PRINCIPLES OF PROPHYLAXIS OF INFECTION

1. PRINCIPLES OF PROPHYLAXIS OF INFECTION • Procedure should have significant risk of infection • Choose correct antibiotic • Antibiotic plasma level must be high • Time antibiotic administration correctly • Use shortest antibiotic exposure that is effective

2. 1)Procedure have significant risk of infection • The procedure must have a high enough incidence of bacteria to be reduced with antibiotic therapy • Factors related to Post-op infection • Size of bacterial inoculum • Duration of surgery ( >4 hrs) • Presence of FB, implant or dead space • State of host resistance (depressed host defense)

3. 2.)Choose correct antibiotic • Antibiotic criteria: • The antibiotic should be effective against the organisms most likely to cause infection • Narrow spectrum antibiotic • Least toxic to patient • Bacteriacidal antibiotic more preferable • Antibiotic prophylaxis of choice before oral surgery= Amoxicilin @ Penicilin • Allergic to penicilin, use clindamycin

4. 3)Antibiotic plasma level must be high • Antibiotic level in plasma must be higher than when antibiotic used therapeutically • Peak Plasma Level should be high-ensure diffusion of antibiotic into all fluid and tissue • Usual recommended: • Dosage for prophylaxis at least 2x of therapeutic antibiotic

5. 4)Time antibiotic administration • Must be given 2 hours or less before surgery • Antibiotic administration after surgery is greatly decreased its efficacy or has no effect on preventing infection • There is evidence administration after 2 hours or more may increase risk of wound infection • If surgery prolonged, additional dose is required, intraoperative dose interval should be shorter

6. 5)Use shortest effective antibiotic exposure • Must be in the target tissue before surgery • Adequate plasma level is maintained • The prophlactic antibiotic is necessary for the time of surgery

7. PRINCIPLES OF PROPHYLAXIS AGAINST METASTATIC INFECTION • Prophylaxis against IE • Prophylaxis in patient with Cardiovascular conditions • Prophylaxis against Total Joint Replacement Infection

8. A)Prophylaxis against IE • Mortality, morbidity of IE are high • IE reaction must be treated in hospital with high dosage of iv antibiotic, damaged heart valve is replaced surgically with prosthetic valve • Dental procedures cause bacteremia -S. viridans which might cause IE • Antibiotic prophylaxis for "All dental procedures that involve manipulation of gingival tissue/periapical region/perforation of oral mucosa” • 2g of Amoxicilin orally ½ to 1 hours before procedure

9. A)Prophylaxis against IE • Patient with antibiotic prophylaxis that required dental tx needs a period of >10 days between the appoinment • Patient at risk of IE should have comprehensive prophylaxis program such as excellent OH and periodic professional care • If surgery is required, the mouth can be rinsed with antibacterial agent preoperatively • Even with appropriate measures are taken, it still can happen. Patient should be informed by dentist about signs & symptom of IE post-operatively

10. B)Prophylaxis in patient with Cardiovascular conditions • Patient with CABG, transvenous pacemaker, atherosclerotic vascular disease, alloplastic graft • No need antibiotic prophlaxis • Patient who receiving renal dialysis or have hydrocephaly • need to consult physician • AHA does not recommend antibiotic prophlaxis for nonvalvular device

11. C)Prophylaxis against Total Joint Replacement Infection • Patient with TJRI- risk of bacteremia & infection • Infection might come from dental procedure eg extraction (recent literature opposed it) • Instead it appears the infection come from others through hematogenous spread which result to septicemia • But odontogenic infection might cause TJRI • ADA & AAOS recognize that patient with prosthetic joint not at a risk of joint infection after dental procedure • ADA recommend antibiotic prophylaxis for susceptible pt only