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DOH210 S1 > Week Six: Antibiotics > Flashcards

Week Six: Antibiotics Flashcards

1
Q

What is important about the word properties regarding ABs?

A
  • The most important property is selective toxicity
  • Ability of an antimicrobial to kill or inhibit a pathogen with little or no harmful effect on the host
  • ABs work by targeting processes that are essential to the survival of bacterial cells, but not eukaryotes.
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2
Q

Define Spectrum:

A
  • Narrow, moderate/intermediate, broad

- Range of microorganisms against which the antibiotic is effective

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3
Q

Define Bactericidal:

A

Kills bacteria

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4
Q

Define bacteriostatic:

A

Inhibits bacterial growth

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5
Q

What are examples of modes of action in ABs?

A
  • Inhibition of synthesis of cell components: Cell wall, Proteins/ essential enzymes, Nucleic acids
  • Cell Membrane Disruptions
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6
Q

What are some commonly used antimicrobials?

A
  • Beta lactams: Penicillin’s, Cephalosporins
  • Nitroimidazoles
  • Glycopeptides
  • Lincosamides
  • Tetracyclins
  • Macrolides
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7
Q

What is penicillin?

A

It is bactericidal, means that it targets cell wall synthesis

There is a modification of basic structure, resulting in an antibiotic with a broader spectrum and resistance to beta lactamase

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8
Q

What are some considerations of penicillin?

A
  • Hypersensitivity

- Development of AB resistance

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9
Q

What are narrow spectrum penicillin’s?

A
  • Gram positive organisms

- Inactivated by beta lactamases

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10
Q

What type of penicillin is Penicillin V?

A

Narrow Spectrum

It is given orally, it is more acid resistant than penicillin G, food impairs absorption. It is for acute odontogenic infections. Penicillin V also has fewer GI symptoms than amoxycillan.

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11
Q

What type of penicillin is penicillin G?

A

Narrow Spectrum

Parenteral administration

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12
Q

Name and describe moderate spectrum penicillin’s.

A
  • Gram positive, with some activity gram negative
  • Destroyed by beta lactamases
  • Amoxycillin and Ampicillan
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13
Q

Name and describe broad spectrum penicillin’s.

A

‘Clavulanate’
Alone, it possesses little inherent antibacterial activity. But it significantly extends the spectrum of amoxycillin when given together.

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14
Q

What is a cephalosporins?

A

These have a similar action to penicillin’s but:
They have a broader spectrum of activity, they are resistant to beta lactamase.

Cephalexin and Cephazolin are active against many gram positive and negative cocci

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15
Q

What are nitroimidazoles?

A
  • Gram negative and gram positive anaerobes
  • Must counsel patients to avoid alcohol with these types of antibiotics.

Metronidazole and Tinidazole

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16
Q

Define Metronidazole as an AB

A
  • Absorbed well (tablets, suppositories)
  • Aerobic and anaerobic infections
  • Drug of choice for spreading dental infection in facial spaces of the neck and acute ulcerative gingivitis.
  • Inhibits metabolism of warfarin, thereby increasing its concentration and patients risk of bleeding - will need to monitor INR
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17
Q

Define Tinidazole as a AB

A

It has a longer half life than metronidazole, therefore can be administered as a single dose.

18
Q

Define glycopeptide as an AB?

A
  • Gram positive organisms
  • IV, IM
  • Vancomycin and teicoplanin
  • Indicated if patient has infection with susceptible organism, but is allergic to penicillin.
19
Q

Define lincosamide as an AB?

A
  • Gram positive aerobes and most anaerobes
  • Second line therapy

Clindamycin and Lincomycin

20
Q

When should tetracyclines be avoided?

A
  • In children up to 12yrs to prevent affecting dentine development
  • Not to be used after first 8weeks of pregnancy
  • It is rarely indicated in dentistry
21
Q

Define tetracyclines as a AB.

A
  • A very broad spectrum, gram positive and negative.
  • Bacteriostatic
  • Doxycycline is the most preferred as a single day dosing
  • Photosensitive
22
Q

What do tetracyclines interact with?

A

Antacids - decreases their absorption

It also enhances the activity of warfarin, thereby increasing its concentration and patients risk of bleeding - will need to monitor INR

23
Q

What are macrolides?

A

A broad spectrum AB

- Rarely indicated in a dental practice

24
Q

Examples of macrolides are?

A
  • Azithromycin
  • Clarithromycin
  • Erythromycin
25
Q

What is the effectiveness of an AB dependant on?

A
  • Susceptibility to pathogen
  • Route of administration
  • Concentration of drug at infection site:
    Adsorption, distribution, metabolism, excretion

Protein binding capacity

Presence of other bacteria

26
Q

Is gingivitis an indication for ABs?

