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unit 1 ABx coverages Flashcards

1
Q
A
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2
Q

Normal Flora of Mouth

A

Gram +
› Viridans Group Streptococci
› Other Strep spps.
› Lactobacillus
› Actinomyces spps.
Gram-
› Prevotella spps.

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3
Q

gram state of most oral bac
* morph?
* Oxygen tolerance?
* Cell wall?

A

Gram Positive organisms:
* Bulk of oral bacteria
* Primarily cocci or irregular shape (pleomorphic)
* Oxygen tolerance varies from facultative anaerobes to strict anaerobes
* Cell wall has thick peptidoglycan layer

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4
Q

Three important genera of gram +

A
  • Lactobacillus
  • Streptococcus
  • Actinomyces
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5
Q

Actinomyces: O2, where?

A

Actinomyces - facultative anaerobe; periodontal pockets, dental plaques, on carious teeth

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6
Q

Lactobacillus -O2, where?

A

Lactobacillus - facultative anaerobe; produce lactic acid; role in dentine caries rather than enamel caries

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7
Q

Streptococcus - O2, where?

A

Streptococcus - facultative anaerobic cocci; produce lactic acid some implicated in caries

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8
Q

Streptococci Species in the Oral Cavity

A

Oral streptococci are referred to as viridans streptococci (Streptococcus viridans)
› Isolated from all sights of the mouth, each species has specific properties for
colonizing different oral sites
› Large proportion of resident microflora

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9
Q

bad streptococci of the mouth

  • Acid?
  • Highly associated with?
  • Bacterial communities collected from dentin carious lesions contain?
A

Strep mutans:
* Acidogenic (acid producing) and aciduric (acid tolerant) species
* Highly associated with caries (+++)
* Bacterial communities collected from dentin carious lesions contain notorious
acidogenic and aciduric species, including S. mutans, Scardovia wiggsiae, Parascardovia
denticolens, and Lactobacillus salivarius

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10
Q

what Abx works for all oral bac

A

augmentin

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11
Q

what spp do penicillins not work on

A

lactobacillus
porphyromanas
bacteriodes
neiserria
aggrebacter

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12
Q

metronidazole works on what spp?

A

peptostreptococcus (only gram + one)
porphyromanas
prevotella
veillonella
fusobacterium
bacteriodies

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13
Q

Bactericidal Abx’s

A

Cell Wall Inhibitors
*Beta Lactams
*Penicillins
*Cephalosporins

Inhibit DNA
*Fluoroquinolones
*Metronidazole

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14
Q

Bacteriostatic abx

A

* Protein Synthesis Inhibitors
– Macrolides
– Clindamycin
– Doxycycline

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15
Q

penicillin are sensitive to?

A

beta lacatamase

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16
Q

Augmentin™-

A

Augmentin™- amoxicillin+clavulanate = more gram negatives, anaerobes, & Staph.:
●Dental infections with abscess or failed amoxicillin

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17
Q

B-lactamase Resistance (MSSA) Versus MRSA

A
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18
Q

penicillin typical spectrum

A

mainly gram + (strep, actino, peptostrep) some gram - but possible resistance

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19
Q

amoxicillin coverage

A

covers gram + (strep, lacto, actino, pepto)
good/SR with some gram -

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20
Q

metro coverage

A
  • mainly gram - except for neiserria and aggregibacter
  • also covers peptostrep
  • can be combined with penicillin for similar effect as augmentin
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21
Q

when should we use augmentin

A

when amox fails

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22
Q

what can be used for prohylaxis with G+ suspected

A

penicillin

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23
Q

natural penicillins

A

penicillin G and VK

24
Q

natty penicillins work on:

A

Primarily - gram-positive Strep. species: Strep. viridans, Group A Strep, and anaerobic (Peptostreptococcus, Peptococcus sp.); activity against Actinomyces spps.

