1. Antibiotic Use in Dental Infection
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2. INTRODUCTION ■ Diagnosis and Treatment of infection
■ Assessment of the Patient
■ Diagnosis and Treatment of infection
■ Antibiotic Therapy
■ Indications for Prophylaxis
■ Antifungal Agent
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3. DIAGNOSIS: Infection Determine etiology > odontogenic
> trauma wound, animal bite
> TB, fungi, actinomycoses
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4. MICROBIOLOGY
Most oral infections are mixed in origin consisting of aerobic and anaerobic gram positive and gram negative organisms
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5. COMMONLY USED A/B
Mechanism of the antibiotics
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6. First choice for odontogenic infection
COMMONLY USED A/B
1. Groups of Penicillin
First choice for odontogenic infection
G(+) cocci and rod, spirochetes, anaerobes
0.7~10% hypersensitivity => PST
Nature: penicillin G (IV), penicillin V (PO)
Penicillinase-resistant: oxacillin, dicloxacillin
Extended spectrum: ampicillin, amoxicillin
Combine β-lactamase inhibitor: augmentin
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7. More resistance to penicillinase G(+) cocci, many G(-) rods
2. Cephalosporin
More resistance to penicillinase
G(+) cocci, many G(-) rods
Third generation: Pseudomonas aeruginosa
Second choice (less effect for anaerobes)
First generation
Second generation
Third generation
Forth generation
Cefazolin
Keflor
Claforan
Cefepime
Generation by G(-) rods against
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8. Bacteriostatic -> bactericidal
3. Clindamycin
G(+) cocci
Bacteriostatic -> bactericidal
Second-line drug: should be held in reserve to treat those infections caused by anaerobes resistant to other antibiotics
Not be used as a subsitute for penicillin or other drugs that are effective against orofacial infections
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9. G(-) aerobes, some G(+) aerobes eg S. aureus
4. Aminoglycoside
G(-) aerobes, some G(+) aerobes eg S. aureus
Poorly absorbed from GI tract
Adjustment of dosage in renal dysfunction
Drugs: Gentamicin, Amikacin, Amikin
Combined with penicillin or cephalosporin
No activity against anaerobes, so don’t use alone
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10. Only for obligate anaerobes Can cross blood-brain barrier
5. Metronidazole*
Only for obligate anaerobes
Can cross blood-brain barrier
To treat serious infections caused by anaerobic bacteria, combined with β-lactam A/B
Effective against Bacteroides species, esp. in periodontal infections
Drugs: Anegyn, Flagyne
Avoid pregnant women
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11. G(+), most anaerobes, some G(-) cocci (Neisseria) Given intravenously,
6. Vancomycin
G(+), most anaerobes, some G(-) cocci (Neisseria)
Given intravenously,
Adjustment of dosage in renal dysfunction
主要用於治療MRSA，口服是用來治療pseudomembrane colitis。注意IV給葯速度
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12. Wide spectrum, highly active against anaerobes
7. Chloramphenicol
Wide spectrum, highly active against anaerobes
Limited to severe odontogenic infection threatening to the eye or brain
Severe toxicity
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13. G(+) cocci, oral anaerobes Bacteriostatic
8. Erythromycin
G(+) cocci, oral anaerobes
Bacteriostatic
Second choice for odontogenic infections
Indication for out-patients with mild infection
Drug resistence: 50% of S. aureus, Strep. viridans,
For PST(+) patient
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14. Only against anaerobes
9. Tetracycline*
Only against anaerobes
Contraindications: pregnant women, children <12
Limited usefulness in orofacial infection
Use as adjunctive therapy for refractory periodontitis
Most likely to cause superinfection
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15. Use the narrowest spectrum antibiotics
SELECTION of A/B
Use the narrowest spectrum antibiotics
Use the antibiotics with the lowest toxicity and side effects
Use bactericidal antibiotics if possible
Be aware of the cost of antibiotics
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16. Side Effect of Commonly Used Antibiotics
1. Penicillin
hypersensitivity
2. Cephalosporin
3. Clindamycin
diarrhea, pseudomembrane colitis
4. Aminoglycoside
damage to kidney, neurotoxicity
5. Metronidazole*
GI disturbance, seizures
6. Vancomycin
neurotoxicity, thrombophlebitis
7. Chloramphenicol
bone marrow suppression
8. Erythromycin
mild GI disturbance
9. Tetracyclin*
tooth discoloration
* Not use in pregnancy. Vancomycin IV too rapid-> decrease blood pressure. BP monitor is needed.
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17. ANTIFUNGAL AGENT Most of fungal infection are from candida
Commonly used drugs:
(1) Nystatin (Mycostatin)= PO 4-600,000 U qid
(2) Amphotericin B= IV for severe systemic infec.
(3) Fluconazole, Ketoconazole
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