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Antibiotic use in odontogenic infection

Principles for the use of appropriate antibiotics :
Once the decision has been made to use antibiotics as an adjunct to treat an infection, antibiotics should be properly selected, the following guidelines are useful:
1. Identification of the causative organisms, this is determined either in the laboratory where the organism can be isolated from pus, or empirically based on the knowledge of the pathogenesis and the clinical presentation of specific infections.
2. Determination of the antibiotic sensitivity.

3. The use of specific, narrow spectrum antibiotic; for example; if the causative organism is Streptococcus, sensitive to Penicillin, Cephalosporin and Tetracycline then penicillin should be selected because it has the narrowest spectrum. The main advantages of using narrow spectrum antibiotic are; less opportunity to develop resistance and minimize the risk of superinfection.

4. The use of least toxic antibiotic. and various drug reactions.

5. Patient's drug history should be known, especially drug allergy and various drug reactions
6. It is imperative to know that the combat of the infection. Bacteriostatic antibiotics inhibit the growth and the reproduction of the bacteria usually by inhibiting protein synthesis, whereas bactericidal antibiotics kill the microorganisms by interfering with cell wall synthesis or nucleic acid synthesis.
The main advantages of bactericidal antibiotics are:
• Less reliance on the host resistance.
• Kill the bacteria.
• Work faster.
• Greater flexibility with dosage interval.


7. Cost of the antibiotic should be taken into consideration.
8. Antibiotics should be administered in proper dose and proper dose interval.
9. Proper dose of administration either; oral (most commonly used), intramuscular or intravenous.
10. The antibiotic administration should be continued for an adequate length of time.

12. A combination of antibiotic therapy is indicated in:

• When it is necessary to increase the antibiotic spectrum.
• To increase bactericidal effect against specific organisms.
• To prevent the rapid emergence of resistant bacteria.
• Severe, rapidly progressing infections.
Most odontogenic infections respond to a combination of Penicillin and Metronidazole.

Monitoring the patient

In the follow up appointments the clinicians should look for the following:
• Response to treatment.
• Recurrence of infection.
• Presence of allergic reaction.
• Toxicity reaction.
• Secondary infections.

Failure of antibiotic therapy may be attributed to:

• Inadequate surgical treatment.
• Depressed host defense.
• Presence of foreign body.
• Problems associated with the patient and antibiotic, like lack of patient's compliance and inadequate dose...etc.


The role of dentists in antibiotic resistance :
The cause of bacterial resistance is multi-factorial including:
1. Long term and repetitive use of broad spectrum antibiotics.
2. Intrinsic resistance.
3. Non-therapeutic use of antibiotics in agriculture.

Sinus formation

When the abscess is not drained properly and neglected for a sufficient period of time, it will burst and drain spontaneously leading to sinus formation in an unfavorable site, the sinus is puckered, thickened and depressed, if the source of infection is not treated the sinus will become chronic and it will be subject to exacerbations and remissions.

During the active phase, the sinus will exhibit signs of inflammation and may be tender while in the quiescence phase it heal over. Sinus excision, after treatment of the source of infection, is carried out through an elliptical incision around the external orifice of the sinus, the tract of the sinus is followed bluntly to its source on the surface of the bone of the mandible. The resulting defect is closed in layers to eliminate dead space, the skin is closed with careful eversion to ensure an acceptable scar.

Necrotizing fasciitis

Necrotizing fasciitis is a progressive, fulminant bacterial infection of subcutaneous tissue that spreads rapidly through the fascial planes causing extensive tissue destruction. It can affect any part of the body; it is a rare but potentially fatal condition.
Typically it occurs in the abdomen/perineum region after trauma or surgery but in 1-10% of the cases it occurs in the head and neck region. Prompt recognition and intervention is essential, as mortality is directly proportional to time to intervention.
Treatment is through surgery and antibiotics. Surgical debridement is of utmost importance, all necrotic tissue must be removed, the wound is washed by hydrogen peroxide and packed regularly. The antibiotic treatment should be directed by culture and antibiotic sensitivity test.


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رفعت المحاضرة من قبل: Mustafa Shaheen
المشاهدات: لقد قام 5 أعضاء و 224 زائراً بقراءة هذه المحاضرة








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