Antibiotics are used in the management of many dental infections since decades. Antibiotics are requisite drugs for the management of oral and maxillofacial infections. They are used for the treatment of odontogenic infections, non- odontogenic infections and as prophylaxis against local infections spreading to surrounding tissues and organs. It has been estimated that 10% of all antibiotics prescriptions are linked to dental infections, the combination Amoxicillin-clavulanate is the most preferred antibiotic amongst dentists. The concurrent prescription of non steroidal anti-inflammatory drugs (NSAIDs) can slightly alter the bioavailability of antibiotics. Over the years various new concepts are been devised in the antibiotic usage, but there is a universal abuse of antibiotics in both medical and dental field.
The ultimate indication for the use of antibiotics is bounded and distinct. Pregnancy, kidney failure and liver failure are certain situations which demands special attention on the part of the professionals while indicating antibiotics.
Keyword : antibiotics, prophylaxis, infection
Antibiotics were first discovered in 1929 in the form of sulfa drugs (1935), penicillin (1941), tetracycline (1948), erythromycin (1952).
Endodontics and surgical therapy in cases like odontogenic infections, antibiotics are more judiciously used. Patients who are medically compromised such as diabetic or having organ transplants also require antibiotic coverage.
In case of dental infections, penicillin is the first drug of choice.
For avoiding less alterations in the gastrointestinal tract, narrow spectrum antibiotics are mainly preferred. Dilemma is often noticed among the dental practitioners concerning the use of antibiotics in dental practice.
Antibiotics act as an adjunct in cases of dental intervention. They are mainly indicated when clinical signs are visible. Antibiotics are majorly used in dental procedures which includes bleeding in the oral cavity. Also In immunocompromised cases and infections which are progressing rapidly antibiotics usage is vastly seen.
ODONTOGENIC INFECTIONS :
In cases of odontogenic infections, penicillin is the first drug of choice. They are more susceptible to gram positive bacteria (aerobes and anaerobes) and microorganisms found in alveolar and periodontal abscess also necrosis involving the pulp. Penicillin are more prone to both aerobic and anaerobic microorganisms. Infections caused by penicillinase producing staphylococcus, ampicillin like drugs are preferable.
Penicillin with clavulanic acid can be preferred for infections involving staphylococci, Streptococci and pneumococci.
Patients having resistance may be prescribed with clindamycin as the first choice of drug and also azithromycin and metronidazole. Since cephalosporin group falls under the broad spectrum antibiotics, it is advisable in delayed allergic reactions to penicillin where erythromycin is restricted. Tetracycline are important in cases of gingivitis as they are bacteriostatic in nature and inhibits the binding of Aminoacyl- t-RNA to the ribosomal acceptor site. Ciprofloxacin is mainly used in cases of endodontic infections. Therefore penicillin followed by clindamycin is more commonly used by health professionals.
NON ODONTOGENIC INFECTIONS :
Non odontogenic infections such as syphilis, tuberculosis, leprosy and other. Infections of bone which are non specific, for them, a prolonged antibiotic coverage is required. New antibiotics such as fluoroquinolones is the drug of choice for non odontogenic infections. Fluoroquinolones are prescribed in cases of joint infections, respiratory tract infection, urinary tract infection. They have a broad spectrum of action.
Tuberculosis require a prolonged duration of antibiotic therapy which consists of rifampicin, pyrazinamide, isoniazid, streptomycin and ethambutol. Penicillin G benzatine is used for the treatment for syphilis.
ANTIBIOTICS USAGE JN INFECTIVE ENDOCARDITIS :
Infective endocarditis is an uncommon and serious condition which may impose certain life threatening condition. An intricate sequence of events are involved with endocarditis.
The adherence of microorganisms is determined by various anatomic sites. Various research has found that dental procedures sometimes lead to infective endocarditis. Similarly a poor oral hygiene with compromised periodontal health impose as a risk factor.
Antibiotics therapy work by not only destroying the microorganisms but also inhibiting its adherence.
The first drug of choice includes high dose of amoxicillin in both children and adults, one hour prior to dental procedures.
2g of oral amoxicillin should be given to adults. In case of patients who are resistant to amoxicillin or B-lactamics, clindamycin can be given.
