Root canals and Tetracycline

[medhacker]

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Hey

Can someone tell me what's the reason tetracycline is not prescribed for post-root/canal work?

😕 Thanks

 

[scalpel2008]

Hey

Can someone tell me what's the reason tetracycline is not prescribed for post-root/canal work?

😕 Thanks

i refuse to contribute to your silly investigation, you damn lawyer with all your bull**** propaganda in your post.

 

[medhacker]

i refuse to contribute to your silly investigation, you damn lawyer with all your bull**** propaganda in your post.

Oh my, you have so hurt my feelings... NOT

ok I was counting on a few asinine replies like yours [as it's always the case @ SDN]

moving on to more adult replies, if anyone knows the answer, I would appreciate it. Thanks

 

[capisce?]

Hey

Can someone tell me what's the reason tetracycline is not prescribed for post-root/canal work?

Thanks

It has been known to cause elephantitis in combination with the rare but labido-destructive "bent-wookiee" syndrome.

 

[medhacker]

Ok

So I guess eventually the dental students who actually know their stuff will post... 😴

 

[HermeytheElf]

Hey

Can someone tell me what's the reason tetracycline is not prescribed for post-root/canal work?

😕 Thanks

Simple enough...prescribing an antibiotic, such as tetracycline, post-op is absolutely the wrong thing to do. Everyone knows that antibiotics, like amalgam fillings, contain chemicals and are therefore harmful to the body. The correct course of action is to chew valerian root and ginseng as well as crystal therapy to redirect your flow of positive healing energy...because let's face it; there's nothing worse than a broken down aura.

 

[All4MyDaughter]

Hey

Can someone tell me what's the reason tetracycline is not prescribed for post-root/canal work?

😕 Thanks

This is from a pharmacy perspective, not dental...

TCN has many drug interactions, food interactions, is pregnancy category D and is contraindicated in children. It is used only when clearly necessary (as in when it is the BEST agent) such as for certain atypical organisms.

It seems to me like TCN would probably work for the purpose you describe, but it isn't necessary - since there are other agents available with few interactions and contraindications.

Why not just amoxicillin? Or something like clindamycin for a severely PCN-allergic patient?

 

[toofache32]

Your question begs another question which has to be answered first:

Why would you prescribe the abx in the first place? And what was the indication for the root canal you speak of?

 

[medhacker]

This is from a pharmacy perspective, not dental...

TCN has many drug interactions, food interactions, is pregnancy category D and is contraindicated in children. It is used only when clearly necessary (as in when it is the BEST agent) such as for certain atypical organisms.

It seems to me like TCN would probably work for the purpose you describe, but it isn't necessary - since there are other agents available with few interactions and contraindications.

Why not just amoxicillin? Or something like clindamycin for a severely PCN-allergic patient?

Thanks All4mydaughter

I agree about the pharmacology rationale

I was wondering if there was a micro reason as well. You know, the bacteria in root canal etc reacting better to amoxicillin than tetracycline - do you know if this is this the case? thanks

 

[scalpel2008]

Thanks All4mydaughter

I agree about the pharmacology rationale

I was wondering if there was a micro reason as well. You know, the bacteria in root canal etc reacting better to amoxicillin than tetracycline - do you know if this is this the case? thanks

i'm going to give you the benefit of the doubt and answer your question and hope i am not contributing to making our increasingly litiginous society, even more so, especially as it relates to healthcare (as you can tell, I've heard enough of "let's order this study because if we don't we can get sued even though the chances of it providing useful information is almost zip", which explains my bias, and i'm working on it). Here are the essential points relevant to your quesiton.

Tetracycline only works against anaerobic bacteria
It has more side effects than penicillin, and resistance is quickier.
Antibiotics don't reach any significant levels within the dental pulp chamber/canals (that's why pulpitis isn't treated with abx)
Removal of the pulp in endodontic therapy rids the source of the infection.

 

[toofache32]

....Removal of the pulp in endodontic therapy rids the source of the infection.

Bingo. There are many reasons to give antibiotics, but just because someone got a root canal isn't one of them. There are root canals that need antiobiotics, but you haven't given enough info for any valid recommendations here.

 

[medhacker]

Your question begs another question which has to be answered first:

Why would you prescribe the abx in the first place? And what was the indication for the root canal you speak of?

Hi toofache32


The indication was amoxicillin, Ibuprofen and Vicodin, a crown about 4 weeks post procedure on the upper biscuspid in question, as well as a 6 month follow-up/check-up.

