Patients with cancer and associated neutropenia Patients with cancer may be neutropenic as a result of their chemotherapy treatments or their underlying cancer. Despite the lack of substantial scientific evidence, the National Cancer Institute advocates use of the AHA-recommended regimen for prophylactic antibiotics for patients with indwelling venous access lines and an absolute neutrophil count (ANC) between Patients on hemodialysis Vascular access sites used for patients receiving hemodialysis are at increased risk of becoming infected. Treatment may require hospitalization, systemic antibiotics, and possible shunt removal. The most common infectious agents are gram-positive bacteria, followed by gram-negative and polymicrobial bacteria. Orofacial bacteria are infrequently the source of vascular access site infections. Infective endocarditis can result from a vascular access infection, with up to 25% of these patients requiring heart valve replacement (Kiefer et al., 2011). The need for antibiotic prophylaxis for the prevention of shunt infections is controversial, and currently there are no specific guidelines. One older review suggested that prophylaxis is warranted at all times for recipients of hemodialysis arteriovenous shunts (after implantation/ Organ transplant patients To prevent rejection of transplanted organs, patients are routinely placed on immunosuppressive medications. These medications may include long-term prednisone, mycophenolate, cyclosporine, azathioprine, or others, which function by moderating the T-cell response of the patient to prevent graft rejection. Unfortunately, an increased risk of infection is one negative side effect of these immunosuppressive medications. Even given this information, the use of antibiotic prophylaxis for invasive dental procedures in these patients is controversial. Discussion with the patient’s transplant physician regarding the use of antibiotics is recommended. However, it is reasonable to use prophylactic antibiotics in the first few months after Periodontitis While early studies suggested that amoxicillin/metronidazole therapy may improve the effectiveness of scaling and root planing (SRP) in patients with periodontitis (Sgolastra, Severino, Petrucci, Gatto, & Monaco, 2014), a recent systematic review and meta-analysis of randomized, placebo- controlled trials actually found that using amoxicillin plus metronidazole as an adjunct to nonsurgical periodontal treatment results in little benefit, and there seems to be no difference among regimens (McGowan, McGowan, & Ivanovski, 2018). Evidence-based clinical practice guidelines on the nonsurgical treatment of chronic periodontitis by means of SRP with or without adjuncts published in 2015, concluded that for patients with chronic periodontitis, SRP showed a moderate benefit which outweighed potential adverse effects. The authors voted in favor of SRP as the initial nonsurgical treatment for chronic periodontitis (Smiley et al., 2015). The most recent published evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral The dental patient who is pregnant or breastfeeding The dental patient who is pregnant represents two significant challenges to the dental professional. First, although most dental procedures are elective and can be postponed until after the baby is delivered, dental treatment for a pregnant woman who has oral pain, advanced disease, or infection should not be delayed. Second, not all women of childbearing age know that they may be pregnant, and when selecting and prescribing a medication for any woman of childbearing age, the clinician should always consider the possibility of her conceiving while she is still receiving the medication. Balancing the risks of the drug’s potential adverse effects (usually on the fetus) with the benefit (usually to the mother) of treating the disease is the goal when prescribing medication to a patient who is pregnant (Donaldson & Goodchild, 2012).
1,000 and 2,000 µL before any invasive dental procedure (National Cancer Institute, 2021). Further consideration should be given to a more aggressive antibiotic therapy in the presence of infection. The prudent OHCP should discuss this with the patient’s oncologist.
revision) when dental procedures capable of inducing high-level bacteremia are planned (Guay, 2012). More recently, Perry et al. found a lack of consistent, established protocols amongst U.S. nephrology fellowships, and in those programs with a protocol, the only antibiotic prophylaxis guidelines for patients with ESRD undergoing dental treatment were published by the AHA in 2003 (Perry, Howell, & Patel, 2017). Still, the AHA guidelines do not discuss whether antibiotic prophylaxis is recommended for all hemodialysis shunts, and no well-designed clinical trials have been published concerning these patients to provide further guidance. Therefore, the best strategy is to consult with the patient’s nephrologist to determine if prophylactic antibiotics are deemed necessary from their medical point of view. by the AHA for prevention of IE, previously shown in Table 4, is also reasonable to recommend since these guidelines recommend providing antibiotic prophylaxis before specific dental procedures in cardiac transplantation recipients and can therefore be extended to other solid organ transplant patients (Wilson, W., et al., 2008). If antibiotic prophylaxis is recommended, the patient's physician should prescribe the medication (type, dose, instructions) (Stoopler, Sia, & Kuperstein, 2012). transplantation, when the patient has the highest risk of infection and acute graft rejection. Dosing of antibiotics recommended swelling by the American Dental Association concur with these earlier suggestions (Lockhart, et al., 2019). While systemic subantimicrobial-dose doxycycline and systemic antimicrobials showed similar magnitudes of benefits as adjunctive therapies to SRP, they were recommended at different strengths (in favor for systemic subantimicrobial-dose doxycycline and weak for systemic antimicrobials) because of the higher potential for adverse effects with higher doses of antimicrobials. The strengths of two other recommendations are weak: chlorhexidine chips and photodynamic therapy with a diode laser. Recommendations for the other local antimicrobials (doxycycline hyclate gel and minocycline microspheres) were expert opinion. Recommendations for the nonsurgical use of other lasers as SRP adjuncts were limited to expert opinion against because there was uncertainty regarding their clinical benefits and benefit-to- adverse effects balance. Note that expert opinion does not imply endorsement but instead signifies that evidence is lacking and the level of certainty in the evidence is low (Smiley et al., 2015). When determining the risks associated with the use of drugs in pregnancy, the U.S. Food and Drug Administration (FDA) has traditionally classified drugs on the basis of the level of risk they pose to the fetus (Table 9; U.S. Department of Health and Human Services, 2008). Drugs in pregnancy risk factor Categories A and B are considered safe for use, whereas drugs in pregnancy risk factor Category C may be used only if the benefits outweigh the risks. Drugs in pregnancy risk factor Category D should be avoided except in certain exceptional circumstances (i.e., life-threatening condition of the mother). The use of pregnancy risk factor Category X drugs in pregnant women is stringently proscribed.
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