Changes

==Antibiotic Use==

==Antibiotic Use==

[[Antibiotics|Antimicrobial agents]] have been extensively used (in both human and veterinary medicine) for more than half a century and the potential and limitations of this therapy are now better understood.<br><br>

[[Antibiotics|Antimicrobial agents]] have been extensively used (in both human and veterinary medicine) for more than half a century and the potential and limitations of this therapy are now better understood.<br><br>

Problems, resulting from the widespread use of [[antibiotics]], have modified the general perception of the capabilities of antimicrobial agents. Over the years, [[:Category:Bacteria|bacteria]] have developed a marked ability to withstand or repel many antibiotic agents. Bacteria are increasingly resistant to many formerly potent agents. The use of antibiotics may disturb the delicate ecologic equilibrium of the body, allowing the proliferation of resistant bacteria and/or nonbacterial organisms. Sometimes this may initiate new infections that are worse than the ones originally treated. In addition, no antibacterial drug is completely nontoxic and the use of any antimicrobial agent will have accompanying risks. It must also be remembered that '''resistant bacteria can cross the species barrier'''. Antibiotics and [[Antiseptics for Oral Disease|antiseptics]] have a role to play in the management of oral diseases, but their use should be limited and selective.<br><br>

Problems, resulting from the widespread use of [[antibiotics]], have modified the general perception of the capabilities of antimicrobial agents. Over the years, [[:Category:Bacteria|bacteria]] have developed a marked ability to withstand or repel many antibiotic agents. Bacteria are increasingly resistant to many formerly potent agents. The use of antibiotics may disturb the delicate ecologic equilibrium of the body, allowing the proliferation of resistant bacteria and/or nonbacterial organisms. Sometimes this may initiate new infections that are worse than the ones originally treated. In addition, no antibacterial drug is completely non-toxic and the use of any antimicrobial agent has accompanying risks. It must also be remembered that '''resistant bacteria can cross the species barrier'''. Antibiotics and [[Antiseptics for Oral Disease|antiseptics]] have a role to play in the management of oral diseases, but their use should be limited and selective.<br><br>

Dosing regimens and strategies that lead to optimal efficacy of antimicrobial agents must be implemented. Antibiotics can be used for prevention and for therapy.

Dosing regimens and strategies that lead to optimal efficacy of antimicrobial agents must be implemented. Antibiotics can be used for prevention and for therapy.

*'''Gross infection'''

*'''Gross infection'''

*'''Chronic [[stomatitis]]'''<br><br>

*'''Chronic [[stomatitis]]'''<br><br>

The choice of prophylactic antibiotic and protocol remains controversial. A wide variety of microorganisms is found in the flora of the mouth and saliva. Antibiotic prophylaxis requires a drug with antimicrobial activity against '''Gram-positive and Gram-negative aerobes and anaerobes'''. The timing of administration of antibiotics is critical. It is generally accepted that antibiotics should be administered '''within 2 hours of the surgery''' and '''not continued for more than 4 hours after the procedure''' <font color="red">(Peterson, 1994; Callender, 1999)</font color>. In addition, antibiotics must be given at a '''high enough dose''' to reach a tissue level four times higher than the MIC of the causative organisms. A number of studies have shown that ampicillin, amoxicillin-clavulanic acid, certain [[cephalosporins]] and [[Macrolides and Lincosamides|clindamycin]] meet the above requirements in dogs, cats and humans <font color="red">(Callender, 1999; Johnson et al, 1997; Harvey et al, 1995a; Harvey et al, 1995b; Mueller et al, 1999).</font color>

The choice of prophylactic antibiotic and protocol remains controversial. A wide variety of microorganisms is found in the flora of the mouth and saliva. Antibiotic prophylaxis requires a drug with antimicrobial activity against '''Gram-positive and Gram-negative aerobes and anaerobes'''. The timing of administration of antibiotics is critical. It is generally accepted that antibiotics should be administered '''within 2 hours of the surgery''' and '''not continued for more than 4 hours after the procedure''' <ref name="Peterson">Peterson, L.J. (1994) '''Principles of antibiotic therapy.''' In:Topazian, R.G. & Goldberg, M.H. (eds) ''Oral and Maxillofacial Infections'', 3rd edn. Philadelphia:W.B.Saunders, p. 160-197.</ref>

A standard protocol often consists of ampicillin prior to surgery (at the time of catheter placement for anesthesia) and repeated after 6 hours if the catheter is still in place. Metronidazole is given intravenously in addition to ampicillin in the presence of severe infection to ensure a wider anaerobic spectrum.

