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Oral Medicine > Antibiotic Prescribing & Resistance > Flashcards

Antibiotic Prescribing & Resistance Flashcards

1
Q

What does an endogenous infection mean?

A

An infection that arises form an individuals own microflora

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2
Q

What are aerobic bacteria?

A

Bacteria that grows in the presence of oxygen

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3
Q

What are capnophilic bacteria?

A

Bacteria that grows in the presence of carbon dioxide

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4
Q

What are facultative bacteria?

A

Bacteria that can grow in the presence OR absence of oxygen (as opposed to obligate aerobes)

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5
Q

What are anaerobic bacteria?

A

Bacteria that grows in the absence of oxygen

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6
Q

What colour stain will gram POSITIVE bacteria produce?

A

Purple

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7
Q

What colour stain will gram NEGATIVE bacteria produce?

A

Red (/pink)

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8
Q

What are the types of purulent dental infections?

A
  • Periapical abscess
  • Periodontal abscess
  • Ludwig’s Angina (& Severed Odontogenic Infections)
  • Osteomyelitis of the jaws (incl. bisphosphonate osteonecrosis)
  • Actinomycosis
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9
Q

What is Ludiwg’s Angina? What is the treatment for this?

A
  • Combination of abscess and cellulitis (inflammation of the underlying CT)
  • Affecting submandibular and sublingual spaces (bilaterally)
  • FOM raised and tongue pushed up & back, systemically unwell and often difficulty swallowing saliva
  • Airway at serious risk!
  • Surgical drainage and AB (usually IV)
  • Treat tooth/teeth that caused infection
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10
Q

What bacteria are commonly involved in Ludwig’s Angina?

A
  • Gram NEGATIVE bacilli (anaerobic)
  • Streptococcus anginosus
  • Anaerobic streptococci
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11
Q

What is osteomyelitis of the jaw? What is the treatment for this?

A
  • Infection of the bone of the maxilla and/or mandible
  • Spread of infection may be caused by decreased host immunity (diabetes), impaired vascularity of bone (radiotherapy, Paget’s), MRONJ, fractures (surgery)
  • IV AB –> Oral AB
  • Surgery (removal of infected bone)
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12
Q

What bacteria are commonly involved in osteomyelitis of the jaw?

A
  • Gram NEGATIVE bacilli (anaerobic)
  • Streptococcus anginosus
  • Anaerobic streptococci
  • Staphylococcus aureus (‘clumps of grapes’ on stain)
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13
Q

What is cervico-facial actinomycosis? And what is the treatment for this?

A
  • Persistent low grade infection with multiple sinuses
  • Usually caused by dental infections, trauma
  • Surgical drainage and removal of necrotic tissue
  • AB: Amoxicillin (500mg 3x daily up to 6 weeks), alternative –> Doxycyline (100mg 1x daily)
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14
Q

What bacteria is commonly associated with cervico-facial actinomycosis?

A

Actinomyces israelii

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15
Q

What is a periapical abscess? What is the treatment for this?

A
  • Dental infection resulting in the collection of pus around the apex of a tooth
  • Tooth usually TTP and non-vital, may be discoloured with hx of trauma/ RCT
  • XR = loss of lamina dura
  • Drainage of pus: via root canal, incision of fluctuant abscess, extraction (LA/GA)
    • -> Palatal/ buccal abscess can be drained via incision of overlying mucosa
  • Cover AB: IF SYSTEMIC INVOLVEMENT
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16
Q

What is a periodontal abscess? What is the treatment for this?

A
  • Dental infection arising from pre-exisitng pocket
  • Tooth usually painful on lateral movements, vital, may be mobile
  • XR = loss of alveolar crest
  • Drainage of pus: incision on overlying mucosa
    • -> Cover AB: IF SYSTEMIC INVOLVEMENT
  • Mechanical debridement to eliminate pocket
  • Extraction
17
Q

What is SIRS?

A

Systemic Inflammatory Response Syndrome

18
Q

What are the criteria for SIRS?

A

Two or more of the following:

  1. Temp <36 OR >38
  2. Pulse >90/min
  3. Resp rate >20/min (or PaCO2 <4.3)
  4. WCC <4 or >12
19
Q

What is sepsis?

A

SIRS + infection (suspected/ confirmed)

20
Q

What is severe sepsis?

A

Sepsis + organ dysfunction

21
Q

What is septic shock?

A

Low BP (‘shock’, due to sepsis) + unresponsive to fluid resuscitation

22
Q

What is ‘Sepsis 6’?

A

Criteria designed to reduced rate of mortality of pts with sepsis

  1. O2 saturation of 94%
  2. Take blood cultures
  3. IV ABs
  4. Measure serum lactacte and send FBC
  5. Start IV fluid resus
  6. Measure urine output
23
Q

What are the main targets of ABs?

A
  • Cell wall synthesis (beta-lactams)

- DNA replication (metronidazole)

24
Q

Define ‘Pharmacokinetics’

A

Encompasses ALL mechanisms by which body metabolises drug

25
Q

Define ‘Pharmacodynamics’

A

Time course of antimicrobial activity

26
Q

What is MIC?

A

Minimum Inhibitory Concentration = used to determined bacteria susceptibility

27
Q

What is AB resistance?

A 
LAB = bacterial suspensions VS antibacterial MIC
CLINICALLY = infection highly unlikely to respond to max dose of AB
28
Q

What are the mechanisms for AB resistance?

A
  1. Altered target sites
  2. Enzymatic inactivation (of AB)
  3. Decrease uptake
  4. Increased efflux i.e. active pumping to eliminate AB
29
Q

What are some signs of systemic involvement in dentoalveolar infections?

A
  • SIRS
  • Gross swelling
  • Trismus
  • Regional lymphadenopathy
  • Tachycardia
30
Q

What is the first line of AB cover? (Acute)

A
  • Amoxicillin 500mg (1 capsule 3x daily for 5 days)
    • Severe infection; 1,000mg 3x daily i.e. 2 capsules
  • Metronidazole 200mg (1 tablet 3x daily for 5 days)
    • Severe infection; 400mg 3x daily i.e. 2 tablets
  • Phenyoxymethylpenicillin 250mg (2 tablets 4x daily for 5 days)
    • Severe infection adults; 1,000mg 4x daily i.e. 4 tablets
31
Q

what is the second line of AB cover?

A

Check diagnosis, refer or speak to specialist…
Used if pt do not respond to first line of AB (but no adv)

If no response to Amoxicillin or Metronidazole …

  1. Clindamycin 150mg (1 capsule 4x daily for 5 days)
  2. Co-amoxiclav 250/125 (1 tablet 3x daily for 5 days)
  3. Clarithromycin 250mg (1 tablet 2x daily for 7 days)

Oral Medicine (13 decks)

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