SDCEP dental abscesses

Question 1

usual MOs

Answer 1

viridans streptococcus spp or gram negative organisms

Question 2

when shouldn’t you prescribe ABs and why?

Answer 2

infection localised to PR tissues

• indicates being adequately managed by immune system
• abscess mostly isolated from circulation so v little AB penetration

Question 3

use local measures first

Answer 3

remove cause
achieve drainage
- abscess - extraction or through RCs
- STs - incision

Question 4

indications for ABs

Answer 4

local measures failed
immediate drainage not achieved using local measures
spreading infection
 - swelling, cellulitis, LN involvement
systemic involvement
 - fever, malaise

Question 5

measure temp of pts with suspected bacterial infections

Answer 5

<36 or >38 degrees indicates systemic involvement

but absence of pyrexia doesn’t preclude an AB if other S+S of spreading infection or systemic involvement are present

Question 6

amoxicillin vs phenoxymethylpenicillin (penicillin V)

Answer 6

amoxicillin is as effective but better absorbed

penicillin V now first line - narrower spectrum of activity, less AMR

Question 7

duration of ABs

Answer 7

depends on severity and clinical response
usually 5days
don’t prolong unduly - promotes resistance

Question 8

ABs in severe infections

Answer 8

double dose of amoxicillin, penicillin V and metronidazole

EO swelling, eye closing, trismus

Question 9

what to do if pt doesn’t respond to ABs

Answer 9

check diagnosis and consider referral to specialist

consider speaking to specialist before prescribing a second line AB

Question 10

amoxicillin

Answer 10

capsules
500mg
15 capsules
1 x3 daily

Question 11

phenoxymethylpenicillin

Answer 11

tablets
250mg
40 tablets
2 x4 daily

Question 12

amoxicillin and phenoxymethylpenicillin cautions

Answer 12

can cause hypersensitivity reactions inc rashes and anaphylaxis, diarrhoea
do not prescribe to pts with hx of anaphylaxis, urticatia or rash immediately after penicillin administration as at risk of immediate hypersensitivity

Question 13

indications to transfer to hospital as emergency

Answer 13

significant trismus
FOM swelling
difficulty breathing

Question 14

what is metronidazole effective against?

Answer 14

anaerobic bacteria

Question 15

indications for metronidazole

Answer 15

if allergic to penicillin

can also be used as adjunct to amoxicillin in pts with spreading infection or pyrexia

Question 16

metronidazole

Answer 16

tablets
400mg
15 tablets
1 x3 daily

Question 17

metronidazole cautions/contraindications

Answer 17

avoid alcohol (disulfiram-like reaction)
contraindicated if pt on warfarin

Question 18

why shouldn’t second line antibiotics be empirically used?

Answer 18

clindamycin, clarithromycin, co-amoxiclav
no advantages over the first line drugs for most dental pts
routine use unnecessary and could contribute to resistance
use of broad-spectrum ABs associated with an increase in c dificile infection

Question 19

what is clindamycin effective against?

Answer 19

gram + cocci including streptococci and penicillin-resistant staphylococci

Question 20

when can clindamycin be used?

Answer 20

if pt not responded to amoxicillin/metronidazole

Question 21

disadvantages of clindamycin

Answer 21

can cause the serious adverse effect of antibiotic-associated colitis more freq than other ABs
c dificile infection

Question 22

clindamycin

Answer 22

capsules 150mg
20 capsules
1 x4 daily with water
5 days

Question 23

when not to use clindamycin

Answer 23

for pts with diarrhoeal states

Question 24

what is co-amoxiclav active against?

Answer 24

B-lactamase producing bacteria that are resistant to amoxicillin

Question 25

when can co-amoxiclav be used?

Answer 25

to tx severe dental infection with spreading cellulitis/infection that has not responded to first-line AB tx

Question 26

disadvantage of co-amoxiclav

Answer 26

c dificile infection

Question 27

clindamycin advice to pt

Answer 27

discontinue use immediately if diarrhoea or colitis develops as clindamycin can cause AB-associated colitis

Question 28

co-amoxiclav

Answer 28

tablets 250/125 15 tablets 1 x3 daily 5 days

Question 29

composition of co-amoxiclav

Answer 29

amoxicillin 250mg as trihydrate and clavulanic acid 125mg as potassium salt

Question 30

clavulanic acid fct in co-amoxiclav

Answer 30

stops bacteria breaking down amoxicillin

Question 31

co-amoxiclav cautions

Answer 31

can cause c dificile infection cholestatic jaundice can occur during/shortly after use - more common >65s and men can cause hypersensitivity reactions inc rashes and anaphylaxis, diarrhoea

Question 32

co-amoxiclav contraindications

Answer 32

don't prescribe in pts with history of co-amoxiclav-associated or penicillin-associated jaundice or hepatic dysfct don't prescribe to pts with hx of anaphylaxis, urticaria or rash immediately after penicillin - at risk of immediate hypersensitivity

Question 33

what is clarithromycin active against?

Answer 33

B-lactamase producing bacteria

Question 34

clarithromycin

Answer 34

tablets 250mg 14 tablets 1 x2 daily 7 days

Question 35

clarithromycin cautions

Answer 35

use with caution in pts predisposed to QT interval prolongation inc electrolyte disturbances and those with hepatic/renal impairment

Question 36

clarithromycin contraindications

Answer 36

pregnant/breastfeeding warfarin statins

Question 37

when would you prescribe amoxicillin over phenoxymethylpenicillin?

Answer 37

if concerns re compliance as phenoxymethylpenicillin should be taken at least 30 mins before food