Bacterial Infection

Question 1

Uses of AB

Answer 1

• when there is evidence of spreading infection, ie: cellulitis, LN involvement, swelling
• systemic involvement, ie: fever, malaise

Question 2

Amoxicillin vs Penicillin V

Answer 2

• amo is more easily absorbed

Question 3

Management of Dental Abscess (1st line)

Answer 3

Local measures
- drain pus in abscess by XLA/ root canals
- pus in soft tissues, drain by incision

If there is cellulitis, systemic involvement/ spread infection,
1. Amoxicillin, 500mg, 5-day regimen
Send: 15 capsules
Label: 1 capsule 3 times daily

** Caution with pt who have anaphylaxis, urticaria/ rash

2. Phenoxymethylpenicillin tablets, 250mg, 5-day regimen
   Send: 40 tablets
   Label: 2 tablets 4 times daily

Question 4

Patient with dental abscess allergic to Penicillin

Answer 4

1. Metronidazole tablets, 200 mg, 5-day regimen
   Send: 15 tablets
   Label: 1 tablet 3 times daily

** advise pt not to take alcohol (has a disulfiram-like reaction with alcohol)
** do not prescribe to pts taking warfarin

Question 5

2nd Line for Dental Abscess

Answer 5

Broad spectrum AB

1. Clindamycin capsules, 150 mg, 5-day regimen
   Send: 20 capsules
   Label: 1 capsules 4 times daily, swallowed with water
   ** discontinue if has diarrhoea issues
2. Co-amoxiclav 250/125 tablets, 5-day regimen
   Send: 15 tablets
   Label: 1 tablet 3 times daily
   ** amoxicillin 250 mg as trihydrate and clavulanic acid 125mg as potassium salt
3. Clarithromycin tablets, 250mg, 7-day regimen
   Send: 14 tablets
   Label: 1 tablet 2 times daily

Question 6

Clindamycin

Answer 6

• active against gram +ve cocci, including steptococci and penicillin- resistant staphylococci
• can cause adverse effect of antibiotic associated colitis more frequently than other AB

** can cause Clostridium difficile infection

Question 7

Co-amoxiclav

Answer 7

• active against beta-lactamase-producing bacteria that are resistant to amoxicillin

** can cause Clostridium difficile infection

Question 8

Clarithromycin

Answer 8

• active against beta-lactamase producing bacteria

Question 9

Necrotising Ulcerative Gingivitis

Answer 9

• painful, superficial infection of gingival margins
• associated with anaerobic fuso-spirochaetal bacteria
• common in pt who smokes, immuno-suppressed and poor OH

Question 10

Pericoronitis

Answer 10

• superficial infection of operculum
• associated with anerobic bacteria

Question 11

Management of NUG and Pericoronitis

Answer 11

Local measures
- PMPR, remove supra and sub-gingival deposits
- provide OHI
- irrigation and debridement

1. Metronidazole tablets, 200mg, 3-day regimen
   Send: 9 tablets
   Label: 1 tablet 3 times daily

** avoid alcohol. do not prescribe to patients taking warfarin

2. Amoxicillin capsules, 500mg, 3-day regimen
   Send: 9 capsules
   Label: 1 capsule 3 times a day

Question 12

Sinusitis

Answer 12

• swelling of sinuses
• normally heal within 2 1/2 weeks
• viral infection

Question 13

Management of Sinusitis

Answer 13

• steam inhalation

1. Ephedrine nasal drops, 0.5%
   Send: 10ml
   Label: 1 drop into each nostril up to 3 times daily when required
   ** use for maximum of 7 days. do not use in patients with HBP
2. Amoxicillin capsules, 500mg, 7-day regimen
   Send: 21 capsules
   Label: 1 capsule 3 times a day
3. Doxycycline capsules, 100mg, 7- day regimen
   Send: 8 capsules
   Label: 2 capsules on first day, followed by 1 capsule a day
   ** advise pt to take in capsule with fluid during meals
   ** do not prescribe to pregnant women, pt taking warfarin
   ** cause staining of teeth
   ** cause nausea, vomitting, diarrhoea, dysphagia