Antimicrobials and Analgesics used in Pediatric Dentistry.pptx

Antimicrobials and Analgesics used in Pediatric Dentistry.pptx

1. D r . Afroza H o q u e A s s o ciate Profe s s o r Pe d iat r ic Dentist r y

2. Ob j ectives § Cla s sify a n tibiotics § D e s c ribe fu n d a m e ntals of ap p ro p riate u s e of a n tibi o tics § E n um e rate A A PD g u id e lines on a p pr o priate u s e of a n tibiotics § Cl a s s ify a n al g e s ic § St a te t h e clini c al g u id e lin e s on a p pr o pri a te u s e o f a n tibi o tics § S h ow pr e s c ription w riting § Li s t the a b br e vi a tion u s ed in p re s cri p tion § C a lc u late drug do s es

3. Classification of antibi o tics On the ba s is of ch e mical structure: β- lactum antibiotics: § § 2 . Aminogl y co s ides: § § P e nicil l ins C e phalo s porins Gentam y cin Streptom y cin

4. Classification of antibi o tics On the bas i s of chemic a l st r ucture: Ma c roli d : § Er y thromycin § Azi t hrom y cin Qui n olo n e: § Ciproflox a cin § Oflox a cin § Levofloxa c in

5. Cont’d On the b a sis of mec h a n ism of a c tion Antibiotics that inhibit the cell w all s y nthesis: § P e nici l l i ns § Cep h alosporins § G l y co p eptides § Azole A n t i biotic that inhibit the protein s y nthesis: § Er y throm y cin § T etrac y clines

6. c e ll memb r a ne p · o l ymix i ns cell wall synthes i s va nc? pe n 1 c 11 1 1 i ns yc i n D N A ., cephalospor ins y ! folic ac i d biosynthesis tr i methoprim su l fonam i des J _ . / -.:. DNA gy r ase q u i : no l ones R NA po l ymerase r i fa mp i n protein sy n t hesis, 3 0S inh i b i tors tetrac y c I i 1 ne s t re p tomyci n p r otein synthes i s, 50S inhib i tor s eryt h rom y c i n chloramphen i col

7. B. On the bas i s of me c hanism of a c t ion Antibiotics that block me t abolic s t eps: § S u lfonamid § T rim e thoprime In h ibition of n u cl e ic a cid s y nthesis: § Rif a mpicin § Q u in o lo n e

8. Fu n dam e ntals of ap p ropriate u se of ant i bi o tics The indica t ions for t he use of Antibiotics in pedia t ric dent a l pa t i e nt a r e to con t rol in f e c t i ons and proph y l a x i s for t he medi c a l ly compromi s ed chi l d to pr e v e nt s e r i ous s y s t em i c probl e m s , when choo s ing an Ant i bio t i c , the fo l lowing gen e r a l prin c ipl e s should be follo w :

9. Fun d amentals….. General Princ i ples Identi f y the c a usa t ive organism and det e rmine s e nsi t iv i ty Use a s pec i fic nar r ow spe c t r um ant i biotic Use the le a st to x ic ant i biotic Kn o w pat i ent ’ s drug his t ory Use a b a c t e r ic i dal r a t her t han a bact e rios t a t ic agent Use an a ntibiotic with a proven his t ory of s ucc e s s .

10. AAPD gu i deli n es on a ppro p riate use o f antib i otics Antibiotic the r apy is n o t indica t ed if the dental inf e c t ion is control within the p u lpul t i s s ue or imm e di a t e ly su r rounded ti s sue. In t his c a s e the child will have no s y s t emic signs of a n inf e c t ion ( n o f e v e r a nd no f a ci a l s well i ng ) A child pres e nting with a fac i al s welling w ill n eed antibiotics to c o n t r ol the spr e ad of the inf e c t ion and then t r e a tm e nt for the involve t e e t h.

11. AAPD gu i del i nes on appropriate….. Prolo n ged ant i biotic the r apy may be ne e ded in pedia t ric periodo n t a l dis e a s e s . A child m a y need ant i biotic cov e r a ge a f t e r se v e r e tooth displa c em e nt (lu x a t ion) injuri e s. F o r vi r al infe c tions antibiotics are n o t in d ic a ted u n le s s there is a s e c o n da r y bac t e r ial inf e c t ion.

