1. Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 8 Antiinfective Agents

2. Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Antiinfective Agents  Types of Dental Infections  Caries Caries are produced by Streptococcus mutans. Caries are produced by Streptococcus mutans. Antibiotics are not used to treat or prevent caries. Antibiotics are not used to treat or prevent caries.  Periodontal Disease Many different bacteria are involved in causing periodontal disease. Many different bacteria are involved in causing periodontal disease. Treatments include the use of local or systemic antibiotics. Treatments include the use of local or systemic antibiotics. 2

3. Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Antiinfective Agents  Types of Dental Infections  Localized Dental Infections Most localized dental infections are an extension of periodontic or endodontic-related sources. Most localized dental infections are an extension of periodontic or endodontic-related sources. Drainage is the normal course of therapy. Drainage is the normal course of therapy. Antibiotics are used if the patient is immunocompromised. Antibiotics are used if the patient is immunocompromised. The choice of antibiotic depends on the infecting organism. The choice of antibiotic depends on the infecting organism. 3

4. Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Antiinfective Agents  Types of Dental Infections  Systemic Infections These infections produce systemic symptoms such as fever, malaise, and tachycardia. These infections produce systemic symptoms such as fever, malaise, and tachycardia. Infections need to be treated with antibiotics. Infections need to be treated with antibiotics. 4

5. Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Antiinfective Agents  Indications for Antiinfective Drugs  Most dental infections do not require antibiotics.  Patients that are immunocompromised may require antibiotic therapy.  Drainage is usually sufficient for localized infections.  Systemic infections may require antibiotics.  The choice of antiinfective therapy depends on the infecting organism. 5

6. Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Antiinfective Agents  Indications for Antiinfective Drugs  Antibiotics are most often used in dentistry as prophylaxis before a dental procedure.  Antibiotic prophylaxis is used when there is a history of rheumatic or congenital heart disease or the presence of a heart valve prosthesis. 6

7. Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Antiinfective Agents  Antibiotic Prophylaxis  Antibiotic prophylaxis is used to prevent infective endocarditis.  Antibiotic prophylaxis depends on the specific dental procedure being performed, the cardiac and medical condition of the patient, and the drug and dose necessary.  Always check the most current guidelines of the American Heart Association and the American Dental Association regarding antibiotic prophylaxis. 7

8. Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Antiinfective Agents  Many different antiinfective drugs are available to treat infections.  All antiinfective drugs share several different adverse reactions and drug interactions.  Review each antiinfective to determine whether it has an adverse reaction or drug interaction that is not shared by all. 8

9. Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Antiinfective Agents  General Adverse Reactions  Superinfection All antiinfectives can produce an overgrowth of organisms that is different from the infecting organism. All antiinfectives can produce an overgrowth of organisms that is different from the infecting organism. The wider the spectrum of the antibiotic, the higher the risk for superinfection. The wider the spectrum of the antibiotic, the higher the risk for superinfection. This adverse effect can be minimized by giving the most narrow spectrum antibiotic as possible. This adverse effect can be minimized by giving the most narrow spectrum antibiotic as possible. 9

10. Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Antiinfective Agents  General Adverse Reactions  Allergic Reaction All antiinfective drugs have the potential to cause an allergic reaction. All antiinfective drugs have the potential to cause an allergic reaction. Allergic reactions can range from a mild rash to anaphylaxis. Allergic reactions can range from a mild rash to anaphylaxis. Penicillin-type antibiotics are more allergenic than other antibiotics. Penicillin-type antibiotics are more allergenic than other antibiotics. 10

11. Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Antiinfective Agents  General Adverse Reactions  Gastrointestinal Complaints All antiinfective drugs produce a variety of GI complaints. All antiinfective drugs produce a variety of GI complaints. GI effects include stomach pain, increased motility, and diarrhea. GI effects include stomach pain, increased motility, and diarrhea.  Chewable and Liquid Dose Forms Chewable and liquid dose forms contain sugar as a sweetener. Chewable and liquid dose forms contain sugar as a sweetener. Children or adults that use these dose forms should brush and floss their teeth after each dose. Children or adults that use these dose forms should brush and floss their teeth after each dose. Long-term administration of antibiotics may increase the risk for caries. Long-term administration of antibiotics may increase the risk for caries. 11

12. Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Antiinfective Agents  General Drug Interactions  Oral Contraceptives Antibiotics can increase the clearance of oral contraceptives from the body, which makes the oral contraceptive less effective. Antibiotics can increase the clearance of oral contraceptives from the body, which makes the oral contraceptive less effective. Women taking oral contraceptives should use an additional method of contraception while receiving systemic antibiotic therapy. Women taking oral contraceptives should use an additional method of contraception while receiving systemic antibiotic therapy. 12

13. Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Antiinfective Agents  General Drug Interactions  Oral Anticoagulants Antibiotics can potentiate the effects of oral anticoagulants. Antibiotics can potentiate the effects of oral anticoagulants. Antibiotics reduce the bacterial flora that produce vitamin K. Antibiotics reduce the bacterial flora that produce vitamin K. Vitamin K is the body’s natural clotting factor. Vitamin K is the body’s natural clotting factor. Oral anticoagulants are vitamin K inhibitors. Oral anticoagulants are vitamin K inhibitors. 13

14. Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Antiinfective Agents  Antibiotics Most Commonly Used in Dental Health Care  Penicillins  Cephalosporins  Macrolides Azithromycin Azithromycin Clarithromycin Clarithromycin  Tetracycline  Clindamycin  Metronidazole 14

15. Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Antiinfective Agents  All the antibiotics used in dental health care share similar adverse effects and drug interactions.  Several antibiotics have adverse effects that have significant concerns to a dental healthcare practitioner. 15

16. Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Antiinfective Agents  Dental Concerns of Selected Antibiotics  Tetracycline Tetracycline is absorbed into calcifying structures including unerupted teeth. Tetracycline is absorbed into calcifying structures including unerupted teeth. Tetracycline can cause permanent discoloration of the teeth and enamel hypoplasia. Tetracycline can cause permanent discoloration of the teeth and enamel hypoplasia. Tetracycline should not be used in children until they have all of their adult teeth. Tetracycline should not be used in children until they have all of their adult teeth. Tetracycline crosses the placenta and into breast milk and affects the primary teeth. Tetracycline crosses the placenta and into breast milk and affects the primary teeth. Tetracycline should not be given to women who are pregnant or nursing. Tetracycline should not be given to women who are pregnant or nursing. 16

17. Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Antiinfective Agents  Dental Concerns of Selected Antibiotics  Metronidazole If alcohol is ingested while a person is taking metronidazole, the person will experience a mild form of a reaction that occurs with alcohol and disulfiram. If alcohol is ingested while a person is taking metronidazole, the person will experience a mild form of a reaction that occurs with alcohol and disulfiram. Symptoms include nausea, abdominal cramps, flushing, vomiting, and headache. The reaction can happen if the patient ingests any form of alcohol including foods, drinks, and mouth rinses containing alcohol. Symptoms include nausea, abdominal cramps, flushing, vomiting, and headache. The reaction can happen if the patient ingests any form of alcohol including foods, drinks, and mouth rinses containing alcohol. Some people have experienced the symptoms if they smell alcohol, apply it to their bodies (e.g., perfumes, colognes, aftershave). Some people have experienced the symptoms if they smell alcohol, apply it to their bodies (e.g., perfumes, colognes, aftershave). Alcohol should not be consumed during metronidazole therapy and one day after finishing therapy. Alcohol should not be consumed during metronidazole therapy and one day after finishing therapy. Other oral adverse effects include dry mouth, unpleasant or sharp metallic taste, glossitis, stomatitis, and a black-furred tongue. Other oral adverse effects include dry mouth, unpleasant or sharp metallic taste, glossitis, stomatitis, and a black-furred tongue. 17

18. Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Antiinfective Agents  Other Antiinfectives  Many other agents are available for nondental uses. Vancomycin Vancomycin Aminoglycosides Aminoglycosides Chloramphenicol Chloramphenicol Sulfonamides Sulfonamides Nitrofurantoin Nitrofurantoin Quinolones Quinolones  These antiinfectives share many of the same adverse effects as other antibiotics manifest. 18