25
extended spectrum aminopenicillins
ampicillin and amxoicillin
26
extended spectrum aminopenicillins work on?
same as natty but Improved Oral absorption and gram negative coverage
27
can we use b lactams with mutated PBP (S. aureus)
no
28
what gram - is not covered by penicillin
porphyromanas bacterioides (anaerobes) neiserria aggregibacter
29
what gram - can penicillin cover (possible R)
30
what gram - can amox cover
neiserria
31
what gram - is not covered by amox
bacterioides (anaerobes) aggregibacter
32
cephlexin coverage
viridans strep strep spp peptostrep Lacto and actino are questionable
33
does cephlexin have any gram - cover
NO questionable with prevotella and fuso
34
cefaclor spp coverage
viridans strep peptostrep strep spp lacto actino maybe and gram - cover of fusobacterium and aggregibacter
35
clindamyacin coverage
36
what does clinda not cover
neiserria and aggregibacter
37
doxy cover
covers gram + and - except for neiserria and veillonella
38
Cephalosporins * beta-lactamases? * Active against? * generations? * Each successive generation includes? * side effects? * Safely tolerated in? * Poor against?
* Most beta-lactamases do not reduce activity of cephalosporins * Active against Gram negatives producing b-lactamase * Several “Generations” * Each successive generation includes more Gram-negative activity * Limited side effect profile * Safely tolerated in penicillin intolerance history * Poor against anaerobes (particularly gram-)
39
1st Generation Cephalosporins * Excellent coverage of? * gram activity? spp? * oral gram -?
* Excellent GRAM POSITIVE Coverage – Strep. spps. & Staph aureus * some gram negative activity: * Proteus, E. coli, and Klebsiella (PEcK) * Limited oral gram negatives- NO P. gingivalis
40
2nd gen cephs * gram coverages? * oral gram -?
* Still excellent GRAM POSITIVE Coverage – Strep. spps. * Some additional gram negatives: * Morexella, Haemophilus, Enterobacter, Neisseria (More HEN PEcK) * Still overall limited oral gram negative- YES P. gingivalis
41
how can we use 1st and 2nd gen ceph in mouth
: may be used for early odontogenic infections. (no perio indications)
42
Metronidazole (Flagyl) ●Bactericidal against all?  spp? ●MOA ●additional targets?
●Bactericidal against all obligate ANAEROBES  Bacteroides spps. and Fusobacterium ●Breaks DNA structure directly through production of free radicals via redox rxns ●Antiprotozoal: amoeba (Entamoeba), Trichomonas, Giardia.
43
metro coverage
44
# clinda coverage
45
tetracycline cover
good aggrebacter acitivity= used for perio dx
46
do we fw ERTHYROMYCIN? ●spectrum? ■ Adverse effects: ■ Strong inhibitor of? ■ Highest risk of?
NOT USED ●Narrow spectrum: LOTS of resistance ■ Adverse effects: Prokinetic, GI disturbances, diarrhea (can be used with gastroparesis, cramping ■ Strong inhibitor of CYP3A –many drug interactions. ■ Highest QTc prolongation risk among antimicrobials
47
why are macrolides not top choice for odontogenic infections? ■ No activity against? ■ Alternative? ■ Less effective than? ■ Overall limit use due to? ■ % of viridans group Streptococci resistant? implications?
■ No activity against Bacteroides, common in dental abscesses ■ Alternative antibiotic in odontogenic infections. ■ Less effective than b- Lactams (2nd choice) ■ Overall limit use due to already high resistance rates. ■ 50% of viridans group Streptococci resistant, not good for prophylaxis
48
Pregnancy and Lactation * Good Safety abx
* Cephalosporins, penicillins, clindamycin, azithromycin
49
Pregnancy and Lactation bad abx
* Doxycycline – Ca++ chelation * Fluoroquinolones – kidneys/cartilage * Sulfamethoxazole/trimethoprim – various/kernicterus * Metronidazole in 1st Trimester – limited data
50
When Are Antibiotics Indicated/ Recommended in dentistry? * NUG ? * Periodontitis? * infection where? * Endo/Perio?
* NUG – systemic symptoms or immunocompromised * Aggressive Periodontitis non responsive to debridement * Fascial space infection * Endo/Perio with systemic symptoms
51
when are abx not needed in dentistry
* Endodontic conditions * Chronic Periodontitis or Gingivitis * Periodontal Abscess * NUG – no systemic symptoms
52
Antibiotics in Odontogenic Infections Antimicrobial agents are indicated if what has is present? Or infection has spread beyond?
Antimicrobial agents are indicated if fever and regional lymphadenopathy are present, or when infection has perforated the bony cortex and spread into surrounding soft tissue.
53
Early odontogenic Infection (< 3 days) abx whatif there are allergies (mild/severe)? what if there is no improvement?
54
late odontogenic infection (>3 days) abx
continue for 2 days after resolution of systemic symptoms
55
Bacterial Infective Endocarditis (BIE) 85% spp are? ~5% caused by?
* Infection of endocardium or valves from blood born bacteria. * 85% are Staphylococci spps & Streptococci spps * ~5% caused by HACEK group Gram-Negatives * (Haemophilus spps, A. actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, Kingella kingae) * HACEK are oral flora with potential for infection.
56
when would 1st and 2nd gen cephs be used in dentistry
1st gen more used for prophylaxis/allergies where as 2nd gen can be used for infections due to increased gram - coverage, however amoxicillin is preferred

pharm 2 (20 decks)

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