口腔牙科的抗生素应用(英文PPT)
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• Antibiotics are merely an adjunctive therapy. Drainage
2020/6/29
Host defense
Antibiotics
INDICATION for ANTIBIOTICS
1. Severity of the infection
• Acute onset • Diffuse swelling involves fascial spaces
• Penicillinase-resistant: oxacillin, dicloxacillin • Extended spectrum: ampicillin, amoxicillin • Combine β-lactamase inhibitor: augmentin
2020/6/29
2. Cephalosporin • More resistance to penicillinase • G(+) cocci, many G(-) rods • Third generation: Pseudomonas aeruginosa • Second choice (less effect for anaerobes)
2020/6/29
5. Metronidazole* • Only for obligate anaerobes • Can cross blood-brain barrier • To treat serious infections caused by anaerobic
bacteria, combined with β-lactam A/B • Effective against Bacteroides species, esp. in
2. Adequacy of removing the source of infection
• When drainage can’t be established immediately
3. The state of patients’ host defense
• When the patient is febrile • Compromised host defenses • For prophylaxis
First generation
Second generation
Cefazolin Keflor
U-SAVE-A Ucefaxim
Tydine
2020/6/29
Third generation Forth generation
Claforan Cefepime
3. Clindamycin • G(+) cocci • Bacteriostatic -> bactericidal • Second-line drug: should be held in reserve to
treat those infections caused by anaerobes resistant to other antibiotics
2020/6/29
4. Aminoglycoside • G(-) aerobes, some G(+) aerobes eg S. aureus • Poorly absorbed from GI tract • Adjustment of dosage in renal dysfunction • Drugs: Gentamicin, Amikacin, Amikin • Combined with penicillin or cephalosporin
2020/6/29
MICROBIOLOGY
• Most oral infections are mixed in origin consisting of aerobic and anaerobic gram positive and gram negative organisms
• Anaerobes predominant (75%)
2020/6/29
DIAGNOSIS (CON’T)
• Determine cellulitis versus abscess
2020/6/29
TREATMENT of INFECTION
• Remove the cause of infection is the most important of all, by either spontaneously or surgically drain the pus.
periodontal infections • Drugs: Anegyn, Flagyne • Avoid pregnant women
2020/6/29
6. Vancomycin • G(+), most anaerobes, some G(-) cocci (Neisseria) • Given intravenously, BP should be monitored • Adjustment of dosage in renal dysfunction • Use as a substitute for penicillin in the
2020/6/29
ASSESSMENT (CON’T)
• Systemic signs of infection < BP ↓ < WBC ↑ < CRP ↑ < urine output ↓
2020/6/29
DIAGNOSIS: Infection
• Determine etiology > odontogenic > trauma wound, animal bite > TB, fungi, actinomycoses
2020/6/29
COMMONLY USED A/B
• Mechanism of the antibiotics
2020/6/29
COMMONLY USED A/B
1. Groups of Penicillin • First choice for odontogenic infection • G(+) cocci and rod, spirochetes, anaerobes • 0.7~10% hypersensitivity =Fra Baidu bibliotek PST • Nature: penicillin G (IV), penicillin V (PO)
2020/6/29
Host defense
Antibiotics
INDICATION for ANTIBIOTICS
1. Severity of the infection
• Acute onset • Diffuse swelling involves fascial spaces
• Penicillinase-resistant: oxacillin, dicloxacillin • Extended spectrum: ampicillin, amoxicillin • Combine β-lactamase inhibitor: augmentin
2020/6/29
2. Cephalosporin • More resistance to penicillinase • G(+) cocci, many G(-) rods • Third generation: Pseudomonas aeruginosa • Second choice (less effect for anaerobes)
2020/6/29
5. Metronidazole* • Only for obligate anaerobes • Can cross blood-brain barrier • To treat serious infections caused by anaerobic
bacteria, combined with β-lactam A/B • Effective against Bacteroides species, esp. in
2. Adequacy of removing the source of infection
• When drainage can’t be established immediately
3. The state of patients’ host defense
• When the patient is febrile • Compromised host defenses • For prophylaxis
First generation
Second generation
Cefazolin Keflor
U-SAVE-A Ucefaxim
Tydine
2020/6/29
Third generation Forth generation
Claforan Cefepime
3. Clindamycin • G(+) cocci • Bacteriostatic -> bactericidal • Second-line drug: should be held in reserve to
treat those infections caused by anaerobes resistant to other antibiotics
2020/6/29
4. Aminoglycoside • G(-) aerobes, some G(+) aerobes eg S. aureus • Poorly absorbed from GI tract • Adjustment of dosage in renal dysfunction • Drugs: Gentamicin, Amikacin, Amikin • Combined with penicillin or cephalosporin
2020/6/29
MICROBIOLOGY
• Most oral infections are mixed in origin consisting of aerobic and anaerobic gram positive and gram negative organisms
• Anaerobes predominant (75%)
2020/6/29
DIAGNOSIS (CON’T)
• Determine cellulitis versus abscess
2020/6/29
TREATMENT of INFECTION
• Remove the cause of infection is the most important of all, by either spontaneously or surgically drain the pus.
periodontal infections • Drugs: Anegyn, Flagyne • Avoid pregnant women
2020/6/29
6. Vancomycin • G(+), most anaerobes, some G(-) cocci (Neisseria) • Given intravenously, BP should be monitored • Adjustment of dosage in renal dysfunction • Use as a substitute for penicillin in the
2020/6/29
ASSESSMENT (CON’T)
• Systemic signs of infection < BP ↓ < WBC ↑ < CRP ↑ < urine output ↓
2020/6/29
DIAGNOSIS: Infection
• Determine etiology > odontogenic > trauma wound, animal bite > TB, fungi, actinomycoses
2020/6/29
COMMONLY USED A/B
• Mechanism of the antibiotics
2020/6/29
COMMONLY USED A/B
1. Groups of Penicillin • First choice for odontogenic infection • G(+) cocci and rod, spirochetes, anaerobes • 0.7~10% hypersensitivity =Fra Baidu bibliotek PST • Nature: penicillin G (IV), penicillin V (PO)