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26 Cards in this Set
- Front
- Back
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Signs of infection
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Local
- Rubor, Tumor, Dolor, Calor, Suppuration. -Pain is more of a sign of acuity than infection Systemic - Fever, chills, lethargy, rigors - Diabetic patients will often report difficulty in managing their blood sugar |
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Common culprits of Dental Abscesses
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Faculative anaerobes - Strep viridians, and Anginosus groups
Anaerobes - Prevotella and Fusobacterior Treponema and Anaerobic Gram-positive rods - Bulleidia extructa, Cryptobacterium Curtum, Mogibacterium Timidum |
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Common culprits of Sialadenitis
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Bacterial
- Staph A - Strep viridians, pyogenes, E.Coli - Haemophilus - **Pseudomonase and Group B have rarely been implicated in submandibular sialadenitis Virus - Mumps, HIV, Coxsackie, Parainfluenza, Influenza, Herpes |
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Antibiotics in dental practice
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Beta Lactams
- Penams - Cephalosporins Macrolides Lincosamides Tetracyclines Quinolones |
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Beta Lactams
Members Characteristics |
Penams - Penicillins and Derivatives
Cephalosporins - Cephems Monobactams Carbapenems - Inhibits bacterial cell wall synthesis by binding to Pen Binding Proteins - Blocks final transpeptidation step in cell wall synthesis |
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Pen VK
Characteristics Dosing Impairment Pearls Side effects |
- First line agent in dental infection
- Used for abscess, cellulitis, SUPPURATIVE pulpitis, and pericoronitis Dosing Adults - 500mg QID x 7days Pediatric - 10 mg/day TID x 7 days Renal impairment - 10-50ml/min give every 8-12hrs - <10mL/min give every 12-16hrs - Food, especially citric foods decrease drug absorption and serum concentration ***- Not appropriate for endocarditis prophylaxis*** - Pregnancy risk factor B - GI problems: Diarrhea, vomiting, nausea, candidiasis - Convulsions, fever, hemolytic anemia, acute interstitial nephritis, Hypersensitivity reactions, Anaphylaxis |
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Pen VK prescription
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Name
Penicillin VK 500mg Disp 28 Take 1 PO QID 7days Signature |
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Amoxicillin
Characteristics Dosage Pearls |
Common therapeutic alternative to PenVK
- Preferred prophylaxis agent for total joint replacements and SBE - First line for sinusitis and sinus bacteria. - NO staph coverage Dosage - 875mg BID x7d - 2g PO 1hr before procedure for prophylaxis Pearls - Higher percentage of patients with infectious mono develop a rash - Chewable tablets contain Phenyalanine. So be aware of PKU patients - ** Unlike PEN VK, ok to take with food. - Small amount enters breast milk so use with caution |
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Amoxicillin Prescription
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Name
Amoxicillin 500mg Disp 21 PO TID x7d Signature |
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Ampicillin
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Similar to Amoxcillin but has lower blood levels compared to Amoxicillin after oral admin so more time sensitive for adult dosing.
- 250-500mg every 6hrs - 2g IV for Endocarditis infective prophylaxis - 2g IM for total joint replacement patients |
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Augmentin
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Now almost useless because its used so much
- Amoxicillin with Clavulanic Acid - Clavulanic acid inactivates beta-lactamases - Can be used for skin infections and bug bits. Pasteurella - Extremely over used Dosage: 875mg BID *- Pregnancy category B but increased risk of Necrotizing Enterocolitis in newborns have been noted after maternal use |
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Dicloxacillin
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Useful for treating Suppurative Sialadenitis
- Pneumonia, skin and soft tissue infections, and osteomyelitis by Penicillinase producing staph. - 125-500mg QID infection - Must take 1hr before or 2hr after meals. |
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Cephalexin (Keflex)
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First generation Cephalosporin
- Staph coverage - Effective against infective endocarditis 2g - but in practice, doesn't work well for dental infections especially of surgical management is being delayed *** - Crosses placenta and produces therapeutic concentrations in fetal circulation and amniotic fluid - Effective against anaerobic but sensitivity of alpha-hemolytic strep vary. |
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Allergy PCN and Ceph
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- How bad was reaction and how quick?
- If PCN was mild rash with no edema, there is only 1% chance of cross reactivity - If its anaphylactic reaction with immediate onset, 1/5 people will have cross-reactivity |
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Keflex Cephalosporin prescription
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Name
Cephalexin 500mg Disp 28 Take 1 PO QID x 7d Signature |
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Macrolides
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Protein synthesis inhibitors
- Binds to 50S subunit P site - Slightly wider spectrum than penicillin - Common substitute for PCN allergy - Mainly bacteriostatic **- Brutal GI upste **- Have some anti-inflammatory properties Erythromycin, Azithromycin, Clarithromycin. |
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Erythromycin
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Fallen out of favor due to GI upset
- Can cause Rhabdomyolysis if used with Statins 500mg QID x 7d |
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Azithromycin
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Frequently given in dose pack
- Good for sinus bugs and pneumonia. Fair coverage for dental infections and can be used for skin infections - Less drug interactions than Erythro and Clarithro - Derived from Erythro and has increased gram negative coverage - 500mg day one and 250mg days 2-5 - 500mg daily x 3days sinusitis - 500mg PO 1hr before procedure. Off label - 10 days of coverage with 5 days of pills. Also has anti-inflammatory effects as well |
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Clarithromycin
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Developed to be more acid stable than Erythro
- Short term therapy in CAD patients may cause higher mortality - Coverage spectrum similar to Azithro by with many more drug interactions - Theoretically can also cause Rhabdomyolysis like Erythromycin 500mg 1hr prior to procedure |
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Lincosamide
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- Bacteriostatic
- Structurally different but functions similar to macrolides - Some cross over in microbial resistance between Macrolides and Lincosamides but not cross in patient allergy |
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Clindamycin
Characteristics Dosing Pearls |
- First line agent of dental infection treatment in penicillin allergic patients
- Recommended for above the diaphragm. Flagyl below - Penetrates Bone and urine well. - Absorbs quickly - 300mg TID for 7 days - SBE 600mg 1hr prior - Elderly have higher risk of developing colitis - Can be taken with food and give full glass of water to minimuze esophageal ulceration - Take 2 hours before bed with lots of water - If pain drink full cup of water, sit up 45deg |
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Clindamycin prescription
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Name
Clindamycin 150mg Disp 42tabs Take ii tabs PO Q8H x 7d |
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Quinolones
Characterstics Side effects Members |
- Inhibit DNA topoisomerase
- Should not be used in pediatric patients or in pregnant patients - Seldom use in dental infection treatment unless no other options exist **- Can cause tendon inflammation and rupture which may occur even after discontinuation. Neuropathies are another finding - Ciprofloxacin - Use with metronidazole to treat acute periodontitis - Levofloxacin - Respiratory quinolone used to treat skin infections - Moxifloxacin - Respiratory quinolone used for severe orofacial infections |
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Tetracyclines
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Protein synthesis inhibitors
- Binds to 30S subunit - Doxycyclin is tetracyclin of choice due to better GI absorption and less interactions *- Beware of Phototoxicity and Pseudotumor *- Outdated Tetracycline can cause SEVERE nephrotoxicity, nausea, vomiting, acidosis, and proteinuria |
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Doxycycline
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- 100mg PO BID for periodontitis
- Being studied for MRSA - Not great for dental abscesses |
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Tetracycline prescription
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Adult: Empty stomach
- 1hr prior to or 2hrs after means - 250-500mg every 6 hrs - Pediatrics only used to treat malaria |