I just overheard the endodontist recommend amoxicillin over tetracyclin and was curious as to the reason why, whether it was a micro reason. Thanks.

 

[medhacker]

i'm going to give you the benefit of the doubt and answer your question and hope i am not contributing to making our increasingly litiginous society, even more so, especially as it relates to healthcare (as you can tell, I've heard enough of "let's order this study because if we don't we can get sued even though the chances of it providing useful information is almost zip", which explains my bias, and i'm working on it). Here are the essential points relevant to your quesiton.

Tetracycline only works against anaerobic bacteria
It has more side effects than penicillin, and resistance is quickier.
Antibiotics don't reach any significant levels within the dental pulp chamber/canals (that's why pulpitis isn't treated with abx)
Removal of the pulp in endodontic therapy rids the source of the infection.

Ah relax,

I have no litigious purposes with my question.

I am not sure why would abx be prescribed. It was an upper biscuspid with a second root canal where one root had been completed and the second had not been removed completely. I assume there was necrotizing tissue in the second canal, which I agree should have been removed via the endodontic procedure, yet abx, ibuprofen and vicodin were prescribed.

 

[sdn1977]

i'm going to give you the benefit of the doubt and answer your question and hope i am not contributing to making our increasingly litiginous society, even more so, especially as it relates to healthcare (as you can tell, I've heard enough of "let's order this study because if we don't we can get sued even though the chances of it providing useful information is almost zip", which explains my bias, and i'm working on it). Here are the essential points relevant to your quesiton.

Tetracycline only works against anaerobic bacteria
It has more side effects than penicillin, and resistance is quickier.
Antibiotics don't reach any significant levels within the dental pulp chamber/canals (that's why pulpitis isn't treated with abx)
Removal of the pulp in endodontic therapy rids the source of the infection.

Sorry - you need to go back to your pharmacology. Tetracycline acts on gram positive & gram negative bacteria - not anerobes. The reason tetracycline is not used is because it is bacteriostatic - not bacteriocidal.

If an antibiotic is indicated clinically post root-canal, you'd use a bacteriocidal one - a pcn or cephalosporin or an erythromycin if pcn allergic and clindamycin if anerobes are suspected.

Anytime there is an infectious process where there might be any significant amount of pus involved, the antibiotic has a hard time with penetration. If you get penetration, you want a bacteriocidal agent rather than a bacteriostatic one.

If a root canal is done & there is any possibility of remaining bacteria, which does not imply remaining root....an antibiotic is indicated.

Tetracycline has no more side effects than any other antibiotics - they are all relative and resistance is a problem with all antibiotics - not just tetracyclines.

It seems rational therapy to me!

 

[medhacker]

Anytime there is an infectious process where there might be any significant amount of pus involved, the antibiotic has a hard time with penetration. If you get penetration, you want a bacteriocidal agent rather than a bacteriostatic one.

Thanks sdn1977,


Out of curiosity, I have read that a bacteriostatic agent, when given in high amounts can also be bacteriocidal. Do you agree this is also the case with tetracycline? thanks

 

[sdn1977]

Thanks sdn1977,


Out of curiosity, I have read that a bacteriostatic agent, when given in high amounts can also be bacteriocidal. Do you agree this is also the case with tetracycline? thanks

Yes, its possible to give sufficient amounts of the drug to reach bacteriocidal levels, particularly in the blood, however, its not practical. It's also questionable that the penetration into the periapical postsurgical area would reach bacteriocidal levels. Its easier & more realiably effective to use a drug which is bacteriocidal to begin with.

 

[crazy_sherm]

Sorry - you need to go back to your pharmacology. Tetracycline acts on gram positive & gram negative bacteria - not anerobes. The reason tetracycline is not used is because it is bacteriostatic - not bacteriocidal.

If an antibiotic is indicated clinically post root-canal, you'd use a bacteriocidal one - a pcn or cephalosporin or an erythromycin if pcn allergic and clindamycin if anerobes are suspected.

Anytime there is an infectious process where there might be any significant amount of pus involved, the antibiotic has a hard time with penetration. If you get penetration, you want a bacteriocidal agent rather than a bacteriostatic one.

I think you need to go back to pharm as well. Last time I checked, erythromycin and clindamycin are also bacteriostatic agents.

 

[sdn1977]

I think you need to go back to pharm as well. Last time I checked, erythromycin and clindamycin are also bacteriostatic agents.

We could go on and on here about the pharmacology, microbiology, ribosomal cell binding of each - I'm happy to do it since I know it really, really well..


