PRINCIPLES OF PROPHYLAXIS OF INFECTION 1)Procedure should have significant risk of infection 2)Choose correct antibiotic 3)Antibiotic plasma level must be high 4)Time antibiotic administration correctly 5)Use shortest antibiotic exposure that is effective

1)Procedure have significant risk of infection The procedure must have a high enough incidence of bacteria to be reduced with antibiotic therapy Factors related to Post-op infection i.Size of bacterial inoculum ii.Duration of surgery ( >4 hrs) iii.Presence of FB, implant or dead space iv.State of host resistance (depressed host defense)

2.)Choose correct antibiotic Antibiotic criteria: – The antibiotic should be effective against the organisms most likely to cause infection – Narrow spectrum antibiotic – Least toxic to patient – Bacteriacidal antibiotic more preferable Antibiotic prophylaxis of choice before oral surgery= Penicilin Allergic to penicilin, use clindamycin

3)Antibiotic plasma level must be high Antibiotic level in plasma must be higher than when antibiotic used therapeutically Peak Plasma Level should be high-ensure diffusion of antibiotic into all fluid and tissue Usual recommended: – Dosage for prophylaxis at least 2x of therapeutic antibiotic

4)Time antibiotic administration Must be given 2 hours or less before surgery Antibiotic administration after surgery is greatly decreased its efficacy or has no effect on preventing infection There is evidence administration after 2 hours or more may increase risk of wound infection If surgery prolonged, additional dose is required, intraoperative dose interval should be shorter

5)Use shortest effective antibiotic exposure Must be in the target tissue before surgery Adequate plasma level is maintained The prophlactic antibiotic is necessary for the time of surgery

PRINCIPLES OF PROPHYLAXIS AGAINST METASTATIC INFECTION A.Prophylaxis against IE B.Prophylaxis in patient with Cardiovascular conditions C.Prophylaxis against Total Joint Replacement Infection

A)Prophylaxis against IE Mortality, morbidity of IE are high IE reaction must be treated in hospital with high dosage of iv antibiotic, damaged heart valve is replaced surgically with prosthetic valve Dental procedures cause bacteremia -S. viridans which might cause IE Antibiotic prophylaxis for "All dental procedures that involve manipulation of gingival tissue/periapical region/perforation of oral mucosa” 2g of Amoxicilin orally ½ to 1 hours before procedure

A)Prophylaxis against IE Patient with antibiotic prophylaxis that required dental tx needs a period of >10 days between the appoinment Patient at risk of IE should have comprehensive prophylaxis program such as excellent OH and periodic professional care If surgery is required, the mouth can be rinsed with antibacterial agent preoperatively Even with appropriate measures are taken, it still can happen. Patient should be informed by dentist about signs & symptom of IE post-operatively

B)Prophylaxis in patient with Cardiovascular conditions Patient with CABG, transvenous pacemaker, atherosclerotic vascular disease, alloplastic graft – No need antibiotic prophlaxis Patient who receiving renal dialysis or have hydrocephaly – need to consult physician AHA does not recommend antibiotic prophlaxis for nonvalvular device

C)Prophylaxis against Total Joint Replacement Infection Patient with TJRI- risk of bacteremia & infection Infection might come from dental procedure eg extraction (recent literature opposed it) Instead it appears the infection come from others through hematogenous spread which result to septicemia But odontogenic infection might cause TJRI ADA & AAOS recognize that patient with prosthetic joint not at a risk of joint infection after dental procedure ADA recommend antibiotic prophylaxis for susceptible pt only