--口腔牙科的抗生素应用(英文PPT)
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Penicillinase-resistant: oxacillin, dicloxacillin Extended spectrum: ampicillin, amoxicillin Combine β-lactamase inhibitor: augmentin
VGH-TPE
2. Cephalosporin More resistance to penicillinase G(+) cocci, many G(-) rods Third generation: Pseudomonas aeruginosa Second choice (less effect for anaerobes)
DIAGNOSIS: Infection
Determine etiology > odontogenic > trauma wound, animal bite > TB, fungi, actinomycoses
VGH-TPE
DIAGNOSIS (CON’T)
Determine cellulitis versus abscess
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
VGH-TPE
INTRODUCTION
This presentation will review the evaluation and management of orofacial infections with emphasis on:
■ Assessment of the Patient ■ Diagnosis and Treatment of infection ■ Antibiotic Therapy ■ Indications for Prophylaxis ■ Antifungal Agent
VGH-TPE
ASSESSMENT
First generation Second generation Third generation Forth generation
Cefazolin U-SAVE-A Tydine
Keflor Ucefaxim
Claforan
Cefepime
VGH-TPE
3. Clindamycin G(+) cocci Bacteriostatic -> bactericidal Second-line drug: should be held in reserve to
Loss of function < dysphagia, trismus, dyspnea >
VGH-TPE
ASSESSMENT (CON’T)பைடு நூலகம்
Systemic signs of infection < BP ↓ < WBC ↑ < CRP ↑ < urine output ↓
VGH-TPE
Host defense
VGH-TPE
Antibiotics
INDICATION for ANTIBIOTICS
1. Severity of the infection
Acute onset Diffuse swelling involves fascial spaces
2. Adequacy of removing the source of infection
Identify local and/or systemic signs and symptoms to support the diagnosis of infection: < erythema, warmth, swelling, and pain > < malaise, fever ( >38 c), chills >
VGH-TPE
COMMONLY USED A/B
Mechanism of the antibiotics
VGH-TPE
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)
When drainage can’t be established immediately
3. The state of patients’ host defense
When the patient is febrile Compromised host defenses For prophylaxis
VGH-TPE
MICROBIOLOGY
Most oral infections are mixed in origin consisting of aerobic and anaerobic gram positive and gram negative organisms
Anaerobes predominant (75%)
VGH-TPE
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
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
VGH-TPE
2. Cephalosporin More resistance to penicillinase G(+) cocci, many G(-) rods Third generation: Pseudomonas aeruginosa Second choice (less effect for anaerobes)
DIAGNOSIS: Infection
Determine etiology > odontogenic > trauma wound, animal bite > TB, fungi, actinomycoses
VGH-TPE
DIAGNOSIS (CON’T)
Determine cellulitis versus abscess
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
VGH-TPE
INTRODUCTION
This presentation will review the evaluation and management of orofacial infections with emphasis on:
■ Assessment of the Patient ■ Diagnosis and Treatment of infection ■ Antibiotic Therapy ■ Indications for Prophylaxis ■ Antifungal Agent
VGH-TPE
ASSESSMENT
First generation Second generation Third generation Forth generation
Cefazolin U-SAVE-A Tydine
Keflor Ucefaxim
Claforan
Cefepime
VGH-TPE
3. Clindamycin G(+) cocci Bacteriostatic -> bactericidal Second-line drug: should be held in reserve to
Loss of function < dysphagia, trismus, dyspnea >
VGH-TPE
ASSESSMENT (CON’T)பைடு நூலகம்
Systemic signs of infection < BP ↓ < WBC ↑ < CRP ↑ < urine output ↓
VGH-TPE
Host defense
VGH-TPE
Antibiotics
INDICATION for ANTIBIOTICS
1. Severity of the infection
Acute onset Diffuse swelling involves fascial spaces
2. Adequacy of removing the source of infection
Identify local and/or systemic signs and symptoms to support the diagnosis of infection: < erythema, warmth, swelling, and pain > < malaise, fever ( >38 c), chills >
VGH-TPE
COMMONLY USED A/B
Mechanism of the antibiotics
VGH-TPE
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)
When drainage can’t be established immediately
3. The state of patients’ host defense
When the patient is febrile Compromised host defenses For prophylaxis
VGH-TPE
MICROBIOLOGY
Most oral infections are mixed in origin consisting of aerobic and anaerobic gram positive and gram negative organisms
Anaerobes predominant (75%)
VGH-TPE
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
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