Prophylaxis And Antibiotic Therapy In Management Protocols-PDF Free Download

Prophylaxis and antibiotic therapy in management protocols
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J Clin Exp Dent 2017 9 1 e141 9 Antibiotic therapy and bisphosphonates. Introduction biotic therapy can help improve overall clinical condi. Antibiotic prophylaxis is used in dentistry to prevent in tion 15 17. fections in high risk cases such as during surgical pro The present article seeks to identify the different publis. cedures that enable pathogens to enter the body or in hed protocols of antibiotic prophylaxis and or antibio. patients whose general health characteristics or specific tic therapy in patients treated with oral or intravenous. medical condition make them more susceptible to con bisphosphonates To this end a systematic review of. tracting new infections 1 5 the literature was carried out focusing on three clinical. Consequently prophylaxis is used to promote appro situations a patients treated with oral or intravenous. priate bioavailability of an antibiotic that can effectively bisphosphonates and without MRONJ who will undergo. tackle microorganisms and therefore prevent their pro a dental extraction b patients treated with oral or intra. liferation and any subsequent infections This concept venous bisphosphonates and with previous incidence of. is the opposite of antibiotic therapy which is prescribed MRONJ who will undergo a dental extraction and c. in cases of already established infection and is aimed at patients treated with oral or intravenous bisphosphona. treating symptoms rather than preventing them 6 tes and with MRONJ as part of their conservative ma. Antibiotic prophylaxis and or antibiotic therapy proto nagement. cols have been established as an effective therapeutic. tool in the prevention or conservative management of Material and Methods. certain diseases One such disease is chemotherapy as A review of the literature published in PubMed over. sociated osteonecrosis of the jaw caused by bisphospho the last 10 years was carried out using the following. nates or other drugs described by Marx in 2003 7 as keywords antibiotic prophylaxis and osteonecrosis. an exposure of necrotic bone with more than eight wee bisphosphonates AND osteonecrosis AND dental ma. ks of evolution associated with bisphosphonates and no nagement bisphosphonate AND osteonecrosis AND. prior radiation therapy These lesions can progress and antibiotic prophylaxis AND oral surgery The results. become infected or even suffer other complications ma returned 29 129 and 13 articles respectively The in. king them difficult to manage and with a wide range of clusion and exclusion criteria were then applied in order. therapies providing inconsistent results 8 10 to fulfill the two proposed objectives. A distinction should be made between oral and intra The inclusion criteria for the first proposed objective. venous routes of administration of bisphosphonates antibiotic prophylaxis protocols were academic publi. 11 12 Intravenous bisphosphonates are indicated for cations written in English that involved reviews of the li. cancer patients pamidronate and zoledronic acid these terature clinical trials case control studies cohorts stu. are the most potent and are more likely to result in onset dies and case series centered on antibiotic prophylaxis. of MRONJ They increase sevenfold the appearance of indicating the antibiotic used doses time and dosage. MRONJ after performing dental surgery in comparison used for treatment in patients treated with oral or intra. with oral bisphosphonates In addition it should be no venous bisphosphonates with or without antecedents of. ted that the longer a treatment the higher the risk of de developing chemotherapy associated osteonecrosis of. veloping MRONJ and larger doses also increase the risk the jaw who were undergoing oral surgery. of MRONJ Intravenous bisphosphonates can remain in The inclusion criteria for the second proposed objective. the blood for up to 10 years antibiotic treatment guidelines were academic publi. The onset of bisphosphonate related MRONJ has also cations written in English that involved reviews of the. been correlated with different local factors extractions literature clinical trials or case series that specify the. implant placement periodontal disease etc and sys type of antibiotic used doses and length of treatment. temic factors endocrine disruptions tobacco alcohol and guidelines used for antibiotic therapy in patients. race age sex etc 13 14 treated with oral and intravenous bisphosphonates with. In view of these risk factors patient medical history and MRONJ as part of their conservative management the. the oral systemic regions affected by bisphosphonates refore antibiotics are used as part of patient treatment. including suppressed bone remodeling deterioration The exclusion criteria for both proposed objectives. of angiogenesis toxicity of the soft tissues modulatory were articles that did not meet the