Antiboitics in dental infection for fighting AMR

Antiboitics in dental infection for fighting AMR

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 Periodontitis Pericoronitis http://www.dentalcare.com/enUS/dentaleducation/continuingeducation/ce336/ce336.aspx?ModuleName=coursecontent&PartID=4&SectionID=-1

4. Co n t d . . Dental caries P o s tsu r gi c al 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 through 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 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 is the infection of the gum flap (operculum) that overlies a partially erupted or impacted third molar tooth. http://emedicine.medscape.com/article/909373-overview#a5

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

11. Amoxicillin-clavulanate 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 epidermidis . Staphylococcus aureus. Staphylococcus saprophyticus . Enterococcus faecalis . Streptococcus pneumon ea . Streptococcus pyogenes . Streptococcus Viridans group. http://www.rxlist.com/augmentin-drug/clinical-pharmacology.htm Gram-Negative Bacteria Proteus species Enterobacter species E . coli Haemophilus influenzae Klebsiella species Anaerobic Bacteria Bacteroides species Fusobacterium species Peptostreptococcus species

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

14. Cefixime Cefixime is a 3 rd generation cephalosporin . Cefixime is used to treat many different types of infections caused by bacteria. Cefixime acts by inhibiting cell wall synthesis.

15. Spectrum of activity Haemophilus influenzae , Moraxella catarrhalis , Streptococcus pyogenes , Streptococcus pneumoniae http://www.rxlist.com/augmentin-drug/clinical-pharmacology.htm

16. Dosage Usual oral dosage: Children: 8 mg/kg daily as a single dose or in two divided doses for 7 to 14 days according to the severity of infection or age. Adults : 4 00 mg daily divided in every 12-24 hours

17. Formulation Suspension, chewable tablet, tablet, C apsule .

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 A randomized, double blind study involving 123 participants was done. I t was observed that , amoxicillin administered pre- operatively or postoperatively showed greater efficacy than placebo in preventing postoperative complications in patients undergoing third molar surgery. http://www.sciencedirect.com/science/article/pii/S0278239111000954

20. 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: A moxicillin continues to be the antibiotic of choice for the prevention of infection i n patients who are “at risk” of bacteremia following dental extractions.. http://aac.asm.org/content/50/9/2996.full

21. Related studies In a randomised comparative study, of co-amoxiclav and penicillin V for dento - alveolar infections shows: After drainage , all patients improved but co-amoxiclav treatment provided significantly greater decrease in toothache during the second and third post drainage days . This is due to the eradication of the beta-lactamase producing bacteria done by co-amoxiclav that would not be en 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.

22. Related studies Comparison of cefixime and metronidazole in the treatment of chronic periodontitis. The conjunction of amoxicillin plus metronidazole or cefixime to the causal treatment of patients with chronic periodontitis led to statistically significant improvement in efficacy in relation to gingival index and bleeding on probing parameters, while cefixime was statistically significantly more efficient than the combination of amoxicillin and metronidazole. Lewis MA, Carmichael F, MacFarlane TW, Milligan SG. A randomised trial of co-amoxiclav versus penicillin V in the treatment of acute dentoalveolar abscess.

23. 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 .

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