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Clinical Pharmacology > Antibiotics in Dentistry > Flashcards

Antibiotics in Dentistry Flashcards

1
Q

Should you first try a broad spectrum antibiotic or narrow?

A
  • Be specific, select the antibiotic with the narrowest antibacterial spectrum and the best history of being effect against the pathogen(s)
    • THis will avoid or reduce the potential for developingn resistant bacterial strains
    • Minimize the risk of secondary infections
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2
Q

What antibiotic has the potential for nephrotoxicitiy?

A

Tetracycline

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3
Q

Between bacterio_cidal_ and bacteriostatic antibiotics which are more clinically effective and effectively prevent the emergence of bacterial resistance?

A

No evidence that one is better than the other and this should not effect your decision in prescribing.

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4
Q

What is difference between bacteriocidal and bacteriostatic antibiotics?

A
  • Cidal = kill the bacteria
  • Static = inhibit growth and replication
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5
Q

What bacterial flora are most oral infections compromised of?

A

Mixed

  • Anaerobic predominate 2:1
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6
Q

Infections that are characterized by cellulitis tend to contain more … bacteria.

A

Aerobic

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7
Q

Infections that result in an abscess are predominately … in nature

A

Anaerobic

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8
Q

What are the 5 most frequent microorganisms present in orofacial infections (in decreasing order of frequency)?

A
  • Bacteroides (prevotella, porphyromonas sp.)
    • gram (-) rod
  • a-hemolytic streptococci (viridans group)
    • Only one that is aerobic
    • gram (+) cocci
  • Peptococci
    • ​gram (+) cocci
  • Peptostreptococci
    • ​gram (+) cocci
  • Fusobacterium
    • ​gram (-) rod
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9
Q

What are the indications for bacterial culture and antibiotic sensitivity testing? (7)

A
  • Non-responsive infections:
    • Current antibiotic therapy has produced no improvement within 48 - 72 hrs (especially after tx to reduce/eliminate the source of infection)
  • Rapid onset and/or rapid spread of an infection
  • Recurrent infection:
    • ​The initial infection has resolved and there has been a clinically infection-free period of 2 days - 2 weeks but a second infection occurs
  • Compromised host defenses
    • ​Infection in a pt that is immunocompromised and/or taking immunosuppressive drugs
  • Post-operative wound infection
    • ​Anything could have gotten into the wound and you need to know what
  • Osteomyelitis
  • Unusal pathogens are suspected, such as:
    • Actinomyces (sulfur-granule pus) , Mycobacterium (Hemoptysis), Histoplasmosis
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10
Q

The sensitivity of an isolate to a particular antibiotic is measured by establishing the …, which is the lowest antibiotic concentration that prevents growth of bacteria after a 18-24 hr incubation period.

A

Minimum Inhibitory Concentration (MIC)

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11
Q

What treatment coincides with a Diffusion Test (Kirby Bauer) Result of Sensitive?

A

Treatment with the antibiotic at standard dose is likely to be successful

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12
Q

What treatment coincides with a Diffusion Test (Kirby Bauer) Result of Intermediate?

A

Treatment is likely to be successful if an increased dose of the antibiotic is used

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13
Q

What treatment coincides with a Diffusion Test (Kirby Bauer) Result of Resistant?

A

Treatment is unlikely to be successul with the antibiotic irrespective of the dosage

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14
Q

Which AST can be used with more organisms?

A

Dilution Test

The disk diffusion mthod can be used only for certain common, rapidly growing organisms

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15
Q

What can neither AST test can be used for?

A

Obligate anaerobes

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16
Q

What levels is the disk diffusion method based on?

A

Serum Antibiotic levels

  • In certain body tissues (bone or body fluids) the concentration of the antibiotic may be considerably more or less thatn the serum concentration, and the results from the disk may be misleading
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17
Q

As a general rule, the concentration of the antibiotic in the blood should exceed the MIC by a a factor of …, to offset the tissue barriers that restrict access to the infected site.

A

2 - 8 times

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18
Q

As a general rule, the concentration of the antibiotic in the tissues should exceed the MIC by a factor of …, to reduce or prevent the emergence of a resistant subpopulation.

A

8 - 10 times

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19
Q

What is the persistent suppression of bacterial growth after a brief exposure (1 -2 hrs) of bacteria to an antibiotic even in the absence of host defense mechanisms, and even when the antibiotics concentration is well below the bacteria’s MIC?

A

Post-Antibiotic Effects (PAE)

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20
Q

What types of antibiotics typically have:

  • Short PAE ( 1 - 3 hrs) in gram (+) organisms
  • No PAE in gram (-) organisms
A
  • Beta-lactams (penicillins, cephalosporins)
  • Carbapenems
  • Clindamycin
  • Erythromycin
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21
Q

What types of antibiotics posses persisten (long) PAE?

A

The FAT CAM(era) is V(ery) long and persistant

  • Fluoroquinolones
  • Azithromycin
  • Tetracyclins
  • Clarithromycin
  • Aminoglycosides
  • Metronidazole
  • Vancomycin
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22
Q

What is the prinicipal that the rate and extent of microorganism killing remain unchanged regardless of antibiotic’s concentration?

