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Guidelines for Antibiotic Use by Dentists

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Show Notes

Slide 1 :

Guidelines for Antibiotics Use by Dentists Dr Najla Dar-Odeh Associate Professor in Oral Medicine University of Jordan

Slide 2 :

“ All antibiotics are potential poisons for some patients. Use them with care and thoughtfulness” (Long, 1951)

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Antibiotics are ‘‘societal drugs’’ that affect microbial resistance not only in the person taking the drug but also everyone else, because resistance genes are easily passed via personal contact, fomites, and human and animal refuse (Levy SB., 2002)

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Does Dental Profession Encourage Development of Antibiotic Resistance? Yes the use of increasingly broad spectrum agents crowding of the most vulnerable members of society in day care centres and nursing homes.(in some countries) over the counter use of antibiotics

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Unscientific Causes for Antibiotic Prescribing patient’s expectation of an antibiotic prescription, convenience and demand necessitated by the social background of the patients. Lack of time and pressure of workload

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Non-indicated Cases for Antibiotic Prescription acute periapical infection dry socket acute pulpitis chronic marginal gingivitis chronic periodontitis.

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guidelines Antibiotic therapy should be used as an adjunct to dental treatment and never used alone as the first line of care. Antibiotics are indicated when systemic signs of involvement are evident. Pain alone or localized swellings do not require antibiotic treatment. Fevers, malaise, lymphadenopathy or trismus are clinical signs that possible spread of the infection has occurred. A rapidly spreading infection or persistent infections

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Indications for the Use of Antibiotics in Dentistry oral infection accompanied by elevated body temperature, evidence of systemic spread, facial cellulitis and/or dysphagia. periodontal abscess acute nercotizing ulcerative gingivitis sinusitis pericoronitis

Slide 9 :

Prescriptions written in generic names are as efficacious as brand names, and produce cost savings.

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‘‘Hit hard and hit fast.’’ Paul Ehrlich (1913):

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Wrong ideas antibiotics should be used for a certain number of required days to ‘‘kill the resistant strains’ as the vast majority acquire their resistance via transposable elements that are preferentially transferred when antibiotics are used in sub-therapeutic doses or for long durations Finish the course : ideally the antibiotic is prescribed for 3-5 days with a sufficient loading dose

Slide 12 :

Generally, antibiotics used in dentistry are most effective when the organism is consistently exposed to the agent (time-dependent rather than concentration-dependent activity)

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Short Vs Long courses Short courses are preferred to long courses particularly when treating children. Children’s compliance with conventional courses is poor There is evidence that short courses of antibiotics, with appropriate treatment are adequate for resolution of dental infections

Slide 14 :

Adapted from Rubenstein E (2007)

Slide 15 :

Longer durations may result in selection of resistant strains reduction in the ability of the oral flora to resist the colonization of harmful micro-organisms which are not normal resident of the oral flora, thereby leading to superimposed infections by multi-resistant bacteria and yeasts.

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In the majority of patients 2 or 3 days of oral antibiotics, in doses recommended by the BNF, will suffice for acute dentoalveolar infections.

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The 2-dose 3 gm regimen of amoxicillin has been shown to be effective in certain situations.

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General Principles

Slide 19 :

make an accurate diagnosis; (2) use appropriate antibiotics and dosing schedules; (3) consider using narrow-spectrum antibacterial drugs in simple infections to minimize disturbance of the normal microflora, and preserve the use of broad-spectrum drugs for more complex infections

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Narrow-spectrum antibiotics Clindamycin Metronidazole Penicillin V

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Broad-spectrum antibiotics Amoxicillin (Semisynthetic Penicillin) Amoxicillin with Clavulanic Acid Ampicillin (Semisynthetic Penicillin) Cefadroxil (First- Generation Cephalosporin) Cefazolin (First- Generation Cephalosporin) Cephalexin (First- Generation Cephalosporin) Cephradine (First- Generation Cephalosporin) Azithromycin (Macrolide) Clarithromycin (Macrolide) Erythromycin (Macrolide) Tetracycline (Doxycycline, Minocycline)