But..erythromycin can be either bacteriostatic or bacteriocidal depending on the microorganism & the concentration of the drug at the site of infection. the bacteriocidal activity is greatest against microorgamisms which divide rapidly & increases as the pH of the medium is raised over a range of 5.5 to 8.5

Erythromycin works by reversibly binding the 50S ribosomal subunits & inhibiting protein synthesis. Some organisms with mutational changes in components of this ribosome fail to bind enough of the drug to make it bateriocidal - thus it becomes bacteriostatic in these organisms - many of the gram negative bacteria. However, most gram positives - which are often causes of periapical infections, bind quite well. That does not discount those which are resistant.

Clindamycin is similar to erythromycin in this respect since it works at exactly the same place - the 50S subunit. In fact, the use of one will inhibit the effectiveness of the other since their effect is REVERSIBLE binding - so there are NO clinical indications in which you would use them both. However, in the case of clinidamycin, it is more active against anaerobes than erythromycin, especially the bacteroides family, which is why it becomes the drug of choice when you suspect an oral anerobic infection.

Tetracycline is considered primarily a therapeutic bacteriostatic agent because, altho it does inhibit protein synthesis - by inhibiting the 30S subunit, it does it in two steps, one of which is energy dependent. First is passive diffusion thru the hydrophillic channels of the outer membrane. Minocycline & doxycycline are better at this than the other tetracyclines. The second process required is the energy dependent active transport system which is required to pump all tetracyclines thru the cytoplasmic membrane & this portion may require a periplasmic protein carrier. Once they do get thru the cell wall - they do inhibit protein synthesis. Differences in the sensitivity at the ribosomal cell level determine if the drug will be active or not. It is just a difficult drug to get to the site of action, however, that does not make it a drug of choice in some circumstances - ie dermatology.

You can find this information from your local hospital's antibiogram, which is published monthly. You'll be able to see what the in vitro MIC is for any given drug with regard to any given organism & compare it with what the concentration/penetration is possible with that drug & know if your drug is going to be bacteriocidal or bacteriostatic or resistant.

You're in SF - I'm 30 miles south of there. My antibiograms are significantly different from those at UCSF, but in my location, erythromycin and clindamycin are bacteriocidal or resistant - not bacteriostatic when reported on an antibiogram.

I hope that clarifies....

 

[S Files]

nevermind

 

[toofache32]

I can pee farther than all of you. Or is it further?

 

[All4MyDaughter]

I can pee farther than all of you. Or is it further?

It's farther (denotes physical advancement, as in distance).

🙂

 

[All4MyDaughter]

Thanks All4mydaughter

I agree about the pharmacology rationale

I was wondering if there was a micro reason as well. You know, the bacteria in root canal etc reacting better to amoxicillin than tetracycline - do you know if this is this the case? thanks

No problem...I was going to try to answer, but someone else around here knows a LOT more than me (waves to SDN1977 🙂 ).

She's good, no?

 

[aphistis]

I think you need to go back to pharm as well. Last time I checked, erythromycin and clindamycin are also bacteriostatic agents.

If I was planning to call out a practicing pharmacist (sdn1977) about drug mechanisms, I'd make really sure he's wrong before I posted it for the world to see. 😉

 

[crazy_sherm]

If I was planning to call out a practicing pharmacist (sdn1977) about drug mechanisms, I'd make really sure he's wrong before I posted it for the world to see. 😉

All I posted was what both my pharm books said, but if she knows more than the authors, more power to her. I guess I should just go toss them books in the fire now.

 

[All4MyDaughter]

All I posted was what both my pharm books said, but if he knows more than the authors, more power to him. I also thought the energy dependent step of tetracycline action only applied to gram positive bacteria, but practicing pharmacists are never wrong.

The energy-dependent second step applies to both G- and G+ because both have cytoplasmic membranes.

The first step (passive diffusion through the OUTER membrane) - I think that is the step that applies only in Gram negative organisms since G+ lack the outer membrane.

In the case of G+ organisms, TCN can diffuse through the outer peptidoglycan layer but still require active transport through the cell membrane.

 

[All4MyDaughter]

All I posted was what both my pharm books said, but if she knows more than the authors, more power to her. I guess I should just go toss them books in the fire now.

Good edit!
Don't throw your books away. Mine describes e'mycin as B'static as well, but SDN1997 did a great job of describing why that can change based on the organism in question, local MICs, site of action, etc.

 

[sdn1977]

All I posted was what both my pharm books said, but if she knows more than the authors, more power to her. I guess I should just go toss them books in the fire now.