A

Time-dependent

  • Once you hit MIC, inc the concentration doesn’t increase efficacy
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23
Q

What antibiotics are time-dependent?

A
  • Beta-lactams
  • Vancomycin
  • Erythromycin
  • Carbapenems
  • Clindamycin
  • Tetracyclines
  • Azole Antifungals
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24
Q

What is the principal that the rate and extent of microorganism killing are a function of the antibiotic’s concentration (bactericidal effect increase as the antibiotic’s concentration increases)?

A

Concentration-dependent

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25
Q

What antibiotics are concentration-dependent?

A

Typically exhibit a long PAE

  • Fluoroquinolones
  • Aminoglycosides
  • Metronidazole
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26
Q

What dosing should be considered for time-dependent antibiotics?

A
  • A supra-MIC serum antibiotic concentration for 40% - 50% of the duration of the dosage interval is usually considered a min effective threshold
  • The concentration of these antibiotics at the site(s) of the infection should (ideally) be maintained above the MIC for the entire time interval between repetitive doses
  • Pts must not skip doses, and they need to take their meds at the correct intervals
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27
Q

What is the concentration of the oral loading dose?

A

2 - 4 times the maintenance dose

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28
Q

When should an antibiotic loading dose be used?

A
  • The 1/2 life of the antibiotic is longer than 3 hrs
  • A delay of 12 hrs or longer to achieve therapeutic blood levels is unacceptable

i.e. penicillin

29
Q

What antibiotics do not require dose or interval adjustment in renal dysfunction?

A

Clindamycin and Azithromycin

Excreated via hepatic circulation not renal

30
Q

What 4 misconceptions lead to unnecessary prolonged use of antibiotics?

A
  • Prolonged antibiotic therapy destroys resistant bacteria
  • Prolonged antibiotic therapy is necessary to prevent rebound/recurrent orofacial infections
  • Antibiotic dosages and duration of therapy can be extrapolated from one infection to another
  • The antibiotic prescriber knows how long the infection will persist
31
Q

How many days of antibiotic tx do most orofacial infections typically require for satisfactory resolution (in conjunction with dental treatment that has been performed to reduce/eliminate the source of the infection)?

A

5 days

32
Q

When should clinical improvement of the infection be seen after initiation of antibiotics?

A

48 hrs

CLinically re-evaluate the pt 2 days after AB initiation

33
Q

How many days of antibiotic tx do pts with an immunosuppressive disease and/or taking immunosuppressive drugs (corticosteroids, antineoplastics) require?

A

May require an additional 3-5 days after clinical resolution of infection signs/symptoms

34
Q

Antibiotic therapy is usually indicated (along with appropriate tx) if an orofacial infection produces what acute signs and symptoms?

A
  • Swelling, suppuration (abscess)
  • Tenderness, redness (facial or cervical cellulitis)
  • Fever (> 100 ºF), chills
  • Trismus, dysphagia, respiratory difficulty
  • Other evidence of systemic involvement (lethargy, malaise)
35
Q

In what condition so the associated microbial flora often contain greater numbers of more invasive bacterial species (bacteroides) as well as penicillin-resistant bacteria?

A

Pericoronitis

36
Q

When treating acute pericoronitis what step should you do first?

A

Best to control or resolve any soft tissue or fascial space infection prior to surgically removing the 3rds to avoid a potentially serious post-surgical infection

37
Q

Should you treat pericoronitis with antibiotics?

A
  • Only in severe cases where tx can’t be accomplished due to trismus and there is a clear infection and fever.
  • Mild cases can be treated with irrigation debridement and possible local tissue excision
38
Q

What is the treatment for osteomyelitis of the jaws?

A

Surgical intervention in addition to antibiotic therapy

39
Q

What are the most frequently encountered causative organisms in osteomyelitis?

A

Staphylococci and Streptococci

40
Q

What is the treatment for soft tissue wounds?

A
  • If they can be adequately cleaned and closed, you can often tx without antibiotics
  • If the wound has been open for several hours, it should be considered infected and antibiotics may be needed
  • Bite wounds are particularly prone to infection and msut be closely monitored
41
Q

When is it okay to give antibiotics in conjunction with endodontic tx?

A

When the spread of infection is systemic and the pt is febrile (abscess, fever, malaise)

42
Q

What are the guidelines for the use of antibiotics in dentistry?

A
  • Determine if an infection is present:
    • Acute or chronic?
    • Localized or spreading (systemic complications)?
  • Evaluate the pts immune function/status:
    • ​Normal vs. severely immunocompromised
  • Evaluate the possibility of incision and drainage and/or elimination of the source of the infection:
    • ​Will intra/extraoral drainage remove suppuration and relieve tissue pressue?
    • Will extraction of the tooth, or extirpation of the pulp eliminate the source of the infection?
43
Q

Are antibiotics indicated for a Class I (clean) surgical wound?

A

No

44
Q

Are antibiotics indicated for a Class II (clean-contaminated) surgical wound?

