Amoxicillin in dentistry

Amoxicillin in dentistry

1. Management of dental infections

2. Overview Common bacterial infections in dentistry Microbiology of infections Empiric Therapy Regimens Amoxicillin- clavulanate   Related studies

3. Common types of bacterial infection in dentistry: Pulpitis Periapical periodontitis P eriodontitis Pericoronitis http://www.dentalcare.com/enUS/dentaleducation/continuingeducation/ce336/ce336.aspx?ModuleName=coursecontent&PartID=4&SectionID=-1

4. Contd.. Dental caries Postsurgical infections Gingivitis

5. Microbiology Odontogenic infections are multimicrobial : Gram (+) cocci , aerobic and anaerobic: Streptococci and their anaerobic counterpart, peptostreptococci Staphylococci, and their anaerobic counterpart, peptococci http://www.dentalcare.com/en-US/dental-education/continuing-education/ce336/ce336.aspx?ModuleName=coursecontent&PartID=4&SectionID=-1

6. Gram (+) rods : Lactobacillus, diphtheroids , Gram (-) rods : Fusobacterium , Bacteroides , Eikenella , Psuedomonas (occasional)

7. Pathophysiology Dental caries results when the demineralization which occurs when certain species of micobes start producing acid and can survive in it. Dental caries erode the protective layers of the tooth ( ie , enamel, dentin) and allow bacteria to invade the pulp, producing a pulpitis . http://emedicine.medscape.com/article/909373-overview#a5

8. Pathophysiology Pulpitis can progress to necrosis, with bacterial invasion of the alveolar bone, causing an abscess. A periapical abscess that originates in the dental pulp and is usually secondary to dental caries is the most common dental abscess in children. http://emedicine.medscape.com/article/909373-overview#a5

9. Pathophysiology A periodontal abscess involves the supporting structures of the teeth (periodontal ligaments, alveolar bone).   This is the most common dental abscess in adults, but may occur in children with impaction of a foreign body in the gingiva . Pericoronitis describes the infection of the gum flap (operculum) that overlies a partially erupted or impacted third molar. http://emedicine.medscape.com/article/909373-overview#a5

10. Empiric Therapy options First line of drugs Penicillin V / Penicillin G Amoxicillin- clavulanate Clindamycin http://emedicine.medscape.com/article/2060395-overview#showall Second Line drugs Metronidazole Moxifloxacin Erythromycin Cephalexin

11. Amoxicillin- clavulanate   Amino penicillins First line of drug in the management of dental infections especially in treating penicillinase -producing staphylococci or those involving gram-negative bacteria. Amoxicillin acts by inhibiting the bacterial cell wall synthesis and clavulanic acid acts by inhibiting the penicillinase enzyme which deactivates amoxicillin – synergistic action http://www.webmd.com/drugs/2/drug-1531/amoxicillin-oral

12. Spectrum of activity Gram-Positive Bacteria Staphylococcus aureus Enterococcus faecalis Staphylococcus epidermidis Staphylococcus saprophyticus Streptococcus pneumoniae Streptococcus pyogenes Viridans group Streptococcus http://www.rxlist.com/augmentin-drug/clinical-pharmacology.htm

13. Spectrum of activity Gram-Negative Bacteria Eikenellacorrodens Proteus mirabilis Enterobacter species Escherichia coli Haemophilus influenzae Klebsiella species Moraxella catarrhalis http://www.rxlist.com/augmentin-drug/clinical-pharmacology.htm

14. Spectrum of activity Anaerobic Bacteria Bacteroidesspecies including Bacteroides fragilis Fusobacterium species Peptostreptococcus species http://www.rxlist.com/augmentin-drug/clinical-pharmacology.htm

15. Dosage Forms : Suspension, chewable tablet , tablet , capsule Usual oral dosage: Children: >3 months and <40kg: 20-40mg/kg/day in divided doses 8 th hourly OR 25-45 mg/kg/day in divided doses every 12 hours

16. Dosage Children : >40 kg and adults: 250-500 mg every 8 hours OR 500-875 mg every 12 hours Adults : > 40 kg: 250-500 mg q8h or 875 mg q12h for at least 7 days; maximum dose: 2g/day

17. Benefits over other 1 st line drugs Available in various dosage formulations Covers both Gram positive and Gram negative bacteria including anaerobic bacteria Broad spectrum of activity Well tolerated Good compliance Safer with fewer adverse effects

18. Related studies A comparative study on amoxicillin and clindamycin was carried as a rationale for antibiotic prophylaxis against infective endocarditis involving 160 patients. They reported that oral amoxicillin given prior to dental extraction produced a significant reduction in post-extraction bacteraemia . Maharaj B, Coovadia Y, Vayej AC. A comparative study of amoxicillin, clindamycin and chlorhexidine in the prevention of post-extraction bacteraemia. Cardiovascular Journal of Africa . 2012;23(9):491-494. doi:10.5830/CVJA-2012-049.

19. Related studies In a randomized, double blind study involving 123 participants it was observed that , amoxicillin administered pre- or postoperatively demonstrated greater efficacy than placebo in preventing postoperative complications in patients undergoing third molar surgery. http://www.sciencedirect.com/science/article/pii/S0278239111000954

20. Related studies Another study evaluated amoxicillin concentration in the serum, jaw cyst and jaw bone after single oral administration among 44patients who underwent enucleation of jaw cyst Reported that amoxicillin attains higher levels in periodontal cysts than in dentigerous cysts, and higher in maxillary bone than in mandibular bone. Akimoto Y, Kaneko K, Tamura T. Amoxicillin concentrations in serum, jaw cyst, and jawbone following a single oral administration. J Oral Maxillofac Surg. 1982 May;40(5):287-93.

21. Comparative Efficacies of Amoxicillin, Clindamycin , and Moxifloxacin in Prevention of Bacteremia following Dental Extractions (BDE) Prevalence of bacteremia at the baseline and postextraction (30 s, 15 min, and 1 h after completion of the dental extractions) in the different study groups. Conclusion: AMX continues to be the antibiotic of choice for the prevention of BDE in patients who are “at risk” of BE and who are not allergic to PEN. MXF is a safe prophylactic alternative when beta- lactams are contraindicated. http://aac.asm.org/content/50/9/2996.full

22. Related studies In a randomised comparative study, of co- amoxiclav and penicillin V for dentoalveolar infections After drainage all patients improved but co- amoxiclav treatment provided significantly greater decrease in toothache during the second and third days post drainage. This may explained by the eradication of the beta- lactamase producing bacteria with co- amoxiclav that would not be eradicated by penicillin V. Lewis MA, Carmichael F, MacFarlane TW, Milligan SG. A randomised trial of co- amoxiclav versus penicillin V in the treatment of acute dentoalveolar abscess. Br Dent J. 1993 Sep 11;175(5):169-74.

23. Related studies A comparitive study of amoxicillin and penicillin on Bacteraemia after dental extraction demonstrated that Both penicillin V (2 g oral dose) and amoxycillin are effective in reducing the incidence of bacteraemia following dental extraction. However, amoxycillin is preferable to penicillin V for the oral prophylaxis of endocarditis as it can provide much higher serum levels than penicillin V during the 6 to 8 hours following extraction. Shanson DC, Cannon P, Wilks M. Amoxycillin compared with penicillin V for the prophylaxis of dental bacteraemia . J Antimicrob Chemother . 1978 Sep;4(5):431-6

24. Thank you