I never meant to give offense nor did I take it!

Books/articles will give you as much as they are willing to offer. In my case, if you get a general pharmacology book which you (or my general dentist husband or even myself as a P1 years & years ago) might give exactly that same information...so you really aren't wrong. You just aren't completely right.

I just happen to be a bit more involved in infectious disease & in particular how & when different antibiotics are bacteriocidal (specifically trying to delineate the MIC's in different tissues/fluids/spaces) since, when I work acute medicine, I'm in the ICU.

I have no more specific knowledge about periapical abcesses other than having lived with someone for 30 years who has had to deal with them daily - either by treating them himself or referring them to endo. I fill the rxs written by both (or & periodontontists too - who actually use lots of tcns). I also tend to read his journals when I get really bored!!!

But...in no way did I intend to demean your knowledge nor your clinical use of it. Sometimes, we just have more specifics.....so call us anytime if you want to get really involved - probably more than you ever wanted - with drugs!

But...the really BIG issue with regard to drugs & dentistry is the whole biphosphonate issue with regard to implants. My husband does lots of implants & some fail for no reason at all. I'm encouraging him to go back & look at the medical hx of these pts to see if they were on biphosphonates. However, that is a whole different thread........

Again...I apologize.....I never meant any insult! And, I pride myself on working well with prescribers...so I hope my comments did not offend - they were only meant to educate.

 

[aphistis]

All4 & sdn1977, thanks for all the information you've contributed to this discussion. 🙂

 

[All4MyDaughter]

All4 & sdn1977, thanks for all the information you've contributed to this discussion. 🙂

We 😍 drugs!

Thanks for letting me hang out here for awhile...it was a nice distraction from studying!

 

[scalpel2008]

oops...i did misspeak. i was thinking of metronidazole's spectrum but i do stand by my other comments about easier resistance to tetracycline and an increased likelihood of "significant" side effects like hepatotoxicity in pregnant pts and dental discoloration. sometimes, what you may see in pharm texts may not apply clinically. for example, at my hospital, 40% or so of skin infections presenting to the ED are MRSA. This may have to do with over prescribing, or lack of compliance. whatever maybe the case, you are almost better off prescribing bactrim or clindamycin (the two drugs these community acquired MRSA bugs are susceptible to) as your first line before something more traditional like keflex (as your pharm textbook might say). This however is also a catch 22 when it comes to resistance. We are starting to see more Vanc resistance in our nosocomial MRSA. All things said, the best cure for odontogenic infections is getting rid of the source of the infection (extraction/endo) and splitting skin/mucosa for drainage.

 

[Lesley]

I was advised by a pharmacist turned dentist who turned back to pharmacy and is very well regarded, that when treating endodontic infections in patients who are not PCN allergic, it is better to use PenVK as opposed to Amoxicillin. He likes Amox fine for pre med but strongly prefers PCN for dental infections. I use that protocol. Thanks for the pharmacy information everyone.

 

[toofache32]

Actually, root canals should never be performed in the first place.

http://www.healingdaily.com/exercise/root-canals.htm

 

[All4MyDaughter]

I was advised by a pharmacist turned dentist who turned back to pharmacy and is very well regarded, that when treating endodontic infections in patients who are not PCN allergic, it is better to use PenVK as opposed to Amoxicillin. He likes Amox fine for pre med but strongly prefers PCN for dental infections. I use that protocol. Thanks for the pharmacy information everyone.

That's interesting; did he mention why?

I worked with a dentist who went to pharmacy school after he retired from dentistry. He was using his pharmacist income to pay for his daughter's medical school!

 

[All4MyDaughter]

oops...i did misspeak. i was thinking of metronidazole's spectrum but i do stand by my other comments about easier resistance to tetracycline and an increased likelihood of "significant" side effects like hepatotoxicity in pregnant pts and dental discoloration. sometimes, what you may see in pharm texts may not apply clinically. for example, at my hospital, 40% or so of skin infections presenting to the ED are MRSA. This may have to do with over prescribing, or lack of compliance. whatever maybe the case, you are almost better off prescribing bactrim or clindamycin (the two drugs these community acquired MRSA bugs are susceptible to) as your first line before something more traditional like keflex (as your pharm textbook might say). This however is also a catch 22 when it comes to resistance. We are starting to see more Vanc resistance in our nosocomial MRSA. All things said, the best cure for odontogenic infections is getting rid of the source of the infection (extraction/endo) and splitting skin/mucosa for drainage.