<ref name="Callender">Callender, D.L. (1999) '''Antibiotic prophylaxis in head and neck oncologic surgery: the role of Gram- negative coverage.''''' International Journal of Antimicrobial Agents'' 12 (Suppl. 1): S21–S25.</ref>. In addition, antibiotics must be given at a '''high enough dose''' to reach a tissue level four times higher than the MIC of the causative organisms. A number of studies have shown that ampicillin, amoxicillin-clavulanic acid, certain [[cephalosporins]] and [[Macrolides and Lincosamides|clindamycin]] meet the above requirements in dogs, cats and humans <ref name="Callender" /><ref>Johnson, J.T., Kachman, K., Wagner, R.L. et al (1997) '''Comparison of ampicillin/sulbactam versus clindamycin in the prevention of infection in patients undergoing head and neck surgery.''''' Head Neck'' 19: 367–371.</ref><ref>Harvey, C.E., Thornsberry, C., Miller, B.R., Shafer, F.S. (1995a) '''Antimicrobial susceptibility of subgingival bacterial flora in dogs with gingivitis. '''''Journal of Veterinary Dentistry'' 12(4): 151–155.</ref><ref>Harvey, C.E., Thornsberry, C., Miller, B.R., Shafer, F.S.(1995b)''' Antimicrobial susceptibility of subgingival bacterial flora in cats with gingivitis. '''''Journal of Veterinary Dentistry'' 12(4): 157–160.</ref><ref>Mueller, S.C., Henkel, K.O., Neumann, J. et al (1999) '''Perioperative antibiotic prophylaxis in maxillofacial surgery: penetration of clindamycin into various tissues.''''' Journal of craniomaxillofacial surgery ''27: 172-176</ref>

A standard protocol often consists of ampicillin prior to surgery (at the time of catheter placement for anaesthesia), repeated after 6 hours if the catheter is still in place. Metronidazole is given intravenously in addition to ampicillin in the presence of severe infection to ensure a wider anaerobic spectrum.

==Therapeutic Use of Antibiotics==

==Therapeutic Use of Antibiotics==

#'''The antibiotic with the narrowest antibacterial spectrum should be used.''' This will minimize the risk of development of resistant bacteria.

#'''The antibiotic with the narrowest antibacterial spectrum should be used.''' This will minimize the risk of development of resistant bacteria.

#'''Combinations of antibiotics are discouraged.''' The exception to this rule is the combination of amoxicillin or cephalosporins with metronidazole in severe mixed infections in which anaerobes are believed to play a major role.

#'''Combinations of antibiotics are discouraged.''' The exception to this rule is the combination of amoxicillin or cephalosporins with metronidazole in severe mixed infections in which anaerobes are believed to play a major role.

#'''A bactericidal antibiotic is preferable to a bacteriostatic agent'''. A bactericidal antibiotic (amoxicillin, cephalosporins and metronidazole) is preferred over a bacteriostatic antibiotic (clindamycin), mainly because there is less reliance on host inflammatory and immune reactions. Other considerations include the toxicity of the antibiotic and the patient’s history of previous allergic reactions to a particular antibiotic.

#'''A bactericidal antibiotic is preferable to a bacteriostatic agent'''. A bactericidal antibiotic (amoxicillin, cephalosporins and metronidazole) is preferable to a bacteriostatic antibiotic (clindamycin), mainly because there is less reliance on host inflammatory and immune reactions. Other considerations include the toxicity of the antibiotic and the patient’s history of previous allergic reactions to a particular antibiotic.

#'''The antibiotic of choice must be administered at the proper dose and correct time interval.''' Refer to a current compendium of data sheets for veterinary products for correct dosing and time interval. A seven-day course of antibiotics is generally recommended. Osteomyelitis generally requires a longer period of treatment. Suboptimal dosing and/or pulse therapy is not recommended.

#'''The antibiotic of choice must be administered at the proper dose and correct time interval.''' Refer to a current compendium of data sheets for veterinary products for correct dosing and time interval. A seven-day course of antibiotics is generally recommended. Osteomyelitis generally requires a longer period of treatment. Suboptimal dosing and/or pulse therapy is not recommended.

#'''The patient must be monitored for response to treatment and the potential development of adverse reactions.''' Re-evaluation of the diagnosis is required if there is no response to treatment. Culture and antibiogram may well be indicated. Minor adverse reactions, e.g. mild gastrointestinal side effects and inappetance, due to changes in the gut flora as a result of systemic treatment with amoxicillin and clindamycin, occasionally occur.

#'''The patient must be monitored for response to treatment and the potential development of adverse reactions.''' Re-evaluation of the diagnosis is required if there is no response to treatment. Culture and antibiogram may be indicated. Minor adverse reactions, e.g. mild gastrointestinal side effects and inappetance, due to changes in the gut flora as a result of systemic treatment with amoxicillin and clindamycin, occasionally occur.

==Summary==

==Summary==

*Antibiotics are not indicated in the treatment of [[gingivitis]]. Their role in [[Periodontal Disease|periodontitis]] is doubtful and is definitely secondary to conservative periodontal therapy.

*Antibiotics are not indicated in the treatment of [[gingivitis]]. Their role in [[Periodontal Disease|periodontitis]] is doubtful and is definitely secondary to conservative periodontal therapy.

[[Category:Dental and Oral Medication]]

[[Category:Dental and Oral Medication]]

[[Category:To Do - Dentistry Images]]

[[Category:Waltham reviewed]]