A

Prophylactic antibiotics may be of benefit

  • Orthognathic surgery, placement of implants, bone grafting, and non-infected extractions
45
Q

Are antibiotics indicated for a Class III (contaminated) surgical wound?

A

Usually manage with pre-operative antibiotics

46
Q

Are antibiotics indicated for a Class IV (dirty) surgical wound?

A

Are often managed with preoperative and postoperative antibiotics

47
Q

What is the prophylactic antibiotic treatment used for implant placement?

A

Single dose of 2g amoxicillin, 1 hr pre-operatively

But others say no antibiotics should be used

48
Q

What antibiotic treatment before mandibular 3rd molar osteotomy surgical extraction significantly decreased the incidence of surgical site infection?

A

Single dose of 2 g of amoxicillin

49
Q

What antibiotic treatment before mandibular 3rd molar osteotomy surgical extraction significantly decreased the incidence of alveolar osteitis?

A

Single dose of 800mg Penicillin V

50
Q

For TMEs in cases where infection does NOT already exist, prophylactic antibiotics could be considered for who?

A
  • Those with co-morbid disease and/or taking drugs that may predispose to a higher risk for infection (poorly controlled Diabetes)
  • Extractions of partial or full bone impacted mandibular 3rd molars
51
Q

Should you give antibiotics to pts with mandibular jaw fractures?

A
  • 1 day pre-op or 1 dose intra-operatively
52
Q

What is the recommendation for antibiotic prophylaxis to prevent infective endocarditis and/or prosthetic joint infections?

A
  • Antibiotic prophylaxis 30 - 60 mins prior to bactermia producing invasive dental procedures
53
Q

What is the infective endocarditis prophylactic antibiotic regimens for oral administration?

A

Amoxicillin 2g, 30 - 60 mins before procedure

54
Q

What is the infective endocarditis prophylactic antibiotic regimens for pts unable to take oral medications?

A

Ampicillin 2 g, IM or IV

OR
Cefazolin or Ceftriaxone 1 g, IM or IV

55
Q

What is the infective endocarditis prophylactic antibiotic regimens for oral administration in pts allergic to penicillins or ampicillin?

A

Clindamycin 600 mg

OR

Azithromycin or Clarithromycin 500 mg

56
Q

What is the infective endocarditis prophylactic antibiotic regimens for pts unable to take oral medication and that are allergic to penicillins or ampicillin?

A

Clindamycin 600 mg IM or IV

57
Q

What is the prophylactic antibiotic regimens for the prevention of prosthetic joint infection for oral administration?

A

Amoxicillin 2 g

Same as Infective endocarditis

58
Q

What is the prophylactic antibiotic regimens for the prevention of prosthetic joint infection for pts unable to take oral medication?

A

Ampicillin 2 g IM or IV*

OR

Ceftriaxona 1 g IM or IV

* IM injections should be avoided in persons receiving anticoagulants

Similar to infective endocarditis (included cefazolin)

59
Q

What is the prophylactic antibiotic regimens for the prevention of prosthetic joint infection in pts allergic to oral penicillins or ampicillin?

A

Azithromycin or Clarithromycin 500 mg

(IE included Clindamycin)

60
Q

What is the prophylactic antibiotic regimens for the prevention of prosthetic joint infection for pts allergic to penicillins or ampicillin and unable to take oral medications?

A

Azithromycin or Clarithromycin 500 mg IV

61
Q

What type of diabetics are at an increased risk for infections?

A

Type I and/or poorly controlled diabetics

62
Q

What lab values for diabetics are associated with an increased risk of infection?

A

Mean serum glucose > 250

HbA1c > 9

63
Q

What are the indications for prophylactic antibiotic use in diabetic pts?

A

Poorly or uncontrolled Type I and Type II and are undergoing extensive surgical dental procedures may potentially benefit from peri-procedural antibiotic prophylaxis to help avoid infection during the post-op period.

64
Q

What hepatically metabolized antibiotics should we limit the dose of/not use in cirrhosis pts?

A
  • Macrolides
  • Clindamyacin
  • Metrondiazole
65
Q

What prophylactic antibiotic measures should be taken in CRF pts?

A
  • Decreasing the antibiotic dose or increasing the interval
  • Administering a new antibiotic dose immediately after dialysis
66
Q

In HIV pts at what point is antibiotic prophylaxis needed?

A

ANC is considered the best indicator

  • ANC (Absolute neutrophil count) is < 500/mm3, and/or
  • Total WBC count is < 2000/mm3, and/or
  • CD4+ cell count is < 200/mm3
67
Q

When should pts taking systemic corticosteroids be placed on antibiotic prophylaxis?

A

If they are taking 40 - 60 mg of prednisone, it could be masking the signs of inflammation.

  • Pts can take antibiotics on the day of OS and post-op until sufficient wound healing ~ 7 days
68
Q

In pts on antineoplastic drugs, when do we administer prophylactic antibiotics?

A
  • ANC < 500/mm3, and/or
  • Total WBC count < 2000/mm3, and/or
  • Pt is febrile ( > 101 °F) with neutropenia (ANC < 2000/mm3

Similar to HIV pts

Clinical Pharmacology (9 decks)

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