Ditto on the textbooks not always applying. Many of my classmates missed a key question on an exam (case study question) because they went with what our ID handbook says right now about the prevalence of MRSA in community acquired infections. Our professor had clarified in class that community-acquired MRSA was on the rise and that our hospital's protocols had been updated to reflect that...
It's just a lesson in using ALL of the info available when making clinical decisions.

 

[Lesley]

That's interesting; did he mention why?

I worked with a dentist who went to pharmacy school after he retired from dentistry. He was using his pharmacist income to pay for his daughter's medical school!

Hi All4MyDaughter, He did. I don't remember specifically what he said, but below is an exerpt from a Board Review regarding antimicrobials. #5 also states PenV is the best choice for dental infections. He really made an impression on me as he was very sure about this choice of meds for dental infections in non-PCN-allergic patients. Occasionally, I'll run into a patient that does not respond to PenVK, but rarely. In that case, I'll call an endodontist who I refer to, although I do most myself, or our local pharmacist to get their opinion regarding alternate Rx choices. If I have any questions, I never hesitate to call our local pharmacist to solicit their opinion about patient medications or dosing. Good luck with your studies.


Antimicrobial agents
1. The Beta-Lactams: Probably the most frequently used antibiotics in dentistry. The two main members of this class of antimicrobials are the penicillins and the cephalosporins.
a. The Penicillins: 4-classes:
1. Pen G and congeners: PEN G and PEN V-both share the antimicrobial spectrum against gram pos. aerobes and most anaerobes. The sole advantage of PEN V is its stability in a gastric medium, allowing for better oral administration. PEN G is drug of choice for txmnt of pneumococcal pneumonia, meningitis, strep pharyngitis, syphilis and actinomycosis.
2. Extended spectrum penicillins: Ampicillin, Amoxicillin, & Carbenicillin. These have a broader spectrum of activity than PEN G, but are all destroyed by B-lactamase. Amoxicillin is more completely and rapidly absorbed from the GI tract. Therapeutic indications include: upper respiratory infections, sinusitis, otitis media, and urinary tract infections.
3. Antistaphylococcal penicillins: Dicloxacillin, Methicillin. The drugs of choice for most staph infections and are less active against strep. These are used infrequently in dentistry.
4. Extended spectrum plus B-lactamase inhibitor: Augmentin (Amoxicillin plus Clavulanic acid). The addition of B-lactamase inhibitors to amox extends the spectrum of these antibiotics to include B-lactamase producing Staph aureus, Staph epidermis, and Haemophilus influenzae.

👍 5. Penicillin V remains the antibiotic of choice against most acute orofacial pathogens; facultative and anaerobic strep. It is theoretically possible that antibiotics may impair the action of oral contraceptives by altering contraceptive pharmacokinetics.

 

[scalpel2008]

it has become very clear to me that once a patient obtains the antibiotics, the most important issue when it comes to compliance is dosing. I, as a healthcare professional and realizing the importance of taking a medication as prescribed, would find it very difficult to remember to take a medication 4 times a day. I can't remember the exact figures but studies have shown that the compliance rates are significantly higher for 3 times a day versus 4, twice a day versus 3, etc. Therefore, I find a great advantage in amoxicillin when it comes to practicality given its 3, and even twice a day dosing. Hell, I think that in my private practice I might even prescribe an azithromycin tri pack (500mg po QD x 3 days) for patients who I know may be like me and would not be able to comply adequately with remembering to pop a pill 4 times a day. Some poeple are just too busy during the day for that (although there's no excuse because it takes 2 seconds, it's just a matter of remembering)It seems to me that azithromycin had good odontogenic coverage and I don't think I would really be contributing to resistance (givesn it's relatively broad spectrum) as much given that a suburban private practice population would likely not need this sort of treatment multiple times in their dental lives and that they would most likely be able to afford it which isn't the case at most OMS residency patient populations.

But for the tests out there, PCN is the antibiotic of choice for uncomplicates dental infections in light of no PCN allergy

 

[All4MyDaughter]

Hi All4MyDaughter, He did. I don't remember specifically what he said, but below is an exerpt from a Board Review regarding antimicrobials. #5 also states PenV is the best choice for dental infections. He really made an impression on me as he was very sure about this choice of meds for dental infections in non-PCN-allergic patients. Occasionally, I'll run into a patient that does not respond to PenVK, but rarely. In that case, I'll call an endodontist who I refer to, although I do most myself, or our local pharmacist to get their opinion regarding alternate Rx choices. If I have any questions, I never hesitate to call our local pharmacist to solicit their opinion about patient medications or dosing. Good luck with your studies.