In patients with amoxicillin and penicillin resistance, first generation cephalosporin can be given.
Patients having prosthetic valves in heart, vancomycin and streptomycin is used. Negligence to administer proper antibiotics at time may lead to worst consequences for patients.
ANTIBIOTIC PROPHYLAXIS IN CASE OF LOCAL INFECTIONS :
Various surgical and medical conditions are routinely prescribed with antimicrobials which also includes impacted third molars,orthognathic surgeries, implants, periapical surgery, benign tumor surgery and immunocompromised patients. In case of endodontics, antibiotics should be prescribed in case of fever and signs of local infection.
Researches show that post operative pain reduce to certain extent after the usage of antibiotics in cases of removal of impacted third Molar.
Abu Taa et al compared the pre and post operative antibiotics in patients undergoing periodontal surgery. Amoxicillin is the preferred choice of drug after third molar removal in a dose of 2000 mg for five days. As the site of periodontal surgery is contaminated with microorganisms, it is highly recommended to use antibiotic coverage.
Immunocompromised patients are a special division for dental professionals as they are more prone to bactaremia which may lead to septecemia. In such cases dental extractions, deep periodontal cleaning is to be avoided as much as possible. Also, a hematologic, oncologic, and other microbiologist should be consulted with. Other Cases include dental implant placement, surgery related to tooth apex, intraligamentary local anaesthetic injections and subgingival placement of antibiotic fibers. In case of
Diabetic patients, antibiotics are also prescribed. Only when the risk factors are controlled the treatment can proceed.
Dental professionals play a vital role in treatment of medically compromised patients who undergo dental treatments as early diabetes is diagnosed during the treatment period.
It's the dentists job to be involved in the health care team and help in the reduction of the diseases.
Various studies have found the correlation between prosthetic joint infections and dental procedures.
Cephalexin 2g given one hour prior is suggested for patients who are non allergic to penicillin and clindamycin 600mg for them who are allergic to penicillin.
ANTIBIOTIC REGIMEN WITH PRECAUTIONS :
Antibiotics prophylaxis should be considered in kidney, liver failure and pregnancy with caution.
Renal failure affects the hard and soft tissues of mouth.
After organ transplants, consultation from the physician is strictly advised.
In case of prevention of adrenal crisis, additional need of corticosteroids is required.
Dose is increased to 30-40mg per day.
It is better to perform. Dental treatments after three months of surgery. Six months are considered best.
In case of invasive dental treatment antibiotics coverage is necessary.
To compensate with increased plasma drug concentration dose adjustments are required in case of kidney impairment.
Penicillin, clindamycin and cephalosporin are the preferred antibiotics. Periodontitis disturbs the Renal function in kidney transplant patient.
Patients are advised to get their dental procedures done on non dialysis days to ensure the the absence of heparin.
The six months just after the kidney transplant is considered to be unfavourable to do any treatment.
25 mg of hydrocortisone administered iv reduces the risk of adrenal crisis.
In case of liver failure dose of ethryomycin, clindamycin, metronidazole, and antitubercular drugs should be reduced.
Zinc supplements is to be prescribed to the patients to decrease health related issues In case of hepatic encephalopathy. Douglas et al in cases of liver failure have restricted the use of tetracycline and anti tuberculosis drugs. As tetracycline and aminoglycosides have teratogenic effect on foetus it is contraindicated. Shrout et al gave importance to antibiotic prophylaxis for pregnant patients as it decreases bacterial load of periodontal pathogens.
Azithromycin, cephalosporin, erythromycin, penicillin with or without beta lactamase inhibitors are prescribed cautiously during pregnancy. The use of NSAIDS during early pregnancy is involved with spontaneous abortion. Risk is also involved with use of diclofenac, naproxen, celecoxib, ibuprofen and rofecoxib alone or in combination. Every pregnant women is advised to get both medical and dental treatment during the period of pregnancy. Antibiotics are mandatory and essential in both medicine and dentistry. Penicillin is mostly the drug of choice in treatment of dental infections, patients having infective endocarditis, immunocompromised patients and dental procedures which may produce bactaremias. Physician consultation is required before any dental procedure in organ transplants and pregnant patients. Thereby certain complications can be avoided at ease. The prescription should de adjunct to dental treatment.
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