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Medically Compromised Patients Pharmacology Restorative Dentistry

How do you treat an oral infection in a patient with a history of C. Difficile?

This question was submitted by a general dentist: A patient presents with an oral infection for which I would like to consider antibiotics as part of overall care. However, she has a history of C.Difficile infection and there is concern that the antibiotic chosen might reactivate the residual C.Difficile in her gut. What is the best course of action in treating the oral infection?

Dr. Dan Haas, DDS, PhD, FRCD(C) Professor and Dean, Arthur Zwingenberger Decanal Chair, Faculty of Dentistry at the University of Toronto

Dr. Dan Haas provided the following quick and initial response: 

A recent history of Clostridium Difficile-associated colitis or diarrhea is a significant concern. If the patient has experienced this, it is best to avoid antibiotic therapy for at least 2 months, if at all possible.

As with all pharmacotherapy, the decision comes down to risk vs. benefit. Is there a clear indication for an antibiotic for this patient? If no, avoid any antibiotic and rely on local measures, i.e. drainage or debridement for treatment. If the answer is yes, then select an antibiotic with a lower association with this condition, recognizing that any antibiotic could induce this problem.

Antibiotics to avoid are amoxicillin and clindamycin. Antibiotics to consider using are penicillin V, clarithromycin, or azithromycin. 

 

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