Antimicrobial agents
1. The Beta-Lactams: Probably the most frequently used antibiotics in dentistry. The two main members of this class of antimicrobials are the penicillins and the cephalosporins.
a. The Penicillins: 4-classes:
1. Pen G and congeners: PEN G and PEN V-both share the antimicrobial spectrum against gram pos. aerobes and most anaerobes. The sole advantage of PEN V is its stability in a gastric medium, allowing for better oral administration. PEN G is drug of choice for txmnt of pneumococcal pneumonia, meningitis, strep pharyngitis, syphilis and actinomycosis.
2. Extended spectrum penicillins: Ampicillin, Amoxicillin, & Carbenicillin. These have a broader spectrum of activity than PEN G, but are all destroyed by B-lactamase. Amoxicillin is more completely and rapidly absorbed from the GI tract. Therapeutic indications include: upper respiratory infections, sinusitis, otitis media, and urinary tract infections.
3. Antistaphylococcal penicillins: Dicloxacillin, Methicillin. The drugs of choice for most staph infections and are less active against strep. These are used infrequently in dentistry.
4. Extended spectrum plus B-lactamase inhibitor: Augmentin (Amoxicillin plus Clavulanic acid). The addition of B-lactamase inhibitors to amox extends the spectrum of these antibiotics to include B-lactamase producing Staph aureus, Staph epidermis, and Haemophilus influenzae.

👍 5. Penicillin V remains the antibiotic of choice against most acute orofacial pathogens; facultative and anaerobic strep. It is theoretically possible that antibiotics may impair the action of oral contraceptives by altering contraceptive pharmacokinetics.

Thank you for posting that. That is all pretty much consistent with what we just finished up in antibiotics class. I'd love to hear anything more from what the other dentist told you if you remember.

 

[sdn1977]

it has become very clear to me that once a patient obtains the antibiotics, the most important issue when it comes to compliance is dosing. I, as a healthcare professional and realizing the importance of taking a medication as prescribed, would find it very difficult to remember to take a medication 4 times a day. I can't remember the exact figures but studies have shown that the compliance rates are significantly higher for 3 times a day versus 4, twice a day versus 3, etc. Therefore, I find a great advantage in amoxicillin when it comes to practicality given its 3, and even twice a day dosing. Hell, I think that in my private practice I might even prescribe an azithromycin tri pack (500mg po QD x 3 days) for patients who I know may be like me and would not be able to comply adequately with remembering to pop a pill 4 times a day. Some poeple are just too busy during the day for that (although there's no excuse because it takes 2 seconds, it's just a matter of remembering)It seems to me that azithromycin had good odontogenic coverage and I don't think I would really be contributing to resistance (givesn it's relatively broad spectrum) as much given that a suburban private practice population would likely not need this sort of treatment multiple times in their dental lives and that they would most likely be able to afford it which isn't the case at most OMS residency patient populations.

But for the tests out there, PCN is the antibiotic of choice for uncomplicates dental infections in light of no PCN allergy

I'd agree with your assessment & studies actually support the compliance problem. However, I'd say...this is more dependent on the type of coverage you're treating - acute or prophylactic. Those who've suffered an infection which has required a root canal are often VERY motivated, particularly if they've had significant pain. They'll do ANYTHING to not go thru that again.

However, those prophylactic txs - like post-extraction pts....they often will continue tx for awhile then "save" the rest for a later infection. Yeah - not good, but reality nonetheless. (These same pts may be pre-treated by themselves before even seeing you with these "saved" antibiotics - happens all the time with women & chronic uti's.)

I don't mind azithromycin for these pts, but our local antibiograms are showing increasing resistance to H.influenza & some of the atypical mycobacteria...so depending on where you practice, it may not work.

Oh...Lesley...there are too many instances where the antibiotics will indeed change the contraceptive coverage enough to cause unexpected issues. And...even if your antibiotic isn't the reason, if you didn't give the warning, you could suffer for it. However....we ALWAYS give the warning, but at least in CA...we have "shared" responsibility. So - cover your *ss & warn just as you do with vicodin & driving, etc...our problems come with the non-english speakers or readers.

 

[Lesley]

there are too many instances where the antibiotics will indeed change the contraceptive coverage enough to cause unexpected issues. And...even if your antibiotic isn't the reason, if you didn't give the warning, you could suffer for it.

A very good reminder. Thanks.