Antibiotic Prophylaxis Flashcards Preview

Oral Surgery Final > Antibiotic Prophylaxis > Flashcards

Flashcards in Antibiotic Prophylaxis Deck (21):
1

Metastatic Infection

Caused by surgical manipulation, transient bacteremia, distant susceptible site and infection

2

Subacute Bacterial EndoCardities (SBE)

Extraction produces bactermia -> Agglutinating antibodies bind bacteria -> clumped AB/Bacteria complex circulates -> Infect sterile thrombus on dz tissue or prosthetic material -> infection

3

Cardiac Conditions at Risk for SBE (pre-2007 guideline = antibiotic prophylaxis)

Always give antibiotic prophylaxis, not needed!
Prosthetic valve
Previous BE
Congenital (high flow) or acquired defect
RHD
Atherosclerotic Valve

4

Cardiac Conditions at Risk for SBE After 2007

Antibiotic prophylaxis given to only highest cardiac risk

Prosthetic Cardiac Valve
Previous Infective Endocarditis
Cardiac Transplant patients w/ valve defects

5

SBE and dentistry

13% of all SBE

97.5 streptococcal
95.5 after extractions

6

Situations Requiring Prophylaxis

Extraction
Root scaling/planing
Dental prophy (bleed)
Implant surgery
Endodontic therapy beyond apex
Retraction cord placement (Fixed)
Ortho bands (not brackets)
Intraligament injection (not IAN block or infiltrations)

7

SItuations not needed

Restorative Dentistry
Rubber Dam placement
Local anesthesia
Intracanal endo
Suture removal
IMpressions
Fluoride treatment
Radiographs
Shedding decidious teeth

8

Prophalyxis Regimen

Amoxicillin 2gm (50 mg/kg) per 1 hour pre-op

9

Why amoxicillin

More effective = same dose = high blood levels = longer half life = slower excretion

All to do with PK not spectrum

10

Allergy to PCN

Clindamycin 600mg (20mg/kg) 1 hour pre-op

Go to drug

Sometimes bad GI problems = Clarithromycin

11

Special Situations

Already on antibiotics = use different class of drug(if PCN, use clindamycin)

Non-coronary vascular grafts = wait until after 6 months

12

Special Situations Ctd

Heart transplant
Ventricular Shunt
AV dialysis Shunt
Other implantable cardiac devices
Forgot prophylaxis = wait 2 hrs

13

Total Joint Replacement

Chronic infection usually lead to bacteria emboli that can lead to infection.

Immunocompromised
Type 1 diabetics

14

AAOS Guidelines

Recommended prophylaxis for all patients w/ TJR undergoing any invasive dental procedure

In 2015 - prophylatic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection

15

TJR Prophylaxis Regiment

Amoxicillin or Cehpalexin 2 gm
Clindamycin 600mg PO or IV

16

Wound Infection Prophylaxis

Be best surgical technique

Asepsis
Gentle tissue handling
Good hemostasis
No dead space
Limit necrotic tissue
Limit foreign body

Clean wound infection rate is important quality indicator

17

WI Prophylaxis Principles

Most dental procedures dont have significant risk

Time antibiotic correctly - First dose before surgery, repeat dose at 1/2 therapeutic interval

Use 2x therapeutic dose!!

18

WI Prohpylaxis Principles

Correct antibiotic - effective against likely organism, least toxic, cidal drug

Use shortest effective exposure - 1 dose pre-op, repeat intra-op at half therapeutic interval (if long procedure), final dose after surgery

19

All you need to know about Antibiotic Prophylaxis

Significant risk
Choose correct antibiotic
Adequate Dose
Give before surgery
Stop immediately after surgery

20

Prevention of Dry socket (happens 7% of time)

Topical CHG rinses

Topical antibiotic within socket

21

Prophylaxis for Dentoalveolar Surgery

Poorly controlled metabolic dz
Immunosuppressed
Surgery longer than 3 hours
Contaminated wound
Insertion of major foreign body
Surgery adjacent to sinus (implant placement)
Bony impactions
Same regimen as SBE prophylaxis