what is the most likely explanation for increasing antibiotic resistance in community-acquired disease?
a - patients not completing prescribed therapy
b - gram negative outer membrane permeability
c - generic branding and import medicines
d - overuse of antibiotics in farming and industry
e - metronidazole resistant spore forming anaerobes
d - overuse of antibiotics in farming and industry
what are the clinical characteristics of IDEAL ANTIBACTERIAL agents
- bacterioCIDAL
- oral & injectable
- long half-life
- low binding to plasma proteins
- good distribution
- minimal side effects
- lack adverse interactions
- narrow spectrum
penicillin V is usually described as ___ spectrum
narrow
isolation of clinical strains of bacteria resistant to specific antibiotics typically occurs within ____ of introduction of specific antibiotic therapy
several years
t/f genes that code for antibiotic resistance were in the gene pool before humans began to produce antibiotics
true
who performed the ‘replica plate’ experiment
Joshua Lederberg
what is the recent new bacterial “superbug”
carbapenem-resistant Klebsiella pneumoniae
what is carbapenem
beta-lactam antibiotic with BROAD spectrum activity against bacteria resistant to penicillins and cephalosporins
what are the steps of laboratory antibiotic susceptibility test
bacteria is streaked on a plate, then antibiotic-impregnated discs are put on the plate & incubated overnight to allow growth
what is the lowest concentration of antibiotic which prevents growth in presence of antibiotic
minimum inhibitory concentration (MIC)
what is the lowest concentration of antibiotic which irreversibly kills bacteria
minimum bactericidal concentration (MBC)
bacteria in __ may be up to a thousand-fold ___ sensitive to antibiotics than bacteria in solution
biofilm, less
when should antibiotics not be prescribed? and what is the exception
- upper respiratory tract infection
- strep throat, or cough lasting 10 days +/- advanced sinusitis
antibiotics must be selected based on ___ responsible for common clinical syndrome & ___ about antibiotic susceptibility within 48 hours
- presumed bacterial species
- current knowledge
when will referrals to an ID specialist or in patient therapies be necessary
if infections do not respond to more routine presumptive approaches or progress
~24 hrs
when should antibiotics be used in dentistry
- apparent & high potential infections
- few clinical syndromes
- young or elders or immunocompromised
- history of infection
most oral-facial infections are ___ of normal flora, resistance to ___ is not common. ____ will often be all that is needed
- mixed anaerobes
- beta-lactams
- draining of lesions
what are the limited clinical situations that require antibiotic therapy
- oral infection accompanied by elevated body temperature
- evidence of systemic spread (lymphadenopathy & restricted jaw movement)
- facial cellulitis
- aggressive acute necrotizing ulcerative gingivitis
- lateral periodontal abscess
- acute pericoronitis with systemic signs
___ that may or may not be associated with dysphagia, is a serious disease that should be treated by antibiotics promptly because of the possibility of infection spread via lymph and blood circulation, with development of ___
- facial cellulitis (soft tissue infection)
- septicemia
___ alone is likely to be effective
drainage
antimicrobials are used prior to surgery/procedures only when:
- high risk of post-op infection
- contaminated wounds w soil or dirt
- serious or life threatening infection consequences
- immunocompromised
what are the 3 conditions where antibiotics are NO LONGER recommended
- mitral valve prolapse (MVP)
- rheumatic heart disease (RHD)
- bicuspid valve disease
what are the 4 condition where antibiotics are STILL RECOMMENDED
- artificial heart valves or parts
- previous history of infective endocarditis
- some congenital heart conditions
- heart transplant recipients w/ valve problem
in general, for patients with prosthetic joint implants, prophylactic antibiotics are ____ prior to dental procedures to prevent prosthetic joint infection
not recommended
