completely repaired congenital heart defect with prosthetic material or device during 1st six months after procedure.

repaired heart defect with residual defect

unrepaired or incompletely repaired cyanotic congenital heart disease

cardiact transplant

joint replacement

other immunocompromised conditions

mitral valve prolapse

rheumatic heart disease

bicuspid valve disease

calcified aortic stenosis

ventricular/septal defect, atrial septal defect/hypertrophic cardiomyopathy

pcn (amoxicillin) 2000mg

clindamycin 600mg

Azithromycin 500 mg

cefazoline 1gram 30 min prior to dental procedure

caries (S mutans.)- treat with flouridated water,chlorhexidine, and bacterial plaque disruption.

periodontal disease- (A.A., P.gingivalis, P. intermedia, fusobacterium spp)-treat with arestin(minocyline) or atridox (doxycycline)

Localized dental infections(endo and perio related)if there is adequate drainage, anti-infectives may not be needed.  when needed anti-infective is dependent on the organisms present.

systemic-(fever, malaise, tachycardia) lesions should be drained, antibiotics used for 2-3 days or until infection is gone.

initially-gram + cocci

then: gram + cocci and gram - anaerobic (a mixed infection)

even later: increase in anaerobic which is primarily contents of an abscess.

the anti-infective chosen is dependent on what stage host is in.

for gram + infection penicillin is good (VK) if pt is allergic to penicillin, use erythromycin or clindamycin.

if later infection clindomycin or metronidazole

cellulitis, gram +

drug of choice VK(penicillin) 500 mg q6h for 5-7 days 

2nd choices:

erythromycin-causes nausea

clindamycin-causes GI distress

when mixed gram + and gram -

use clindamycin and metronidazole (flagyl)

PCN/VK may work too.

 antimicrobials used in dentistry

pen VK

amoxicillin

doxycyline and tetracycline (these are bacterialstatic they wont kill all micro organisms)

metronidazole

clindamycin

metronidazole used

tetracycline

cephalosporin 

if allergy to pen VK

 antibiotic agents destroy or suppress growth and multiplication of MO

they are produced by microorganisms

 bacteria learn to make enzyme to destroy penVK which inactivates it

cause by

appropriate choice of antibiotic

not taking full prescription

not taking as prescribed

incection with resistant strain

range of activity of drug against bacteria

narrow

intermediate

broad(kills everything even the normal flora)

indirect toxicity/superinfection-new infection with different resistant bacteria or fungi due to killing normal flora

(example, stomatitis or glossitis)to treat use antifungal meds or yogurt to replenish normal flora of GI.

fungal-use nystatin to treat

hypersenstitivity/delayed immune response(rash, fever)discontinue meds and use corticosteriods.

anaphylaxis-allergic reactions PCN and cephalosporin cause more.  erythromycin and clindomycin cause less.

direct toxicity- tissue damage (ototoxicity, hepatoxicity, blood dyscrasias, phlebitia, photoxiticty (tetracycline)

good immune response is best defense

natural drainage of abcess may eliminate need for antibiotics.

acute severe rapidly spreading infectio should be treated with effective 

status of liver

age

if pregnancy or lactating

likelihood of organisms resistance

methicillin-resistant staph Aureaus

treat with vancomycin

few treatment options, mortality rate high

for hemodialysis patient graft site with MRSA

oral contraceptives

oral anticoagulants (VITAMIN K)

pain

pseudomembranous colitis

metronidazole-causes pseudomembranous colitis, diarrhea and pain

also tetracycline

staphylococcal, streptococcal, and meningococcal infections

syphilis

and dental premed (amoxicillin)

also helicobater pylori(bacteria in stomach)

allergy

impaired renal function

electrolyte imbalance

potentiation (build up theraputic levels 0+1=2)when combined with probenecid(antigout)

benemid

antagonistic with antacids or food, slowed absorption

antagonistic with other anti-infectives

one of the least toxic antibiotics

used to treat respiratory infections

acne

sexually transmitted infections(like syphilis if allergic to pcn)

COMMON SIDE EFFECT IS NAUSEA!!!!

erythromycin

clarithromycin

azithromycin-zpack

hypertension

liver dysfunction(alcoholism)

bacterialstatic

interferes with protein synthesis

poor second choice to PCN to treat anearobes

theophyline-for breathing problems

digoxin-heart pump better but slower

warfarin-blood thinner

cyclosporine-gingival overgrowth

broad spectrum antibiotic

bacteriostatic

interferese with protein synthesis

adverse reactions: to tetracylcine

nausea and vomiting

diarrhea

glossitis

stomatitis

superinfection(candidiasis)

aka flagyl

to treat mature infections gram -

crohns disease

antibiotic associated diarrhea

rosacea

h. pylori

perio infections

when combined with amoxicillin it becomes poor mans augmentin a synergistic antibiotic.

GI 12% infections bad

xerostomia

bad when mixed with alcohol

amino sugars

bacteriacidal

examples: neomycin

kanamycin, gentamycin

not true antibiotic because not developed from living organisms.

bactrim and septra are examples

antibacteria

hard on kidneys

drink lots of water when on these

cipro-anthrax cure

izoniazid

rifampin

pyrazinamide

liver damage 1% get hepatitis