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TREATMENT of INFECTION
Remove the cause of infection is the most important of all, by either spontaneously or surgically drain the pus.
Antibiotics are merely an adjunctive therapy. Drainage
■ Assessment of the Patient ■ Diagnosis and Treatment of infection ■ Antibiotic Therapy ■ Indications for Prophylaxis ■ Antifungal Agent
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ASSESSMENT
Requires a complete medical history and exam of the head and neck region with awareness to systemic factors as part of a comprehensive dental examination
Host defense
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Antibiotics
INDICATION for ANTIBIOTICS
1. Severity of the infection
Acute onset Diffuse swelling involves fascial spaces
2. Adequacy of removing the source of infection
Loss of function < dysphagia, trismus, dyspnea >
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ASSESSMENT (CON’T)
Systemic signs of infection < BP ↓ < WBC ↑ < CRP ↑ < urine output ↓
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Penicillinase-resistant: oxacillin, dicloxacillin Extended spectrum: ampicillin, amoxicillin Combine β-lactamase inhibitor: augmentin
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2. Cephalosporin More resistance to penicillinase G(+) cocci, many G(-) rods Third generation: Pseudomonas aeruginosa Second choice (less effect for anaerobes)
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MICROBIOLOGY
Most oral infections are mixed in origin consisting of aerobic and anaerobic gram positive and gram negative organisms
Anaerobes predominant (75%)
First generation Second generation Third generation Forth generation
Cefazolin U-SAVE-A Tydine
Keflor Ucefaxim
Claforan
Cefepime
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3. Clindamycin G(+) cocci Bacteriostatic -> bactericidal Second-line drug: should be held in reserve to
Identify local and/or systemic signs and symptoms to support the diagnosis of infection: < erythema, warmth, swelling, and pain > < malaise, fever ( >38 c), chills >
When drainage can’t be established immediately
3. The state of patients’ host defense
When the patient is febrile Compromised host defenses For prophylaxis
Antibiotic Use in Orofacial Dental Infection
台北榮民總醫院 牙科部 Speaker 陳雅薇 Moderator 羅文良 大夫
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INTRODUCTION
This presentation will review the evaluation and management of orofacial infections with emphasis on:
DIAGNOSIS: Infection
Determine etiology > odontogenic > trauma wound, animal bite > TB, fungi, actinomycoses
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DIAGNOSIS (CON’T)
Determine cellulitis versus abscess
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COMMONLY USED A/B
Mechanism of the antibiotics
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COMMONLY USED A/B
1. Groups of Penicillin First choice for odontogenic infection G(+) cocci and rod, spirochetes, anaerobes 0.7~10% hypersensitivity => PST Nature: penicillin G (IV), penicillin V (PO)