Table 4: Typical Prescriptions for the Most Commonly Used Antibiotics in Treating Orofacial Infections Generic Name (Brand Name) Available Formulations Usual Adult Dosage Usual Pediatric Dosage Notes Erythromycin (multiple generics) 250-500 mg q6h 7.5-12.5 mg/kg q6h
• 250 mg capsules • 200 mg/5 mL oral solution • 400 mg/5 mL oral solution • 250, 500, 750 mg tablets • 125 mg/5 mL oral solution
May want to consider an alternative macrolide in patients with underlying cardiac disease.
Levofloxacin (Levaquin, generics)
250-750 mg once daily
Not recommended for routine use in children or adolescents <18 years old.
Take at least 2 hours before, or 6 hours after, the dose of a multivitamin that contains polyvalent cations (i.e., calcium, iron, magnesium, selenium, zinc).
Metronidazole (Flagyl, generics)
• 250, 500 mg tablets • 375 mg capsules • 750 mg ER (extended- release) tablets
500 mg q6-12h
30 mg/kg/d divided q6h
Key adverse event(s) related to dental treatment: unusual/metallic taste, glossitis, stomatitis, xerostomia (normal salivary flow resumes upon discontinuation), and furry tongue. Do not take with alcohol as a disulfiram-like reaction may occur. ake at least 2 hours before, or 6 hours after, the dose of a multivitamin that contains polyvalent cations (i.e., calcium, iron, magnesium, selenium, zinc).
Moxifloxacin (Avelox)
• 400 mg tablets
400 mg once daily
Not recommended for routine use in children or adolescents <18 years old. 25-50 mg/kg/ day divided q6-8h
Penicillin (Pen VK, generics)
• 250, 500 mg tablets • 125 mg/5 mL oral solution • 250 mg/5 mL oral solution • 250, 500 mg tablets • 250, 500 mg capsules
250-500 mg q6-8h
Also available as a suspension that may not be equivalent on an mg/mg basis to the tablets.
Tetracycline (multiple generics)
250-500 mg q6h 25-50 mg/kg/d divided q6h
Tetracyclines are not recommended for use during pregnancy or in children ≤ 8 years of age since they have been reported to cause enamel hypoplasia and permanent teeth discoloration. Take at least 2 hours before, or 6 hours after, the dose of a multivitamin that contains polyvalent cations (i.e., calcium, iron, magnesium, selenium, zinc).
TREATMENT OF OROFACIAL INFECTIONS
While many orofacial infections are self-limiting, the discomfort the patient feels (pain, fever, nausea), in addition to the physical findings that the clinician may note (swelling, purulent discharge, fever), often leads the OHCP to prescribe an antibiotic for treatment of the infection. So far, this module has focused on the traditional tenet of infectious disease management: “Match the right drug to the right bug.” When clinicians know the pathogens most commonly associated with orofacial infections and they understand the spectrum of activity of the antibiotic they wish to prescribe, additional insight into the patient’s Antibiotic prophylaxis for cardiac patients Oral bacterial pathogens may be responsible for cases of infective myocarditis (IE) or late-prosthetic joint infections (LPJIs), yet it is unclear to what extent these problems result from dental office procedures as opposed to bacteremia from routine daily activities such as tooth brushing and chewing food. There is very little evidence demonstrating that dental office procedures cause distant site infections (Skaar, O’Connor, Hodges, & Michalowicz, 2011; Rademacher et al., 2017). Therefore, the driving force behind the practice of antibiotic prophylaxis is based on the improbable, yet possible, devastating impact of a
medical history (i.e., allergy, pregnancy, and other issues) helps guide the most appropriate prescription for the infection. Prophylaxis of orofacial infections When considering antibiotics for prophylaxis , the same antibiotics are employed as in Table 3. However, depending on the indication, they may be administered slightly differently: either as a one-time preoperative prophylactic dose in the case of cardiac and orthopedic patients or as a routine prescription of several days’ duration for an immunocompromised patient (e.g., a cancer patient, a patient undergoing hemodialysis, or an organ transplant recipient). bacteremia-induced infection of a cardiac valve, prosthetic joint, or indwelling medical device such as implantable defibrillators and pacemakers. Antibiotic prophylaxis in dentistry has been a subject of debate and controversy since 1955, when the American Heart Association (AHA) began developing recommendations for prophylactic antibiotics to prevent IE. These recommendations have set the standard of care for the past 66 years. However, there remains confusion surrounding which patients are at risk for distant site infections and which dental procedures and bacteria
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