The use of antibiotics in oral pathologies

7/28/2019 The use of antibiotics in oral pathologies

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Samuel Lea Erasmus Student 1

The use of antibiotics in oral pathologies

Antibiotics are commonly used in dental practice and it has been estimated that 10% of all

antibiotic prescriptions are related with dental infections. The most common drug association

prescribed by dental professional is amoxicillin+clavulanate.

The antibiotic drugs were introduced in the mid-twentieth century in the form of sulfa drugs

(1935), penicillin (1941) tetracyclines (1948) and erythromycin (1952). Since then, antibiotics

have focused much clinical and pharmacological research, in response to the progressive

challenges posed by bacterial infections: identification of new pathogens, the development of

resistances to antibiotics, and nre clinical situations such as the increase in chronic processes,

survival of patients with disorders considered to be fatal until only recently, among others.

Dentist use of antibiotics is characterized by a number of particularities. In effect, antibiotic

prescription is empirical (the clinician does not know what microorganism is responsible for

the infection, since pus or exudate cultures are not commonly made). Based on clinical and

bacterial epidemiological data, the germs responsible for the infectious process are only

suspected, and treatment is decided on a presumptive basis.

As a result of the above, broad spectrum antibiotics are typically prescribed. A broad range of

organisms can be isolated from the oral cavity, and although not all of them are potential

human pathogens, the list of bacteria related with oral infections is relatively long (cocci,

bacilli, gram + and gram - organisms, aerobes and anaerobes).

Antibiotics are indicated for the treatment of odontogenic infections, oral non-odontogenic

infections, and in prophylaxis against focal infection.

Below, there is a list of the recommended antibiotics for each pathology.

Pulpitis the use of antibiotics is not indicated Pericapical/dentoalveolar Abcess- amoxicilin is the antibiotic of first choice. Tis

patology is commonly caused by a mixed infection, although it can be caused by purely

aerobic or purely anaerobic pathogens. Among anaerobes, microorganisms from the

Bacteroides group, Peptostreptococcus spp., Peptococcus spp., and Fusobacterium

spp. can be found.

Pericoronitis - amoxicilin is the antibiotic of first choice. This pathology can be definedas an inflammatory or infectious condition, involving the soft tissue that covers the

crown of an impacted tooth, generally the third molar. Some of the signs and

spontaneous pain, localized swelling, purulence/drainage and foul taste. Antibiotics

are used when the patient has difficulty swallowing, enlarged lymph nodes, fever,

limited mouth opening or facial cellulitis/infection

Antibiotic treatment is not recommended in chronic gingivitis or periodontalabscesses. Only in case of systemic dissemination or multiple abscesses, there is

considerable agreement that the beta-lactam derivatives are the antibiotics of choice

for these processes, provided there are no allergies or intolerances. However, there is

less consensus regarding which drug belonging this family should be prescribed. While

some authors consider the natural and semisynthetic penicillins (amoxicillin) to be the

options of first choice, others prefer the association amoxicillin-clavulanate, due to the


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growing number of bacterial resistance, as well as its broad spectrum,

pharmacokinetic profile, tolerance and dosing characteristic

Periodontitis if this pathology is substantially caused by anaerobe microrganisms(such as P. intermedia, Fusobacterium as well as spirochetes Borrelia and Treponema),

the drug of first choice is metronidazole or the association of metronidazole with

amoxicillin. If the cause is mainly inflammatory, caused by chronic plaque

accumulation, its removal is the advised treatment and antibiotics are not

recommended. In clinical situations of gingivitis and fibrinolytic alveolitis is not

indicated prescribing antibiotics. In the acute necrotizing ulcerative periodontitis are

first-line drugs metronidazole or metronidazole combination with amoxicillin.

In severe infections, with the involvement of fascia and deep tissues of the head andneck, the antibiotic of choice is amoxicillin with clavulanic acid

In cases of clinical immunosuppression is mandatory prescription of antibiotics, thesebeing appropriate to each disease

Table 1- Most common antibiotics with the respective administration route, posology and side effects.

Amoxicilin

Classification: Moderate-spectrum, bacteriolytic, -lactam

Special

characteristics:

Better absorbed, following oral administration, than other -lactam

antibiotics

Method of action: By inhibiting the synthesis of bacterial cell walls


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Table 2,3,4- Characteristics of the most important antibiotics

In case of the patient is allergic to penicilins, other alternatives to Amoxicilin such as

Cefalexin (first-line alternative, cephalosporin effective against Gram + bacteria and some

Gram -), Clindamycin (lincosamide, effective agains some protozoa and anaerobic bacteria),

Azitromicin/Clarithromycin (Macrolide, effective against certain Gram-negative bacteria) can

be used.

References

1. Portuguese Health Ministry. Guidelines for the Antibiotical Prescription in Dentistry. releasedin 30/11/2011

2. Faculty of General Dental Practice (2000) Adult antimicrobial prescribing in primary dental carefor general dental practitioners. London: Royal College of Surgeons of England.

3. Bresc-Salinas M, Costa-Riu N, Berini-Ayts L, Gay-Escoda C. Antibiotic susceptibility of thebacteria causing odontogenic infections. Med Oral Patol Oral Cir Bucal. 2006 Jan 1;11(1):E70-5

4. American Academy of Periodontology (2004) Position paper: systemic antibiotics inperiodontics. Journal of Periodontology 75(11), 1553-1565.

5. Antibiotic prophylaxis in surgery, a national clinical guideline. Scottish Intercollegiate GuidelinesNetwork 2008, acessed in 06-12-2012.6. Cachovan G, Bger RH, Giersdorf I, Hallier O, Streichert T, Haddad M, Platzer U, Schn G,

Wegscheider K, Sobottka I. Comparative efficacy and safety of moxifloxacin and clindamycin in

the treatment of odontogenic abscesses and inflammatory infiltrates: a phase II, double-blind,

randomized trial. Antimicrob Agents Chemother. 2011 Mar;55(3):1142-7.

7. Caton J, Ryan ME. Clinical studies on the management of periodontal diseases utilizingsubantimicrobial dose doxycycline (SDD). Pharmacol Res. 2011 Feb;63(2):114-20.

8. Machuca M, Espejo, Gutierrez L, Herrera J. Anlisis de la prescripcin antibitica en unafarmacia comunitaria. Pharm Care Esp 2000;18:300-7

9. Vallano A, Izarra A. Principios de teraputica antimicrobiana. Medicine 2006;9:3196-203.

Amoxicilin + clavulanic acid

Classification:Combination antibiotic consisting of amoxicillin trihydrate, a -

lactam antibiotic, and potassium clavulanate, a -lactamase inhibitor

Special

characteristics:Is effective against beta-lactamase producing bacteria

Method of action: Same as Amoxicilin

Metronidazole

Classification: Nitroimidazole antibiotic medication

Special

characteristics:Effective against anaerobic bacteria and protozoa

Method of action: Deactivating important enzymes in bacterial metabolism

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The use of antibiotics in oral pathologies