4 general considerations before prescribing antibiotic
- Determine if there is a clear indication for antibacterial therapy
- Patient’s health status
- Select best antibiotic
- Decide on dosage of regimen and overall duration of therapy
- Is the infection life-threatening?
- Will pt be compliant?
- Can they afford medication?
3 considerations to determine if there is a clear indication for antibacterial therapy
- Systemic symptoms
- Signs and symptoms that may progress to systemic levels
- Oral soft tissue swelling appears to be spreading into surrounding tissues
5 systemic symptoms
- Malaise
- Fever
- Chills
- Swelling
- Erythema of the skin
3 considerations for the patient’s health status prior to prescribing antibiotic
- Systemic considerations (diabetes, immunosuppression, renal failure, liver failure, pregnancy)
- History of adverse drug reactions
- Potential drug-drug interactions
4 things to consider in order to select best antibiotic
- Narrow spectrum
- Low toxicity
- Cost
- Selection based on micobiological culture and sensitivity tests when available (if in hospital setting)
6 signs/symptoms for which one should go to the hospital emergency
- Can not swallow liquids (dehydration)
- Can not swallow pills
- Vomiting (loss of medication)
- Difficulty breathing (airway obstruction)
- Decreased level of consciousness (not oriented to time and day)
- Rapidly spreading infection
4 things to check at follow-up appoointment in 48 - 72 hours
- Determine if pt is getting better
- Measure temperature
- Assess level of consciousness
- Monitor for adverse drug effects (skin rash, diarrhea)
First choice for treatment of odontogenic infections
Penicillin unless allergy
- Penicillin V (potassium) –> APO-PENVK or PEN VEE K
- 300 or 600 mg q6h for 5-10 days
- NOTE: may use loading dose of 600 mg
Dosage form of penicillin V available
300 mg tabs
Treatment of severe odontogenic infection with penicillin V
600 mg q6h x7 days
NOTE: caution for elderly or frail pt –> 300 mg may be safer
Alternative for treatment of odontogenic infection if compliance to penicillin dosing regimen is an issue (2nd choice antibiotic)
Amoxicillin 500 mg q8h 7-10 days
Available dosage form of amoxicillin
250 mg or 500 mg caps
Contraindication for amoxicillin prescription
Penicillin allergy
Antibiotic regimen for resistant odontogenic infections (not usually prescribed in private practice without culture and sensitivity results)
- Amoxicillin/clavulanic acid (CLAVULIN)
- 250/125 mg q8h OR
- 500/125 q12h x 7-10 days
CLAVULIN regimen for more severe resistant odontogenic infections
500/125mg q8h or 875/125 q12h x 7-10 days
3 things to do if no signifiant improvement in patient’s odontogenic infection symptoms in 48-72 hours
- Refer patient to hospital
- Consider adding an additional antibiotic (metronidazole)
- Do not stop penicillin or amoxicillin
When to prescribe metronidazole for odontogenic infections
If no significant improvement noted in 48-71 hours
NOTE: add to penicillin or amoxicillin. good for management of chronic infections with obligate anaerobic bacteria
Metronidazole prescription for treatment of odontogenic infection
- Metronidazole
- 250 mg q6h x 7 days
NOTE:if added to amoxicillin, prescription would be q8h
Dosage form available for metronidazole
250 mg tabs
Indication for clindamycin
Serious infections, including possiblity of osteomyelitis
Clindamycin prescription for serious dental infections
- Clindamycin 300 mg q6h x 7 days
- May be prescribed for 10 days and dose may vary from 150-450 mg
Dosage forms available for clindamycin
150 or 300 mg caps
3rd choice for treatment of odontogenic infections (allergy to penicillin with relatively mild infection)
Other macrolides:
- Azythromycin (ZITHROMAX)
- 500 mg (single dose) day 1;
- then 250 mg qd x 4 days
- Clarithromycin (BIAXIN)
- 250-500 mg bid x 7 days
Dosage form available for azithromycin
250 mg tabs
