台北荣民总医院.pptVIP

Antibiotic Use in Orofacial Dental Infection 台北榮民總醫院 牙科部 Speaker 陳雅薇 Moderator 羅文良 大夫 INTRODUCTION This presentation will review the evaluation and management of orofacial infections with emphasis on: ■ Assessment of the Patient ■ Diagnosis and Treatment of infection ■ Antibiotic Therapy ■ Indications for Prophylaxis ■ Antifungal Agent ASSESSMENT Requires a complete medical history and exam of the head and neck region with awareness to systemic factors as part of a comprehensive dental examination Identify local and/or systemic signs and symptoms to support the diagnosis of infection: erythema, warmth, swelling, and pain malaise, fever ( 38 c), chills Loss of function dysphagia, trismus, dyspnea ASSESSMENT (CON’T) Systemic signs of infection BP ↓ WBC ↑ CRP ↑ urine output ↓ DIAGNOSIS: Infection Determine etiology odontogenic trauma wound, animal bite TB, fungi, actinomycoses DIAGNOSIS (CON’T) Determine cellulitis versus abscess TREATMENT of INFECTION Remove the cause of infection is the most important of all, by either spontaneously or surgically drain the pus. Antibiotics are merely an adjunctive therapy. INDICATION for ANTIBIOTICS 1. Severity of the infection Acute onset Diffuse swelling involves fascial spaces 2. Adequacy of removing the source of infection When drainage can’t be established immediately 3. The state of patients’ host defense When the patient is febrile Compromised host defenses For prophylaxis MICROBIOLOGY Most oral infections are mixed in origin consisting of aerobic and anaerobic gram positive and gram negative organisms Anaerobes predominant (75%) COMMONLY USED A/B Mechanism of the antibiotics COMMONLY USED A/B 1. Groups of Penicillin First choice for odontogenic infection G(+) cocci and rod, spirochetes, anaerobes 0.7~10% hypersensitivity = PST Nature: penicillin G (IV), penicil