The use of antibiotics in Endodontics

1. Lecturer of Endodontics Al-Azhar University Ashraf Refai BDS MSc DD HMD ashraf_refai@hotmail.com AshrafSamirRefai www.arefai.edublogs.orgwww.idclinics.com +20101434323

2. Antibiotics in Endodontics AMDA (Arab Microdentistry Association) Advanced Endodontic Training Crouse 30/11/2010

3. What Do We Know About Antibiotics?? One of Greatest Medical Advances 1935 Sulfanilamide & Penicillin The Single Most Abused Drug in Medicine

4. Myths About Antibiotics… Myth #1: Antibiotics Cure Patients

5. Myths About Antibiotics… Myth #2: Antibiotics Are Substitutes for Surgical Drainage

6. Myths About Antibiotics… Myth #3: 60% of Infections Resolve by Host Defesnses The Most Important Decision is Which Antibiotic to Use

7. Myths About Antibiotics… Myth #4: Culture & Sensitivity Testing Are Required

8. Myths About Antibiotics… Myth #5: Tetracyclinesvs Beta Lactams Antibiotics Increase the Hosts Defense

9. Myths About Antibiotics… Myth #6: ADRs Microbial Resistance Expensive Antagonistic Effects Multiple Antibiotics Are Superior to Single Antibiotics

10. Myths About Antibiotics… Myth #7: Antibiotics Prophylaxis is Usually Effective

11. Myths About Antibiotics… Myth #8: Drug Resistant Bacteria Antibiotics are Effective Against Chronic Infections

12. Myths About Antibiotics… Myth #9: Prolonged Antibiotics Kill Resistant Infections Prolonged Antibiotics are Necessary to Prevent Rebound Infections (Remove the Cause) What Works for One Specialty Should not be Extrapolated to Another (2-7 Day Infections) Infections Require a Complete Course

13. Nosocomial Infections“Hospital BornInfections”

14. 5 Million Treated for Infections / Year3 Million Come in With One2 Million Get One at the Hospital

15. 5-6% of Patients in HospitalsGet a Nosocomial Infection6-8% Mortality Rate

16. 45-65% of Antibiotic Prescriptions are Inappropriate

17. What About inEgypt??? 3rd World Countries are a Major Source of Resistant Infections

18. Some Reasons Why Antibiotic Therapy Fails… Inappropriate Choice of Antibiotics Too Low Blood Concentration (Improper Dosing) Poor Penetration (Abscess) Limited Vascularity & High Acidity in the Affected Area

19. Some Reasons Why Antibiotic Therapy Fails… Antibiotic Antagonism (Multiple Antibiotics) Resistant Organisms Failure to Take Antibiotics (Patients Fault) Failure to Eradicate Infection

20. The Bacterial Mix… Initially Pulpal Infections are Mixed in Nature After Oxygen Depletion Facultative & Anaerobic Bacteria Predominate

21. When to Use Antibiotics??? When there is a Reasonable Chance that the Infection may Spread Beyond the Periapex

22. Type of Antibiotics… Bactericidal (Fast Killing) Bacteriostatic (Slow Killing)

23. Penicillins Incorporates Beta-Lactam in Structure Bactericidal Short Half Life (Regular Doses) Accumulates in the Kidney Least Toxic Antibiotic

24. Cephalosporins Similar to Penicillins in Chemical Structure Also Incorporates Beta-Lactam in Structure Bactericidal Wide Spectrum 1st , 2nd, 3rd,4th & 5th Generations

25. Considerations When Using Pennicilin & Cephalosporins Severe Allergic Reactions are Rare with these Groups If you are Allergic to One then you Could be Allergic to the Other

26. Considerations When Using Pennicilin & Cephalosporins Ressistance to this Group May Happen Beta-Lactamase Enzyme Neutralizes them Some Antibiotics Incorporate Clauvanic Acid which Makes it Resistant to the Enzyme

27. Metronidazole Bactericidal Mainly Affects Only Anearobic Bacteria Used in Combination with Other Antibiotics like (Augmentin) Causes Stomach Upset Darkened Urine

28. Macrolides (Erythromycin) Bacteriostatic Kills Same Range of Bacteria Like Penicillin Drug of Choice with Penicillin Allergy Has Serious Drug Interactions with Certain Antihistaminic & Bronchodialators

29. Clindamycin Bacteriostatic Wide Spectrum of Action Can Cause Pseudomembranous Colitis Over Growth of Clostridium difficile Penetrates well into Abscesses

30. Tetracycline (Doxycycline) Bacteriostatic Kills the Broadest Spectrum of Bacteria Excellent for Endo-Perio Lesions Not to be Given to Children, Pregnant or Lactating Women May Causes Photosensitivity

31. Antibiotic Prophylaxis The Purpose To Prevent Clinical Infection by Helping Destroy Small Numbers of Bacteria Present Before or Introduced During Treatment

32. Viridans Streptococcus Alpha Hemolytic Stores Energy by Forming Intra & Extra Cellular Polysaccharides(Sticky Vegetation) Colonies Form and Trap Fibrin & Blood Cells

34. When to Use Prophylaxis??? Lets Look at the Handouts!!

35. Review Myths Surrounding Antibiotics Some Stastics Around the Abuse of Antibiotics Nosocomial Infections Bactericidal vsBacteriostatic The Different Types of Antibiotics When to use Antibiotic Prophylaxis