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Antibiotic Use in Orofacial Dental Infection

Antibiotic Use in Orofacial Dental Infection. 台北榮民總醫院 牙科部 Speaker 陳雅薇 Moderator 羅文良 大夫. INTRODUCTION. This presentation will review the evaluation and management of orofacial infections with emphasis on: ■ Assessment of the Patient

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Antibiotic Use in Orofacial Dental Infection

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  1. Antibiotic Use in Orofacial Dental Infection 台北榮民總醫院 牙科部 Speaker 陳雅薇 Moderator 羅文良 大夫 VGH-TPE

  2. INTRODUCTION • This presentation will review the evaluation and management of orofacial infections with emphasis on: ■ Assessment of the Patient ■Diagnosis and Treatment of infection ■Antibiotic Therapy ■Indications for Prophylaxis ■Antifungal Agent VGH-TPE

  3. ASSESSMENT • Requires a complete medical history and exam of the head and neck region with awareness to systemic factors as part of a comprehensive dental examination • Identify local and/or systemic signs and symptoms to support the diagnosis of infection: <erythema, warmth, swelling, and pain > < malaise, fever ( >38 c), chills > • Loss of function < dysphagia, trismus, dyspnea > VGH-TPE

  4. ASSESSMENT (CON’T) • Systemic signs of infection < BP ↓ < WBC ↑ < CRP ↑ < urine output ↓ VGH-TPE

  5. DIAGNOSIS: Infection • Determine etiology > odontogenic > trauma wound, animal bite > TB, fungi, actinomycoses VGH-TPE

  6. DIAGNOSIS (CON’T) • Determine cellulitis versus abscess VGH-TPE

  7. TREATMENT of INFECTION • Remove the cause of infection is the most important of all, by either spontaneously or surgically drain the pus. • Antibiotics are merely an adjunctive therapy. Drainage Host defense Antibiotics VGH-TPE

  8. INDICATION for ANTIBIOTICS 1. Severity of the infection • Acute onset • Diffuse swelling involves fascial spaces 2. Adequacy of removing the source of infection • When drainage can’t be established immediately 3. The state of patients’ host defense • When the patient is febrile • Compromised host defenses • For prophylaxis VGH-TPE

  9. MICROBIOLOGY • Most oral infections are mixed in origin consisting of aerobic and anaerobic gram positive and gram negative organisms • Anaerobes predominant (75%) VGH-TPE

  10. COMMONLY USED A/B • Mechanism of the antibiotics VGH-TPE

  11. COMMONLY USED A/B 1. Groups ofPenicillin • 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 VGH-TPE

  12. 2. Cephalosporin • More resistance to penicillinase • G(+) cocci, many G(-) rods • Third generation: Pseudomonas aeruginosa • Second choice (less effect for anaerobes) VGH-TPE

  13. 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 VGH-TPE

  14. 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 VGH-TPE

  15. 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 VGH-TPE

  16. 6. Vancomycin • G(+), most anaerobes, some G(-) cocci (Neisseria) • Given intravenously, BP should be monitored • Adjustment of dosage in renal dysfunction • Use as a substitute for penicillin in the prophylaxis of the heart valve p’t VGH-TPE

  17. 7. Chloramphenicol • Wide spectrum, highly active against anaerobes • Limited to severe odontogenic infection threatening to the eye or brain • Severe toxicity VGH-TPE

  18. 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, VGH-TPE

  19. 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 VGH-TPE

  20. SELECTION of A/B • Use Empiric therapy routinely • 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 VGH-TPE

  21. Empiric Antibiotics in OMF Infection ■ First-line Penicillin 3MU IVA q6h -> Cefazolin 1000mg q6h Gentamycin 60-80mg IVA q8h-q12h ■Second line (3A) Augmentin 1200mg q8h + Amikin 375mg q12h + Anegyn ■Mild infection Amoxicillin 250mg #2 PO q8h Clindamycin 300mg PO q6h VGH-TPE

  22. Side Effect of Commonly Used Antibiotics VGH-TPE

  23. PROPHYLAXIS • Indications Updated JADA 2004 VGH-TPE

  24. PROPHYLAXIS (CON’T) • Dental procedures recommended for prophylaxis Updated JADA 2004 VGH-TPE

  25. PROPHYLAXIS (CON’T) • Regimen Updated JADA 2004 VGH-TPE

  26. 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 VGH-TPE

  27. Parmason Gargle • 0.2% Chlorhexidine gluconate • Against G(+), G(-), fungus • Reduce pain and inflammation, enhance healing • Indication: immunocompromised patient, C/T R/T (prophylaxis mouthrinse reduce oral mucositis) • Use: 2-3 times daily,10-20cc/ time, 20-30sec. VGH-TPE

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