Why do dentists load ABX's?

[npage148]

Pen VK 500mg 2 stat then 1 qid, Why load the ABX? I see it all the time and it drives me crazy

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[Requiem]

Pen VK 500mg 2 stat then 1 qid, Why load the ABX? I see it all the time and it drives me crazy

Pts. are at elevated risk for bacterial infection post dental work. Some of these bacteria are the typical gram positive flora... the big concern though is endocarditis as people with heart valve problems, murmurs, etc have an increased risk. The antibodies your body creates against the bacteria may cross-react against a heart valve for example and cause an autoimmune rxn against your heart -> endocarditis. There are some similar epitopes on the bacteria as the heart valves.

 

[npage148]

But why load it? Its half life is so short I dont see a reason to load

 

[PharmDstudent]

Pen VK 500mg 2 stat then 1 qid, Why load the ABX? I see it all the time and it drives me crazy

They load antibiotics so that their patients get really sick to their stomachs, have diarrhea, and stop eating. That way, the dentist doesn't have to redo any work . It's pretty difficult to crack a filling or tooth when you can't eat.
The idea is ingenious! How else are they supposed to get weekends off?

 

[njac]

I was at the dentist a couple weeks ago and he mentioned an article recently that showed no significant decrease in infections using prophylactic abx in dental procedures except for specific risk factors. I think. I may call him and ask if he can point me in the right direction.

but this was also the dental visit where he was numbing me up and said "this is a short acting local anesthetic" and in a mumbly fumbly my mouth has been open for 20 minutes way I was like "so it must be an ester". (This guy has been doing my teeth since I was 3, and I still go to him despite living 2000 miles away) He was so proud Then he threatened to put an amide in instead.

 

[npage148]

I'm not talking about the 2 grams 1 hour prior premed dosing which has its valid indications (much rarer given the new guidelines)

 

[njac]

after a quick pubmed search I'm thinking it must've been:
(sorry my computer is being a pain in the arse)
Prophylactic Antibiotics Before Dental Work Passé
[DEPARTMENT: In the NEWS]
Mennick, Fran BSN, RN
American Journal of Nursing Volume 107(8), August 2007, p 19

Here's the abstract as it isn't allowing me to get the full text at the moment.

"For the past 50 years, most people with heart conditions have received antibiotics before undergoing dental, gastrointestinal, or genitourinary procedures. It has been believed that the antibiotics prevent the development of bacteremia that could result in infective endocarditis—uncommon but often fatal or debilitating. Now, because there is no clear evidence to support antibiotic prophylaxis, and there are associated risks—allergic reactions and the possible development of drug-resistant bacteria—the American Heart Association has revised its guidelines. It now recommends antibiotic prophylaxis only in patients at high risk for severe illness or death if they contract endocarditis, such as people with prosthetic cardiac valves, a history of carditis or cardiac transplantation with cardiac valvulopathy, or certain types of congenital heart disease. Prophylaxis may be reasonable in these patients before "dental procedures that involve manipulation of the gingival tissue or the periapical region of teeth or perforation of the oral mucosa" or invasive procedures "that involve incision or biopsy of the respiratory mucosa," such as tonsillectomy or adenoidectomy."

 

[Old Timer]

They give large loading doses because they are trying to get high tissue levels in a difficult area. Getting penetration into a dental abscess is not the same as getting penetration in an upper respiratory infection.

 

[sdn1977]

They give large loading doses because they are trying to get high tissue levels in a difficult area. Getting penetration into a dental abscess is not the same as getting penetration in an upper respiratory infection.

ding, ding, ding - we have a winner here!

This is what they are seeking. Abcesses - whether they're periapical or in the bone, tend to be acidic. They degrade the antibiotc and prevent penetration into the site of infection. This isn't limited to dentistry - urology does the same thing with prostatitis, but the duration of tx goes on longer. Likewise....why does tx for sinusitis go on for a minimum of 14 - 21 days for complete tx??? Because of such poor penetration into infected sinuses.

For dentists, not all their rxs start w/ 2 stat - but, if clinically, they know they've cleaned out a root & penetrated the end, or there has been a periapical abcess which has on x-ray shown extension into areas which might have bony involvement, they want high & fast blood levels because their manipulation has caused that infectious agent to get into the blood (anytime they get "bloody" the purulent material will get into the blood) & they then want that high & fast blood level to start so it will get into the tissue with poor penetration.

Similar to the pre-op or perio-op dose of cefazolin along with 2 post op doses for ortho surg.

Live with a dentist long enough you learn too much.....

 

[WVUPharm2007]

Endocarditis, man...endocarditis...