12. Gui d eline on Antibio t ic Prophyl a xis for D e ntal Patients at Risk for Infection by AAPD (2 1 9 ) Immu n osup p r e s s i o n* s e conda r y to: Hu m an immu n o d e f ic i en c y vi r us ( HIV); Severe com b ined imm u n o defi c ien c y (SCI D S); Neutropenia; Canc e r chemothe r a p y ; or Hema t o p oie t ic s t em c e ll or solid organ t r anspl a nta t ion. His t ory of he a d and neck r a diother a p y .

13. Cont’d A u toimmune disease (e.g . , juvenile arthr i t i s, s y stemic lupus er y themato s u s ) Sickle cell an e mia. A s plenism or status post s plene c tom y . C h ronic high dose steroid u sa g e. U n co n trolled diab e tes mel l i t us. Bisp h os p hon a te t hera p y [Bisphos p hon a tes are a class of drugs that are us e d to preve n t bone lo s s demineralization ( w ea k ening or destruct i on)]. H e modial y sis.

14. T a b l e 1 . Antibiotic prophy l axis regimens for p e diatric patients. mg: m i lli g r am s ; kg: kilogram s ; g: gram s ; I V : intr a venou s ; I M : intramuscula r . ANT I B IOTIC PRO P HYLAX I S REGIMENS C h ild r en a l l ergic to penicil l in and with proble m s for o r a l drug do s ing Chi l d r en not a l l e rg i c to penici l l in Children not a l l e rgic to penici l lin and with no problems for oral drug do s ing Children allergic to p e nicillin Amoxicil l in 50 mg/kg + clavulanic acid 6 . 25 mg/kg ( m aximum 2 g) oral route 1 hour b e fore dental treatment. Amoxicil l in 50 mg/kg + clav u lanic acid 5 mg/kg ( maxim um 2 g) IV or I M ) 3 minutes before den t a l t r eatment. C lin d amycin 20 mg/kg ( maximum 600 mg ) oral route 1 hour before dental treatment. Clindamycin 1 5 mg/kg ( m axi m um 600 mg ) IV or I M , 30 minutes b e fore dental treatment.

15. R e f : BM&DC BDS Curriculum 2016

16. Cont’d Prescriber off i ce informa t ion. D a te. Patient data (Name, Ag e , Sex, and Ad d ress of t he Patient) S u p e rscription (S y mb o l ℞ ) Ins c r i ption (Me d ication pre s cribe d ) - Main p a rt of a pre s cription. S u b s cription (Di r e c tion to Ph a rmacist/ Dispe n s e r) Sig n ature or T ran s cription (Di r e c tion for Patient)

17. Some c o mm o n Latin pre s cript i on abbrevi a tions ac ( a nte cib u m ) me a ns "b e fore me a ls" bid (bis in die) me a ns "twice a da y " gt (gut t a) means "drop" hs (hora s o mn i ) me a ns " a t bed t ime" od (oculus dex t er) means "right e y e" os (o c ulus sinis t er) me a ns "le f t e y e" po (per o s ) means "by mouth"

18. Cont’d pc (post ci b u m ) me a ns " a f t er me a ls" prn (pro r e na t a) me a ns " a s ne e ded" q3h (quaque 3 hora) means "e v ery t hree hours" qd ( qua q ue die) me a ns " e v e ry da y " qid (quat e r in die) means "four times a da y " Sig ( s igna) me a ns "write" tid (ter in die) means "three times a da y "

19. T ask Sig: 1 t ab p o qid pc & hs " T a k e o n e t a blet by mo u th four tim e s a da y , a f t e r m e al s , and at bedtime . "

20. Ce f 3 Sus p ension 100 mg/5 ml

21. Amoxici l l i n Dosage s : childr e n 2 5 - 5 mg/kg ( d iv 8 - 12 h) ma x imum 1 5 mg/day Ro u t e : oral l y , I/V , I/M Side e f f e ct : Rash Dia r rhoea

22. D o s a g e : c h i l dren po : 5 - 1 0 mg/k g /day R o ute : oral l y , I/V , I /M Side effect: Rash Diar r ho e a Drug fev e r Oral c a n d ido s is