eligibility require. dysfunction of the immune system and delayed healing ments for both proposed objectives articles unrelated to. there are many reasons to use antibiotic prophylaxis in pa the research topic articles that did not have an abstract. tients treated with oral or intravenous bisphosphonates or with an anonymous author letters to the editor and. On the other hand patients treated with oral or intra expert opinions. venous bisphosphonates who have already developed The selection process was finished by manually sear. chemotherapy associated osteonecrosis of the jaw may ching through all the bibliographic references of the se. also benefit from antibiotic therapies to avoid potentially lected articles. serious infection that can worsen symptoms thus anti. J Clin Exp Dent 2017 9 1 e141 9 Antibiotic therapy and bisphosphonates. Results When antibiotic prophylaxis is used in patients without. The initial search in PubMed yielded 171 results with previous MRONJ who are receiving treatment with oral. an additional 17 articles identified during the manual bisphosphonates Table 1 as well as in patients trea. search of the collected articles bibliographic references ted with intravenous bisphosphonates Table 1 the. The flow chart seen in figure 1 details how the eligibility most frequently used antibiotics are penicillin amoxi. criteria were applied A total of 18 articles were selected cillin amoxicillin clavulanic acid metronidazole and. for final inclusion in the present study or a combination thereof Erythromycin clindamycin or. Results taken from the different articles can be seen in even lincomycin are prescribed if the patient is allergic. tables 1 to 3 Table 1 shows the antibiotic prophylaxis to penicillin or amoxicillin 15. protocols applied to patients without previous MRONJ In the same way the most widely used antibiotics for the. receiving treatment with oral bisphosphonates The table treatment of MRONJ in patients taking oral bisphospho. also provides information on the antibiotic prophylaxis nates are penicillin amoxicillin amoxicillin clavulanic. protocols used in patients without previous MRONJ acid metronidazole and or a combination thereof. receiving treatment with intravenous bisphosphonates With regard to the length of prophylactic antibiotic. Table 2 is centered on antibiotic prophylaxis protocols treatment prior to and following tooth extraction there. in patients treated with oral or intravenous bisphospho is no uniform approach applied in all patients receiving. nates who had previously had MRONJ Lastly Table 3 treatment with oral or intravenous bisphosphonates. table 3 continue shows the antibiotic treatment protocols Despite this most authors agree that post extraction. applied within a conservative management approach for treatment regimens in patients receiving oral and intra. patients with MRONJ receiving treatment with both oral venous bisphosphonates should be continued until the. and intravenous bisphosphonates surgical site has completely healed. Fig 1 Flow Chart, J Clin Exp Dent 2017 9 1 e141 9 Antibiotic therapy and bisphosphonates. Table 1 Antibiotic prophylaxis in patients treated with oral and intravenous bisphosphonates without previous MRONJ and who will undergo. an extraction, Author Year Number of Number of and site Oral Causes for Guidelines for antibiotic prophylaxis. Type of study patients of extractions Bisphosphonate treatment with. Average age Treatment type bisphosphonates, route of and number of. administration patients, time and number, of patients. INTRAORAL BISPHOSPHONATES, Lodi et al 2010 14 23 patients 38 extractions Clodronate PO 1 Multiple Amox 1g 18h x 20d.
Mand 23 myeloma 11, Average age Max 5 Duration of BP Mammary Ca 8 3 days before and 17 days after. Prospective 68 2 years Both 2 17 5 months Solid tumors 2 extraction. osteoporosis 2, Saia et al 2010 15 60 patients 185 extractions Risedronate PO 2 Metabolic bone Will be prescribed if. Mand 103 diseases 16 there is no pain 7 days after extraction. Average age 65 Max 82 Duration of BP Multiple there is pain 7 days before and after. Prospective years ND myeloma 44 extraction, Guideline to follow. Amox 1 g Clavulanic acid 8h x 3d, Amox Clavu ac 1g 12h x 4d and. Metro 500mg 8h x 4d, Allergy Linco 500mg 12h x 7d, INTRAVENOUS BISPHOSPHONATES.
Lodi et al 2010 14 23 patients 38 extractions Zoledronate IV Multiple Amox 1g 18h x 20d. Mand 23 20 myeloma 11, Average age Max 5 Pamidronate IV 1 Mammary Ca 8 3 days before and 17 days after. Prospective 68 2 years Both 2 Solid tumors 2 extraction. Duration of BP Severe, 17 5 months osteoporosis 2, 60 patients 185 extractions Zoledronate IV Metabolic bone Prescribed if. Saia et al 2010 15 Mand 103 38 diseases 16 there is no pain 7 days after extraction. Average age 65 Max 82 Pamidronate IV Multiple there is pain 7 days before and after. years 15 myeloma 44 extraction, Prospective Neridronate IV 4. Guideline to follow, Duration of BP, ND Amox 1g Clavu ac 8h x 3d. Amox Clavu ac 1g 12h x 4d and, Metro 500mg 8h x 4d.
