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1、Antibiotic Use In Dentistry,Kevin Nakagaki, D.D.S. Director, Hospital Dental Clinic University of Minnesota,Writing Prescriptions,Rx: Drug Name (can be generic) Unit Dose (ex: Pen V-K 500 mg, Elixer, Soln)Disp: # of pills, milliliters (ml)Sig: Directions for use. q24h (daily), q12h, q8h, q6h, q4h, p
2、rn pain, till goneRefills_ SignatureDEA #,General Rules,Write Legibly! Remember your audience (Generally non-docs) this will improve compliance. Preferable to order specific hourly dosage time (q12h vs. bid, q8h vs. tid, etc.) Sig: Specify # of pills to take each dose Prescribe an endpoint. (prn pai
3、n, till gone),Antibiotic Strategies,Cardinal Rules: 1) Use the right drug. 2) Use the right dose. 3) Use the correct dosing schedule. 4) Correct duration. Hard and FastEspecially early. Why? Use a loading dose to rapidly achieve therapeutic blood levels. Avoid combinations of bacteriostatic and bact
4、eriocidal drugs.,Considerations,Gram Positive? Gram Negative? Mixed Infection? Anaerobes?,Discussion: Antibiotic Choice,Narrow Spectrum? Extended/Broad Spectrum? Designer Antibiotics? Anaerobes? Consider if the infection is present 3days or if no improvement.,Narrow Spectrum Antibiotics,Specific for
5、 the pathogen. Fewer disturbances of non-pathogenic bacteria. Fewer side effects. Rapid response for sensitive organisms. Ex: Pen VK, Pen G, Erythromycin,Broad Spectrum Antibiotics,Affects both Gram + and Gram bacteria, better for mixed infections. May give up some effectiveness for Gram + to gain e
6、ffectiveness for Gram -. Examples: Amoxicillin, Ampicillin,Common Pathogens,Necrotic pulp and apical abscesses Obligate anaerobic bacteria Gram negative rods Prevotella & porphyomonas spp. Fusobacterium spp. Campylobacter rectus Gram positive rods Eubacterium spp. Actinomycetes spp. Gram positive co
7、cci Peptostreptococcus spp. Facultative anaerobic bacteria Gram positive cocci Strep and Entercoccus spp.,Common Pathogens,Periodontal Diseases Gingivitis Fuso, strep, & actinomycetes Adult peritonitisBacteroides, porphyomonas, peptostreptococcus & prevotella Acute necrotizing ulcerative gingivitis
8、Spirochetes, prevotella, fuso Localized juvenile periodontitis Actinobacillus,Common Pathogens,Fungal Infections Candida spp. Mucorales spp.,Lets Talk About Resistance,Three main types Chromosome mediated Spontaneous mutations Non-major form of drug resistance Rarely lead to complete resistance Plas
9、mid mediated (conjugation) VERY important from clinical standpoint Mostly gram negs Mediate resistance to multiple drugs High transfer rate from cell to cell Transposon (transduction and transformation) Phage mediated Clinically important for Gram +,Antibiotic Choices,-Lactams,Natural penicillins Pe
10、n VK and Pen G MOA: Inhibit cell wall synthesis Dose: 250-500 mg qid x 7-10 days Contraindications: Allergies Poor renal fxnAdverse events: GI upset Drug interactions: oral contraceptives Pregnancy category B,-Lactams,Natural penicillins Pen VK and Pen G Bactericidal Allergic reaction: rare (4 per 1
11、00,000) Spectrum: Strep, staph, enterococcus, neiseria, treponema, listeria Resistance: Mostly staph (80%),-Lactams,Amino-penicillins Amoxicillin, ampicillin MOA: Inhibit cell wall synthesis Dose: 250-500 mg q 8 h x 7-10 days Contraindications: Allergies Poor renal fxnAdverse events: GI upset Drug i
12、nteractions: oral contraceptives Amoxicillin and clavulanic acid (Augmentin),-Lactams,Amino-penicillins Amoxicillin, ampicillin Bactericidal “ampicillin” rash (4-10%) Spectrum: Strep, staph, enterococcus, neiseria, treponema, listeria, E. coli, proteus, H. Flu, shigella, salmonella Resistance: Enter
13、o, citro, serratia, proteus vulagris, provedincia, morganella, pseudomonas aeriginosa, acinetobacter,Cephalosporins,Cephalexin (Keflex) MOA: Inhibit cell wall synthesis Dose: 250-1000mg q 6 h x 7-10 days Contraindications: Allergies Poor renal fxn Adverse events: mild GI Drug interactions: probeneci
14、d Pregnancy category B,Cephalosporins,Cephalexin (Keflex) Bactericidal Spectrum: Gram + Resistance: Methicillin resistant gram + Low cross sensitivity with PCN,Lincosamides,Clindamycin (Cleocin) MOA: binds to the 50S ribosomal subunit and inhibits protein synthesis Dose: 100-450mg q 6 h x 7-10 days
15、Precautions: Poor hepatic fxn Adverse events: GI upset, pseudomembraneous colitis Drug interactions: neuromuscular blocking agents Pregnancy category B,Lincosamides,Clindamycin Bactericidal or static depending on concentrationSpectrum: Gram +, anaerobes, parasites Resistance Enteroccocus*Clostridium
16、 diff. pseudomembranous colitis!,Macrolides,Azithromycin (Zithromax), clarithromycin (Biaxin) MOA: bind to the 23S rRNA in the 50S subunit ribosome Dose: 250-500 mg/day x 5-10 days Precautions : Poor hepatic fxn Adverse effects: GI Drug interactions: Cytochrome P-450 (Remember Seldane?) Pregnancy ca
17、tegory B,Macrolides,Azithromycin, clarithromycin Bactericidal Spectrum: Gram +, gram -, anaerobes Resistance: B. fragilis, and strep pneumo,Tetracyclines,Doxycycline (Vibramycin) MOA: inhibit protein synthesis by preventing aminoacyl transfer RNA from entering the acceptor sites on the ribosome Dose: 100mg qd-bid x 7-14 days Contraindications: Food pregnancy Adverse events: GI Drug interactions: anti-epileptics Pregnancy category D,