23. Dental Absce s s T h e most common o n es used for an a bsc e ss include: Am o xi c illin Azi t hrom y cin Cefoxit i n Me t ronidazole Penicillin

24. Metro n ida z o l e h a s b e en pro v ed to be efficacio u s in t r e a ting: a c ute ulc e rat i ve gingivitis, p e r i c o ronitis, c e r t ain p e r i a p ical infection s , some ca s es of oste om y eli t is a nd infected so c ket. in ca s es of c h ronic pro g ressi v e p e r i o d o n ti t is w he r e a n a e rob e s are i mplicated as patho g ens. Metronidazo l e

25. Metronidazo l e D o s e s: c h i l dren 3 - 5 mg/k g . q 6 h p o / I V R o ute: Orally & I / V Side effect N a u s ea He a da c he Met a l l ic taste Pare s the s ia T ran s ient leu k emia

26. It is par t icul a rly a c ti v e a gainst many E n t e robac t e r ia c e a e, Haemophilus influen z a e . Str e ptococcus p y o g e nes, Str e ptococcus p n eumo n iae and Branhame l la c a t a r r hali s , and is r e si s t a nt to h y dro l ysis by many bet a - la c t a ma s e s . In d ic a tions: U p per and l o w er re s piratory tr a ct infe c tions, Urina r y t r a c t i nfe c tions, Go n ococc a l ure t hrit i s, Acute otit i s media.

27. Cla s sif i c a tion of NSAIDs A. A c cording to COX isoenz y me selectivity 1. N o n selective N S AIDs A s pir i n Diclofenac K e torolac Ibuprofen N a prox e n 2. C OX-2 selective NS A IDs Celec o xib Etoricoxib Roficoxib V aldec o xib Analg e sics

28. B. According to e f f ic a cy L o w e f fi c a c y Par a c e t a mol Mo d e r a t e e f fi c a c y Ib u profen Ketoprof e n Feno p rof e n 3. High e f fi c a c y Aspirin Diclo f enac In d o n etha c in

29. Cont ’ d A c c o rding to plas m a h a lf l i fe Sh o rt a c ting As p i r in Diclofe n ac Ibu p rofen 3. Lo n g a c ting Piroxic a m Na b umetone 2 . Interm e dia t e a c ting Cele c oxib Rofe c oxib V alde c oxib Ke t orolac

30. Ib u profen Do s age : children 5 - 10m g /kg/dose q. 6 - 8 h po R o ute : oral l y Side effect : H e art b u rn A b d u minal p a in GI b lee d ing Gran u loc y top e nia A n emia A c ute ren a l failure

31. Paracetamol D o s a g e : c h i l dren 1 - 1 5 mg/k g /dose q. 4 - 6 h po ma x imum d o s a g e : 5 d o s e / d a y Ro u te : oral l y Side effect : H e p a totox i city R e n a l toxicity

32. Fla m e x Susp ensio n 1 mg/5 ml

33. Acyclovir Indication: It is active again s t Herpes simplex and Herpes z o ste r . D o s a g e : 20 mg/kg/ d o s e ( 3 - 5 times d a i l y for 5 d a y s) Ro u te: oral l y , I / V , topical ap p l i cation Side effect : N e p h rot o xicity Bo n e mar r ow su p pression GI irr i tation F e v e r Rash

34. Nystatin D o s a g e : 4 - 6 lac u n its to ea c h side of mo u th QID R o ute: orall y , topic a l a p plication Side effect: Na u sea V omiting Diarrho e a

35. Cont ’ d

36. Cal c ul a tion of drug do s es Bas e d o n bod y w t (C l a r k ’ s formula) Bas e d o n bod y sur f a c e a r ea Bas e d o n age ( Y o u n g ’ s formula)

37. Child ' s dose  weight of child in pounds  adult dose 15 lbs Clark ’ s ru l e - us e s the weight of the ch i ld and the wei g ht of a v er a ge a d ult (all ag e s ).

38. Child ' s BSA  m  2  adult dose   Child ' s Dos e  1. 7 m 2 C a l c ul a t i n g p e di a t r i c do sa g e b ase d o n bod y s u r f ac e a r ea , w e igh t o r a g e .

39. BSA W e s t Nom o gram