2007 Antibiotic Prophylaxis Guidelines and Antibiotics for Oral Infection

The use of antibiotics is being impacted by the emergence of drug resistant microorganisms.  This event has called for the reconsideration to specify when these agents are necessary.  This course will identify the main issues involved in the antibiotic resistance controversy and the implications for dentistry. The current antimicrobial agents and protocols recommended for oral infections will be included with emphasis on the indications, dosage and relevance to microbial drug resistance.  The most recent American Heart Association regimen recommending antibiotic prophylaxis to prevent bacterial endocarditis and the updated American Dental Association/AAOS joint policy regarding antibiotic prophylaxis to prevent infection in a total joint replacement will be explained with emphasis on using professional judgment to determine when to prescribe antibiotics.  Potential adverse drug effects of antibiotic therapy will be discussed.

OBJECTIVES:

1.        Consider the factors that have caused emergence of antibiotic resistant microorganisms and adverse drug effects as a result of antibiotic therapy.

2.        Review pharmacological principles for prescribing antimicrobials for orodental infection.

3.        Describe the 2007 American Heart Association recommendations regarding antibiotic prophylaxis prior to dental procedures which may result in bacterial endocarditis.

4.        Consider medical conditions that are recommended for antibiotic prophylaxis prior to dental treatment.

5.        Determine situations that require professional judgment prior to prescribing antibiotics.

6.        Review 2003 ADA/AAOS antibiotic prophylaxis recommendations for the total joint replacement patient and their recommendations to dentists related to legal issues of antibiotic prophylaxis.

COURSE OUTLINE

I.                     Emergence of antibiotic resistant microbes

a.        Indiscriminant prescribing, other reasons for problem

b.       Indications for proper prescription of antibiotics

                                                               i.      Adverse drug effects

c.        Unwarranted antibiotic use in orodental infection

II.                   Infective endocarditis (IE) vs bacterial endocarditis

a.        Hematogenous bacteremia

b.       Signs and symptoms of IE

c.        2006 AHA recommendations for antibiotic prophylaxis to prevent bacterial endocarditis.

d.       Indications for antibiotic prophylaxis to prevent bacterial endocarditis (BE)

e.        Various agents recommended for prevention of BE

f.         Dental procedures recommended for coverage

III.                 Total joint replacement

a.        2003 ADA/AAOS joint policy

b.       Selected clients indicated

c.        Various agents recommended and why

d.       Legal issue recommendations

IV.                 Antibiotic use in dentistry

a.        Recommendations from AAOM, Lippincott’s Dental Drug Reference/Clinical Implications

b.      Systematic review for management of acute periapical pulpitis, acute periapical abscess