口腔牙科的抗生素应用（英文ppt）

Antibiotic Use in Orofacial Dental Infection 台北榮民總醫院台北榮民總醫院 牙科部牙科部 Speaker 陳雅薇陳雅薇 Moderator 羅文良羅文良 大夫大夫 INTRODUCTION n 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 ASSESSMENT n 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 n Identify local and/or systemic signs and symptoms to support the diagnosis of infection: 38 c), chills n Loss of function ASSESSMENT (CONT) n Systemic signs of infection odontogenic trauma wound, animal bite TB, fungi, actinomycoses DIAGNOSIS (CONT) n Determine cellulitis versus abscess TREATMENT of INFECTION n Remove the cause of infection is the most important of all, by either spontaneously or surgically drain the pus. n Antibiotics are merely an adjunctive therapy. Host defense Drainage Antibiotics INDICATION for ANTIBIOTICS 1. Severity of the infection n Acute onset n Diffuse swelling involves fascial spaces 2. Adequacy of removing the source of infection n When drainage cant be established immediately 3. The state of patients host defense n When the patient is febrile n Compromised host defenses n For prophylaxis n Most oral infections are mixed in origin consisting of aerobic and anaerobic gram positive and gram negative organisms n Anaerobes predominant (75%) MICROBIOLOGY COMMONLY USED A/B n Mechanism of the antibiotics COMMONLY USED A/B 1. Groups of Penicillin n First choice for odontogenic infection n G(+) cocci and rod, spirochetes, anaerobes n 0.710% hypersensitivity = PST n Nature: penicillin G (IV), penicillin V (PO) n Penicillinase-resistant: oxacillin, dicloxacillin n Extended spectrum: ampicillin, amoxicillin n Combine -lactamase inhibitor: augmentin 2. Cephalosporin n More resistance to penicillinase n G(+) cocci, many G(-) rods n Third generation: Pseudomonas aeruginosa n Second choice (less effect for anaerobes)First generation Second generation Third generation Forth generation Cefazolin U-SAVE-A Tydine Keflor Ucefaxim Claforan Cefepime 3. Clindamycin n G(+) cocci n Bacteriostatic - bactericidal n Second-line drug: should be held in reserve to treat those infections caused by anaerobes resistant to other antibiotics 4. Aminoglycoside n G(-) aerobes, some G(+) aerobes eg S. aureus n Poorly absorbed from GI tract n Adjustment of dosage in renal dysfunction n Drugs: Gentamicin, Amikacin, Amikin n Combined with penicillin or cephalosporin 5. Metronidazole* n Only for obligate anaerobes n Can cross blood-brain barrier n To treat serious infections caused by anaerobic bacteria, combined with -lactam A/B n Effective against Bacteroides species, esp. in periodontal infections n Drugs: Anegyn, Flagyne n Avoid pregnant women 6. Vancomycin n G(+), most anaerobes, some G(-) cocci (Neisseria) n Given intravenously, BP should be monitored n Adjustment of dosage in renal dysfunction n Use as a substitute for penicillin in the prophylaxis of the heart valve pt 7. Chloramphenicol n Wide spectrum, highly active against anaerobes n Limited to severe odontogenic infection threatening to the eye or brain n Severe toxicity 8. Erythromycin n G(+) cocci, oral anaerobes n Bacteriostatic n Second choice for odontogenic infections n Indication for out-patients with mild infection n Drug resistence: 50% of S. aureus, Strep. viridans, 9. Tetracycline* n Only against anaerobes n Contraindications: pregnant women, children Cefazolin 1000mg q6h Gentamycin 60-80mg IVA q8h-q12h Second line (3A) Augmentin 1200mg q8h + Amikin 375mg q12h + Anegyn Mild infection Amoxicillin 250mg #2 PO q8h Clindamycin 300mg PO q6h n Side Effect of Commonly Used Antibiotics 1. Penicillin hypersensitivity2. Cephalosporin hypersensitivity 3. Clindamycin diarrhea, pseudomembrane colitis 4. Aminoglycoside damage to kidney, 8th neurotoxicity 5. Metronidazole* GI disturbance, seizures 6. Vancomycin 8th neurotoxicity, thrombophlebitis 7. Chloramphenicol bone marrow suppression 8. Erythromycin mild GI disturbance 9. Tetracyclin* tooth discoloration, photosensitivity PROPHYLAXIS n Indications Updated JADA 2004 PROPHYLAXIS (CONT) n Dental procedures recommended for prophylaxis Updated JADA 2004 PROPHYLAXIS (CONT) n Regimen Updated JADA 2004 ANTIFUNGAL AGENT n Most of fungal infection are from candida n Commonly used drugs: (1) Nystatin (Mycostatin)= PO 4-600,000 U qid (2) Amphotericin B= IV for severe systemic infec. (3) Fluconazole, Ketoconazole Parmason Gargle n 0.2% C