A

No.

Plaque induced gingivitis is treated by removal of plaque retentive factors, oral hygiene skills development and patient education

Exceptions - (ANUG) ‘Acute necrotising ulcerative gingivitis.

27
Q

Is periodontitis an indication for ABs?

A

No.

Chronic periodontitis is treated by scaling and root debridement, removal of plaque retentive factors, oral hygiene skills development, patient education and improving access for good oral hygiene behaviours.

Antibiotic therapy is rarely required and is not effective without concomitant debridement

28
Q

Regarding the use of ABs and periodontitis what are the exceptions?

A
  • Unresponsive or aggressive periodontal disease and periodontitis in an immunocompromised patient must be managed by a specialist
29
Q

What is an indication for the use of ABs?

A

A dental abscess!

- Periapical, Peri coronal, periodontal

30
Q

So how do you decide on treating a dental abscess with ABs?

A

You treat when:
- The infection has spread beyond the confines of the jaw and causes facial swelling: It is not indicated if solely confined to buccal space or if gum boil/acute abscess)

Also: If there are systemic symptoms - fever, malaise, dehydration, lymphatic node involvement

31
Q

What are treatment considerations for a dental abscess?

A
  • Remove the causative agent (caries, inflamed pulp, tooth, calculus)

ABs should be used as a adjunct to treatment and treatment should be attempted on presentation of complaint
- Phenoxymethylpenicillin and amoxycillin
or clindamycin for patient allergic to penicillin’s

32
Q

What is infective endocarditis?

A
  1. Bacteria from the mouth enter the blood stream during at risk dental procedures and travel through the cardiovascular system
  2. Bacteria then settle and colonise on structures.
  3. here bacterial proliferation goes unchecked in the heart, resulting in inflammation of the inner lining of the heart - known as endocarditis.
33
Q

In infective endocarditis where are bacteria likely to settle and colonise?

A
  • Structures that are predominately or completely avascular:
    • Valves: Semi lunar
    • Scar tissue
  • Structures or regions where blood flow is not continuous, and smooth flow may briefly be altered or interrupted
  • Valves where blood flow may briefly be altered or uninterrupted
  • Valves where blood flow settles temporarily to prevent backflow
  • Structural abnormalities/ anomalies/ defects
34
Q

What is antibiotic prophylaxis?

A

A prescription of ABs to minimize the risk of infective endocarditis.
Now recommended only for patients with cardiac conditions who have the highest risks of adverse outcomes
- Involves a single high does of ABs given before the dental procedure.

35
Q

How do you prevent endocarditis?

A

Understand the key risk factors:

  • Nature of the cardiac condition
  • Type of dental procedure, periodontal health and duration of procedure
36
Q

What are some cardiac conditions associated with the highest risk of adverse outcomes from endocarditis?

A
  • Prosthetic cardiac valve or prosthetic cardiac valve repair
  • Previous infective endocarditis
  • Congenital heart disease: When including prosthesis such as shunts, conduits, devices, patches etc.
  • Cardiac transplantation
  • Rheumatic heart disease in indigenous Australians only
37
Q

When are examples when prophylaxis is always required?

A
  • Extraction
  • Periodontal procedures: surgery, scaling, root planning
  • replanting avulsed teeth
  • Surgical procedures:
    Implant placement
38
Q

What are the AB prophylaxis dose requirements?

A
  • Check if allergy
  • Dosages:
    Amoxycillin 2g (child: 50mg/kg up to max does of 2g) orally 1 hour prior to procedure
    • See Therapeutic Guidelines for other alternatives
  • Must watch the patient take the ABs
  • Document in clinical notes
  • Specific guidelines for the use of AB prophylaxis - stay up to date.
39
Q

How should you prevent infection of joint prostheses?

A
  • Before placement of a joint prostheses patients should be see a dentist for a comprehensive examination
  • After placement evidence suggests there is minimal value of antibiotic prophylaxis to reduce risk of infection of prosthesis, particularly if fit patient with established joint prosthesis.
40
Q

Regarding ABs - Prevention of dentoalveolar surgical site infections - when is it indicated?

A
  • For most procedures, with a fit patient it is not required or recommended.

Should be considered for: Surgical removal of bone, impacted tooth or periapical surgery in patients with history of recurrent infections.
- immunocompromised patients

41
Q

How does AB resistance occur?

A
  • Overuse and misuse of ABs - bacterial infections that were once easily cured with ABs are becoming harder to treat
    This is due to AB resistance.
42
Q

What are some strategies to discourage emergence of resistance?

A
  • Use prudently/prescribe responsibly
  • Monitor emergence of resistance
  • Educate physician, patient and public
  • Restrict use to only evidence based situations

DOH210 S1 (15 decks)

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