

Prophylactic regimen for infective endocarditis for those unable to take oral meds

A

Ampicillin

  • Adults 2.0 g IM or IV
  • Children 50 mg/kg IM or IV

within 30 min before procedure

39
Q

Prophylactic regimenfor infective endocarditis for those allergic to penicillin

A

​Clindamycin

  • Adults 600 mg
  • Children 20 mg/kg
  • Orally 1 h before procedure

Azithromycin or clarithromycin

  • Adults 500 mg
  • Children 15 mg/kg
  • Orally 1 h before procedure
40
Q

Prophylactic regimen for infective endocarditis for those allergic to penicillin and unable to take oral meds

A

Clindamycin

  • Acults 600 mg
  • Children 20 mg/kg

IV within 30 min before procedure

41
Q

4 conditions for patients with total joint replacement which merit antibiotic prophylaxis according to the 2003 guidelines

A
  • All pts during first two year following joint replacement
  • Immunocompromised/immunosuppressed patients
  • Patients with co-morbidities
  • Previous prosthetic joint infections
42
Q

5 comorbidities that may merit antibiotic prophylaxis for pts with total joint replacement according to 2003 guidelines

A
  • Malnourishment
  • Hemophilia
  • HIV infection
  • Type 1 diabetes
  • Malignancy
43
Q

Prophylaxis for pts with total joint replacement when NOT allergic to penicillin

A

Cephalexin, cephradine, or amoxicillin

  • 2 g po 1 hr prior to dental procedure
44
Q

Prophylaxis for pts with total joint replacement who are not allergic to penicillin and are unable to take oral meds

A

Cefazolin 1g OR ampicillin 2g IM or IV 1 hr prior to dental procedure

45
Q

Prophylaxis for pts w/ total joint replacement who are allergic to penicillin

A

Clindamycin 600 mg po 1 hr prior to dental procedure

46
Q

Prophylaxis for pts w/ total joint replacement who are allergic to penicillin and are unable to take oral meds

A

Clindamycin 600 mg IV 1 hr prior to dental procedure

DENT 319 - Pharmacology (7 decks)

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