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(4) avoid unnecessary use of antibacterial drugs in treating viral infections;

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(5) if treating empirically, revise treatment regimen based on patient progress or test results (6) obtain thorough knowledge of the side effects and drug interactions of an antibacterial drug before prescribing it

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Interactions with other drugs additional contraceptive precautions should be taken whilst taking a short course of a broad spectrum antibiotic and for 7 days after stopping. A patient taking warfarin, requiring antibiotics, should have their baseline INR determined before medication is started.

Slide 25 :

(7) educate the patient regarding proper use of the drug and stress the importance of completing the full course of therapy (that is, taking all doses for the prescribed treatment time).

Slide 26 :

Special Conditions

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Periodontal Disease Antimicrobial prescribing should be the exception rather than the rule and, in the majority of cases, only considered after conventional therapies have been unsuccessful.

Slide 28 :

Addy and Martin (2003) suggest the use of systemic antimicrobials on the following basis: As Adjuncts to mechanical therapy Acute periodontal conditions where drainage is impossible Local spread of infection Systemic upset Refractory and aggressive disease

Slide 29 :

In indicated cases of periodontal disease, the recommended dosage of amoxicillin and metronidazole is 250 mg amoxicillin and 200 mg metronidazole, three times a day for 7 days. The suggested alternative to amoxicillin in cases of known penicillin allergy is ciprofloxacin (250–500 mg twice daily).

Slide 30 :

The combination of metronidazole and amoxicillin is particularly advised for the treatment of indicated cases of chronic periodontal diseases.

Slide 31 :

Endodontics The treatment of acute and chronic infections of endodontic origin is primarily by operative intervention. When indicated, the antibiotic of choice may be cephalosporins or clindamycin

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Prophylaxis Although antibiotics treat infections, limited benefit has been demonstrated in preventing infections. The absolute risk rate for bacterial endocarditis after dental treatment even in at-risk patients is very low. Reliance on antibiotics alone, and particularly broad spectrum rather than specific antibiotics, may result in failure to control infections and encourage the development of resistant bacterial strains.

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The evidence for antibiotics acting to prevent infection from surgical wounds in the mouth is poor to non-existent

Slide 34 :

Parenteral and broad-spectrum antibiotics have an important role in the following patients with severe odontogenic infections those requiring major elective head and neck surgery management of medically compromised patients. Prophylaxis for third molar surgery

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Infective Endocarditis

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Dental Procedures Requiring Antibiotic Coverage (2007 Guidelines) All dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa Suture removal Extractions Periodontal procedures (scaling, root planing, probing, surgery, recall maintenance) Implant placement and remimplantation of avulsed teeth

Slide 37 :

Dental Procedures Requiring Antibiotic Coverage (2007 Guidelines) Endodontic instrumentation or surgery when beyond the apex Subgingival placement of antibiotic fibres or strips Intraligamentary local anaesthetic injections Prophylactic cleaning of teeth or implants Biopsies Placement of orthodontic bands

Slide 38 :

Amoxicillin remains the first choice, however it is recommended that administration of amoxicillin (and any other recommended antimicrobial) is 30-60 minutes before the procedure.

Slide 39 :

Alternatives to Penicillin although considered by most dentists to be the alternative to penicillin in penicillin-allergic individuals erythromycin is a weakly active, bacteriostatic antibiotic to most oral micro-organisms susceptible to acid degradation when taken orally resistance is a problem with erythromycin and can even develop during a course it has a high incidence of adverse effects such as nausea, vomiting, abdominal pain, diarrhoea and anorexia.

Slide 40 :

Conclusions Appropriate dental treatment, Analgesic therapy, Education of the patient will alleviate the patient’s symptoms and build trust in the doctor– patient relationship.

Slide 41 :

Thank You Thank You

	najla_dar_odeh@yahoo.com 1 Years ago. Category: Dental

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