PRESCRIPTION OF ANTIBIOTIC FOR PERIAPICAL ABSCESS

WHAT IS PERIAPICAL ABSCESS….????

PERIAPICAL ABSCESS IS AN ACUTE OR

CHRONIC SUPPURATIVE PROCESS OF THE

DENTAL PERIAPICAL REGION

ANTIBIOTICS USED IN TREATMENT

• When drainage cannot be achieved or the patient shows signs of systemic involvement, antibiotic therapy is indicated; in addition, an increasing number of immunocompromised patients require antibiotic therapy.

Antibiotics

• Empirical antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

Penicillin

• Traditionally been considered the DOC for the treatment of a dental abscess. Antibiotic therapy alone, without surgical drainage, may not be effective because of poor antibiotic penetration into the abscess cavity, ineffectiveness at low pH levels, and the inoculum effect. Bactericidal against sensitive organisms when adequate concentrations are reached and is most effective during the stage of active multiplication. Inadequate concentrations may produce only bacteriostatic effects.

Dosing• Adult• Penicillin V: 250-500 mg 6-8h• Pediatric• Penicillin V: 25-50 mg/kg 6-8h

Contraindications

Documented hypersensitivity reactionPrecautionsCaution in impaired renal function and in seizure

disorders; excreted into breast milk (peak breast milk concentration achieved 1 h after IV dose)

.

Azithromycin

• an option for the treatment of a dental abscess in patients who are allergic to penicillin. Indicated for mild-to-moderate microbial infection .

Dosing

• Adult• Day 1: 500 mg PO/IV once

Days 2-5: 250 mg PO/IV daily• Contraindications• Documented hypersensitivity; hepatic

impairment

Metronidazole (Flagyl)

• Effective against anaerobic organisms. It can be combined with penicillin.It inhibits DNA synthesis by affecting the helical DNA structure leading to DNA strand breakage causing cell death.

Dosing

• Adult• 250-500 mg PO q8h; alternatively, 1 g loading

dose IV, followed by 500 mg q6h• Pediatric• 30 mg/kg/d PO divided q8h; not to exceed 4

g/d• Contraindications Documented hypersensitivity;

avoid use during first trimester of pregnancy.

Clindamycin (Cleocin)

• Can be used in patients who are penicillin allergic. Inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit preventing peptide bond formation. Excellent activity against aerobes and anaerobes; penetrates bone and abscess cavities.

Dosing

• Adult• 300-450 mg/dose PO q8h

600-900 mg/dose IV q6-8h

• Pediatric• 20-30 mg/kg/d PO divided q8h• Contraindications • Documented hypersensitivity; regional enteritis,

ulcerative colitis, hepatic impairment, antibiotic-associated colitis

Amoxicillin and clavulanate (Augmentin)

• Amoxicillin works by binding to one or more of the penicillin-binding proteins, which interferes with bacterial cell wall synthesis during active bacterial replication. The final transpeptidation step of peptidoglycan synthesis is inhibited leading to cell death. Clavulanic acid binds and inhibits beta-lactamase enzymes that inactivate amoxicillin resulting in an expanded spectrum of activity for Augmentin.

Dosing

• Adult• Immediate-release: 500 mg/dose PO q8h or

875 mg/dose PO q12hExtended-release: 2000 mg/dose PO q12h

• Pediatric• 80-90 mg/kg/d PO divided q12h • Contraindications- hypersensitivity reaction

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