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Antibiotics use in Dentistry

Antibiotics use in Dentistry

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Published by Iyad Abou-Rabii

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Published by: Iyad Abou-Rabii on Jun 01, 2010
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03/21/2013

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Antibiotics in Dentistry
 
Iyad Abou Rabii DDS, OMFS, MRes, PhD
 
QASSIM UNIVERSITY 
 
 
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 Antibiotics in Dentistry
Iyad Abou Rabii DDS, OMFS, MRes, PhD
 A 
ntibiotic is a a chemical substance derivable from a mold or bacterium that can killmicroorganisms and cure bacterial infections
Best use of Antibiotics
Cardinal Rules:
1.
 
Use the right drug.2.
 
Use the right dose.3.
 
Use the correct dosing schedule.4.
 
Correct duration.5.
 
Use a loading dose to rapidly achieve therapeutic blood levels.6.
 
Avoid combinations of bacteriostatic and bacteriocidal drugs.
Chose well
1.
 
Narrow Spectrum?2.
 
Extended/Broad Spectrum?3.
 
Designer Antibiotics?4.
 
Anaerobes? Consider if the infection is present > 3days or if no improvement
Know your enemy (bateria)
1.
 
Gram Positive?2.
 
Gram Negative?3.
 
Mixed Infection?4.
 
Anaerobes?
Identify your weapon
1.
 
Specific for the pathogen.2.
 
Fewer disturbances of non-pathogenic bacteria.3.
 
Fewer side effects.4.
 
Rapid response for sensitive organisms. Ex: Pen VK, Pen G, Erythromycin5.
 
Affects both Gram + and Gram - bacteria, better for mixed infections.6.
 
May give up some effectiveness for Gram + to gain effectiveness for GramExamples: Amoxicillin, Ampicillin
Identify you patients
1.
 
Age, allergies, compliance, pregnancy risk2.
 
Patient function3.
 
Renal, hepatic, immunosuppresion, route applicability4.
 
Cost Brand name, length of course, alternatives?
 
 
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Prophylactic antibiotic
The goal of antibiotic prophylaxis in Odontology is to prevent the onset ofinfections through the entrance wayprovided by the therapeutic action, therefore it is indicated provided there is aconsiderable risk of infection,either because of the characteristics of the operation itself or the patient’s localor general condition.The physician’s criterion for choosing antibiotic prophylaxis or not must be basedon the benefit and the cost of the risk. In the last instance, the prophylaxisdecision is the choice of the physician, who will use the equation:risk = degree of damage x probability of experiencing it.To that aim, patients could be classified as:a)healthy patients,b) patients with local or systemic infection risk factors, andc) patients with post-bacteraemia focal infection risk factors.In healthy subjects, prophylaxis is based exclusively on the risk of the procedure.
Topical Antibiotics
Pharmaceutical Forms
Some topical antibiotics are available without a prescription and are sold inmany forms, including creams, ointments, powders, and sprays. Some widelyused topical antibiotics are bacitracin, neomycin, mupirocin, and polymyxin B.Among the products that contain one or more of these ingredients areBactroban (a prescription item), Neosporin, Polysporin, and Triple AntibioticOintment or Cream.Antibiotic mouthwash can be prepared by the patient by dissolving the contentsof 250 mg tetracycline capsule in 10 ml of water to give a 2% solution. It may bemore effective to add glycerol to the solution as a demulcent, this must be doneby pharmacist
.
 
Advantages
The value of topical antibiotics overweighs such risks in some cases. Tetracyclineis a useful topical antibiotics. As at 2% solution it’s often effective in reducingsecondary infection (and thus the discomfort) in cases of aphtous stomaitis,primary herpetic stomaitis, and all oral ulcerative conditions.Use of topical antibiotics is also seen to be helpful in acute chronic gingivitistreatment.
Disadvantages
There are inherent disadvantages associated with the use of topical antibioticsbecause of the possibilities of selection for resistant strains and inducinghypersensitivity reaction at the patient.
Use of Topical AntibiticsIndication

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