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Abstract
Antibiotic therapy is an art and a science. There are so many confounding variables, such as suspected pathogen, ability
to establish drainage, pharmacokinetic properties of the drug, mechanism of action of the antibiotic, virulence of the
infection, the current health status of the host, and host defense mechanisms, that it is not possible to make antibiotic
therapy into a mechanistic technologic science. The most important decision for the dental practitioner to make is not
only which antibiotic to use but whether to use one at all. This article will discuss important factors to be kept in mind
while prescribing antibiotics in dentistry.
Key Words: - Antibiotics, SABE, Drug Resistance
Penetration barriers may hamper the access of the AMA to anaerobic bacteria (70%). Bacteria found in well-
the site of infection in sub-acute bacterial endocarditis circumscribed chronic non-advancing abscesses are mostly
(SABE), Endopthalmitis prostratitis etc. anaerobic bacteria, while cellulitis type of infection that do
not have abscess formation show exclusively aerobic
4. Improved host defense
bacteria, i.e. early infection (cellulitis like) aerobic
Integrity of host defense plays a crucial role in overcoming bacteria, Severe infection mixed flora (Aerobic +
an infection. Pyogenic infections occur readily in anaerobic), If infection becomes longer contained &
Neutropenic patients, while if cell mediated immunity is controlled aerobic environment (only anaerobic flora)
impaired, low grade pathogens attack. In an individual with Abscess anaerobic bacteria alone
normal host defense, a bacteriostatic AMA may achieve
C. Antibiotic Sensitivity for causative organism
cure, while intensive therapy with cidal drugs is imperative
in those with impaired host defense or when organisms are Penicillin is excellent for treatment of streptococcal
protected with barrier. infection and is good to excellent for major anaerobes of
odontogenic infections.
5. Pregnancy
Erythromycin is effective against streptococci,
All AMA should be avoided in pregnancy that has risk to
peptostreptococci & prevotella but ineffective against
foetus.
fusobacterium.
Penicillin, cephalosporins & erythromycin are reasonably
Clindamycin is both effective against streptococci and five
safe
major anaerobes.
Tetracyclines carry a risk of acute yellow atrophy of liver,
Cephalexin is only moderately active against streptococcus
pancreatitis and kidney damage in mother. They also cause
(approximately 10% of strain are resistant 70%
tooth discoloration and bone deformities in offspring.
intermediate sensitive, and 20% are sensitive) and good to
Aminoglycosides can cause foetal ear damage. very good against all groups of anaerobes.
Metronidazole though hot teratogenic, its mutagenic Metronidazole has no action against streptococcus but has
potential warrants caution. excellent activity against all anaerobic groups.
6. Genetic factors Drug Factors
Some drugs like sulphonamides & chloramphenicol cause 1. Use of Specific narrow spectrum antibiotic
haemolysis in G- 6pd deficient patient. For definitive therapy a narrow spectrum drug which
selectively affects the concerned organism is preferred,
Organism Related Considerations
because it is generally more effective than a broad
A. Empirical Therapy spectrum. It is less likely to disturb the normal microbial
Antibiotic therapy is initial / empirical or definitive, flora (super infections).
depending on whether the organism is identified precisely.
Less chances for development of resistant strains.
Ideally, identification and antimicrobial sensitivity of the
infecting bacteria should be determined before instituting For empirical therapy often a broad spectrum drug is used
systemic antibacterial therapy. However being time to cover all pathogens.
consuming (at least 48 hrs), expensive & impractical for
2. Use of Bactericidal rather than a bacteriostatic
dental infections, initial empiric therapy is indicated.
drug
Initial empiric therapy may be instituted with a fair
A bactericidal antibiotic may be preferred over
degree of reliability, When the site and features of
bactoriostatic because it directly reduces number of bacteria
infection are well defined, the circumstances leading to
at site of infection by killing them while bacteriostatic only
infection are well known and the organisms that most
prevents increase in number [inhibit growth & reproduction
common causing such infections are well known.
of bacteria]
Empirical therapy is especially important in dentistry.
Because most dental infections are acute in nature and This is especially important while treating life-threatening
treatment cannot be delayed. Also it is not always possible infections in patients with impaired host defense. Antibiotic
to obtain appropriate samples of infected material for therapy basically reduces the bacterial challenge to allow
bacteriologic testing. host defenses to complete treatment and if bactoriostatic
drugs are used, they slow growth so that host defense can
B. Identification of causative Organism
now eliminate a static population of bacteria & cure the
Type of bacteria (Aerobic/ anaerobic) and their specific infection but if host defense system is compromised use of
Identification is important for dentist Typical odontogenic bactericidal drug becomes critical. Acute infection
infections (alveolar abscess, periodontal abscess, dental generally resolves faster.
pulp infection, chronic periodontitis acute necrotizing
gingivitis etc.) are caused by a mixture of aerobic and