Refresher: Why use anti-infectives?

This summary is based on the Clinical Info provided by the Canadian Pharmacists Association: Drugs in Dentistry (December 2012)

By Dr. Dan Haas, DDS, PhD, FRCDC

Consider the following points when using antibiotics:

• Use only when there is an indication.
• Use only when the risk-benefit ratio is favourable.
• They are not a substitute for establishing adequate drainage.
• Choose an effective agent with the narrowest spectrum of activity.
• Prescribe a therapeutic dose.
• Consider a loading dose.
• Prescribe at an appropriate frequency.
• Prescribe for an appropriate duration.
• Choose the drug with the fewest side effects.
• Consider laboratory culture and sensitivity tests to target specific bacteria with antibiotics identified as effective.
• Recognize that antibiotics encourage development of resistance if used for too long and/or at suboptimal doses.
• In superficial infections, consider alternatives to antibiotics such as topical debridement and application of topical antiseptics when appropriate.
• Consider individual patient factors such as age, allergies and drug interactions, especially with azole antifungals (fluconazole, itraconazole, ketoconazole), clarithromycin, erythromycin, metronidazole, tetracyclines; consult individual product monographs and drug interaction references.
• Consider cost.

 Antibacterial Dosages for Orofacial Infections

Antifungals for the Treatment of Oral Candidiasis

References

1. Haas DA. Adverse drug interactions in dental practice: interactions associated with analgesics, Part III in a series. J Am Dent Assoc 1999;130(3):397-407.
2. United States Pharmacopeial Convention. USP DI Volume 1: Drug information for the health care professional. 24th ed. Englewood (CO): Micromedex; 2004.
3. Haas DA. An update on analgesics for the management of acute postoperative dental pain. J Can Dent Assoc 2002;68(8):476-82.
4. Haas DA, Epstein JB, Eggert FM. Antimicrobial resistance: dentistry’s role. J Can Dent Assoc 1998;64(7):496-502.
5. Levine M, Lexchin J, Pellizzari R, editors. Drugs of choice: a formulary for general practice. 3rd ed. Ottawa (ON): Canadian Medical Association; 1998. p. 78. 

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