Allergy Linco 500mg 12h x 7d, Scoletta et al 2011 16 64 patients 220 extractions Zoledronate IV Mammary Ca 32 Amox Clavulanate potassium 1g 8h x. 57 Multiple 6d, Average age Mand 113 Pamidronate IV 2 myeloma 21. Prospective 64 81 10 98 y Max 107 Zoled IV Pam IV Osteoporosis 2 Allergy Erythromycin 600mg 8h x 6d. 5 Prostate Ca 4, Other diseases 3 1 day before and 5 days after extraction. Duration of BP Other cancers 3, 19 59 18 95, Ferlito et al 2011 17 43 patients 102 extractions Zoledronate IV Multiple Prophylaxis. Mand 43 myeloma 28 Amox Clavu ac 1g 12 h, Average age Max 59 Duration of BP Mammary Ca 8.
Case series 56 4 y 16 2 3 2 Prostate Ca 5 2 days before and 5 days after extraction. months Lung Ca 2, Kato et al 2013 19 20 patients 62 extractions Zoledronate IV Mammary Ca 11 Amox. Mand 36 14 Multiple Amox Metro, Average age Max 26 Pamidronate IV 6 myeloma 5 Clindamycin. Retrospective 62 2 y Zoled IV Pam IV Prostate Ca 3. 1 Non Hodgkin s 1 day before and 9 days after extraction. lymphoma 1, Duration of BP 1, Abbreviations BP Bisphosphonates IV Intravenous PO Oral IM Intramuscular MRONJ Osteonecrosis of the jaw ND Not documented. Ca Cancer Metro Metronidazole Amox Amoxicillin Amox Clavu ac Amoxicillin Clavulanic Acid Linco Lincomycin Erythro Eryth. romycin Clinda Clindamycin Peni Penicillin, J Clin Exp Dent 2017 9 1 e141 9 Antibiotic therapy and bisphosphonates. Table 2 Antibiotic prophylaxis in patients treated with oral 0 articles or intravenous bisphosphonates without previous MRONJ and who. will undergo an extraction, Author Year Number of Number of and Treatment Causes for Guidelines for antibiotic.
Type of study patients site type route of treatment with prophylaxis. Average age of extractions administration bisphosphonates. time and and number of, number of patients, INTRAVENOUS BISPHOSPHONATES. Vescovi et al 2015 20 36 patients 82 extractions Zoledronate IV Multiple Extraction prophylaxis. myeloma 11 Amox 2g d, Average age Mand 51 Duration of BP Osteoporosis 7. 68 5 y Max 31 9 24 months Other cancers 18 Management of MRONJ. Prospective Same treatment as before and, Metro 1g d. 3 days before and 2 weeks, after extraction, Abbreviations BP Bisphosphonates IV Intravenous PO Oral IM Intramuscular MRONJ Osteonecrosis of the jaw ND Not document. ed Ca Cancer Metro Metronidazole Amox Amoxicillin Amox Clavu ac Amoxicillin Clavulanic Acid Linco Lincomycin Erythro. Erythromycin Clinda Clindamycin Peni Penicillin, Discussion Similarly post extraction recommendations vary with.
Antibiotic prophylaxis can be beneficial in avoiding articles suggesting that antibiotic prophylaxis be admi. the onset of MRONJ in patients who are set to undergo nistered anywhere from seven 15 to seventeen days. oral surgery extraction and are currently being treated 14 post intervention. with oral and intravenous bisphosphonates If MRONJ For patients receiving treatment with intravenous bis. has already developed and is under control antibiotic phosphonates the articles recommendations for when. treatment prophylaxis can prevent its recurrence Mo to begin pre extraction prescription of antibiotics range. reover antibiotic prophylaxis can help reduce the symp from one 16 19 two 17 or three days before 14 to. toms of osteonecrosis of the jaw aiding in a conserva seven days before extraction 15 Post extraction anti. tive management regimen However despite the many biotic treatment is recommended to be started five 16. studies found in the literature there is no consensus on 18 seven 15 nine 19 or seventeen days 14 after. which is the most used antibiotic and its dosage 17 the procedure Despite this most authors agree that post. antibiotic prophylaxis AND oral surgery The results returned 29 129 and 13 articles respectively The in clusion and exclusion criteria were then applied in order to fulfill the two proposed objectives The inclusion criteria for the first proposed objective antibiotic prophylaxis protocols were academic publi cations written in English that involved reviews of the li terature

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