ANTI INFECTIVES

• Formula for Pediatric Dose

  Weight x Therapeutic Dose x Available Dose
• Compute for the dosage of analgesic using 250mg/5ml

  15.4kg x 20mg/kg x 5ml/250 mg = 6.16 ml or 6 ml
• Prescription Writing

  • Analgesic
  • Antibiotics
• Anti-infectives


  Medicines that work to prevent or treat infections, they include anti bacterials, antivirals, antifungals and antiparasitic medications
• Anti-infectives have revolutionized healthcare and are now critical in curing and even helping to prevent many kinds of infection
• Infection


  Invasion of the body by pathogenic microorganisms and the reaction of the tissues to their presence and to the toxins
• How Microorganism Causes Infection

  • Virulence of the microorganism
  • Number of organisms present
  • Resistance to the host
• Factors Involve in the Appropriate Selection of Antimicrobial Drug

  • Microorganism must be isolated and identified
  • Microorganism's susceptibility to the drug
  • Location of infection
  • Cost of drug, adverse effect – possibility of patient allergic reaction
• Anti-Infectives in Dentistry

  • Prophylactic
  • Therapeutic
• Prophylactic Antibiotics

  For clinical situations that requires the use of antibiotic for the prevention rather than treatment of infections
• Situations requiring prophylactic antibiotics

  • Local infections, tx of odontogenic and non odontogenic infections
  • For immunocompromised patients, patients with cancer
  • For health patients undergoing surgery of benign tumors, periapical surgery, removal of impacted teeth
  • For pretreatment of patients undergoing dental extraction who have implanted prosthetic devices such as artificial heart valves to prevent seeding of the prosthesis
  • For patient with a history of rheumatic heart disease or congenital heart disease
  • For prophylaxis against infective endocarditis
• Therapeutic Antibiotics

  • Caries
  • Acute oral infections
  • Periodontal infections
• Dental Caries

  Streptococcus Mutans
• Antibiotics for caries

  Vancomycin and Kanamycin
• Oral infections

  • Abscess
  • Osteomyelitis
  • Soft tissue infections
• Antibiotics for Oral Infections

  Penicillin V
• Indication of Antibiotic in Dental Practice

  • Odontogenic infection
  • Non odontogenic infection
  • Local infections
  • Focal infection
• Odontogenic infections


  Caused by resident bacteria in the dental plaque, not primarily pathogenic, but in higher levels and at the wrong location may initiate and sustain infectious process
• Odontogenic Infections


  • Gram positive cocci and gram negative bacilli
  • Commonly presented by symptoms of pain and swelling in the oral area
  • Should be treated as soon as possible as it could lead to osteomyelitis, brain abscess, carotid infection, septicemia, meningitis
  • The most common feature is dentoalveolar abscess
• Treatment of Odontogenic infections

  • Surgical intervention (Incision and drainage, Debridement, Irrigation)
  • Endodontic therapy
  • Antibiotic prescription
• Non-Odontogenic Infections

  • Bacterial (Staphylococcus Aureus, B hemolytic A strep, Helicobacter pylori)
  • Fungi (Candida albicans)
  • Virus (Herpes simplex, mumps virus, Varicella zoster, Cytomegalovirus, HIV)
• Therapeutic Indication

  • The patient (Best defense against pathogens are host responses)
  • The infection (Virulence and invasiveness of the etiologic microorganism in producing an infection, Rapidly spreading infection – treated with antimicrobial agents, Localized infection - drainage)
• Prophylactic Indication


  • Without high risk (Healthy person) (Oral penicillin, Erythromycin – if with allergy)
  • High risk (Immunocompromised person) (Ampicillin + gentamycin parenterally, Vancomycin if allergic to Ampicillin + gentamycin)
• Therapeutic Spectra


  Refers to species of organism affected by the drug, Each drug is generally effective to only a limited number of pathogenic bacteria
• Types of Antibiotics

  • Bactericidal (Fast Killing)
  • Bacteriostatic (Slow Killing)
• Antibiotic Spectra

  • Narrow spectrum (Acting only on a single or limited group of microorganism)
  • Extended spectrum ((+) and a significant number of (-))
  • Broad Spectrum (Effective against (+) and (-))

  
• Antibiotic Classes

  • Beta Lactams (Penicillin, Cephalosphorins)
  • Macrolides (Erythromycin, Azithromycin, Clarithromycin)
  • Lincosamide (Clindamycin)
  • Flouroquinolones (Ciprofloxacin, Moxifloxacin)
  • Tetracycline
  • Nitroimidazole (Metronidazole)
• Duration of Dosage


  A patient should be given a sufficient amount of anti infectives to last for 2 days after the resolution of the symptoms of infection, but not so long as to produce side effects, suprainfection, or development of resistant organisms
• Typical Durations

  • Dental infection without complication – 5 to 7 days
  • Immunocompromised host – 2 weeks therapy
  • B hemolytic strep (Tonsillitis) – 10 days
  • Clindamycin for severe infection – 10 days
• Adverse Reactions Associated with Anti-Infectives

  • Hypersensitivity reactions (Immediate, Accelerated, Late)
  • Superinfection
  • Antimicrobial Resistance
• Superinfection


  is the process by which a cell that has previously been infected by one virus gets co-infected with a different strain of the virus at a later point in time.
• Common organisms in Superinfections

  • Clostridium difficile
  • MDR (Multi-Drug Resistant) gram-negative rods
  • MRSA (Methicillin-resistant Staphylococcus aureus)
  • Candida or other fungi
• Antimicrobial Resistance

  Drug loses its effectiveness due to indiscriminate use and unnecessary exposure, requiring substitution with another drug
• Innovative medicinal products (IMP) are defined as new chemical entities that have not been previously authorized by any regulatory authority worldwide.
• Hypersensitivity reactions ranging from urticaria to anaphylactic shock
• Immediate - less than 30 minutes, includes anaphylaxis, most serious danger to the patient (bronchoconstriction). Treatment is parenteral administration of epinephrine
• Accelerated - 2 to 48 hours, serum sickness and laryngeal edema
• Late - 3 or more days, including rashes and oral lesions (stomatitis, cheilosis, furred tongue)
• killing of normal flora removes the inhibitory effect of the normal flora (which produce antibacterial substances and compete for essential nutrients) This allows for the unhibited growth of potentially pathogenic bacteria and fungi.
• more broad spectrum the antibiotic and the more prolonged the therapy, the greater is the change in the normal flora, and the greater the chance that a single drug-resistant microo will proliferate and cause infections.