Therapeutics

Most frequently prescribed antibiotics for oro-facial infections

• Amoxycillin
• Metronidazole
• Augmentin
• Flucloxacillin

Most frequently prescribed analgesics for oro-facial pain

• Co-codamol 30/500
• Ibuprofen
• Paracetamol
• Diclofenac

Prophylaxis against infective endocarditis.

Some patient will require prophylactic antibiotics to reduce the risk of infective endocarditis following dental treament.

This text is taken from the BNF please check to make sure it is up to date here.(may require a log in and password if not on an NHS internal computer).

Prevention of endocarditis (1) in patients with heart-valve lesion, septal defect, patent ductus, prosthetic valve, or history of endocarditis

Dental procedures (2) under local or no anaesthesia ,
patients who have not received more than a single dose of a penicillin (3) in the previous month, including those with a prosthetic valve (but not those who have had endocarditis ), oral amoxicillin 3 g 1 hour before procedure; child under 5 years quarter adult dose; 5-10 years half adult dose

patients who are penicillin-allergic or have received more than a single dose of a penicillin (3) in the previous month, oral clindamycin (4) 600 mg 1 hour before procedure; child under 5 years clindamycin (4) 150 mg or azithromycin (5) 200 mg; 5-10 years clindamycin (4) 300 mg or azithromycin (5) 300 mg

patients who have had endocarditis , amoxicillin + gentamicin , as under general anaesthesia

Dental procedures (2) under general anaesthesia ,

no special risk (including patients who have not received more than a single dose of a penicillin in the previous month),

either i/v amoxicillin 1 g at induction, then oral amoxicillin 500 mg 6 hours later; child under 5 years quarter adult dose; 5-10 years half adult dose

or oral amoxicillin 3 g 4 hours before induction then oral amoxicillin 3 g as soon as possible after procedure; child under 5 years quarter adult dose; 5-10 years half adult dose

special risk (patients with a prosthetic valve or who have had endocarditis ), i/v amoxicillin 1 g + i/v gentamicin 120 mg at induction, then oral amoxicillin 500 mg 6 hours later; child under 5 years amoxicillin quarter adult dose, gentamicin 2 mg/kg; 5-10 years amoxicillin half adult dose, gentamicin 2 mg/kg

patients who are penicillin-allergic or who have received more than a single dose of a penicillin in the previous month,
either i/v vancomycin 1 g over at least 100 minutes then i/v gentamicin 120 mg at induction or 15 minutes before procedure; child under 10 years vancomycin 20 mg/kg, gentamicin 2 mg/kg
or i/v teicoplanin 400 mg + gentamicin 120 mg at induction or 15 minutes before procedure; child under 14 years teicoplanin 6 mg/kg, gentamicin 2 mg/kg

or i/v clindamycin (4) 300 mg over at least 10 minutes at induction or 15 minutes before procedure then oral or i/v clindamycin 150 mg 6 hours later; child under 5 years quarter adult dose; 5-10 years half adult dose

(1) Advice on the prevention of endocarditis reflects the recommendations of a Working Party of the British Society for Antimicrobial Chemotherapy, Lancet , 1982, 2 , 1323-26; idem , 1986, 1 , 1267; idem , 1990, 335 , 88-9; idem , 1992, 339 , 1292-93; idem , 1997, 350 , 1100; also J Antimicrob Chemother , 1993; 31 , 437-8

(2) Dental procedures that require antibiotic prophylaxis are, extractions , scaling , and surgery involving gingival tissues . Antibiotic prophylaxis for dental procedures may be supplemented with chlorhexidine gluconate gel 1% or chlorhexidine gluconate mouthwash 0.2% , used 5 minutes before procedure

(3) For multistage procedures a max. of 2 single doses of a penicillin may be given in a month; alternative drugs should be used for further treatment and the penicillin should not be used again for 3-4 months

(4) If clindamycin is used, periodontal or other multistage procedures should not be repeated at intervals of less than 2 weeks; clindamycin is not licensed for use in endocarditis prophylaxis

(5) Azithromycin is not licensed for use in endocarditis prophylaxis