Common Dental Prescriptions

    Common Abbreviations Utilized in Prescription Writing
    There are many variations of abbreviations in writing prescriptions. One must be very cautious in using them. A few common ones to dentistry are listed in the table:

    Abbreviation
    Its meaning:
    b.i.d. or b.d.
    Means twice daily
    npo
    Nothing by mouth
    po
    By mouth
    prn
    As needed
    q.6.h
    Every 6 h, you can change the number of hours, i.e., q.8.h means every 8 h
    stat
    Immediately
    t.i.d.
    Three times daily

    22.2 Antibiotics Indications

    22.2.1 Precautions for All Antibiotics

    • Note that all antibiotics have the potential to interfere with oral contraceptives. Patients should be advised to take additional precautions when taking antibiotics and oral contraceptives together.
    • Antibiotics can cause “nuisance” diarrhea which is nonthreatening. Patient should call the prescriber before discontinuing the medication.
    • In general all antibiotics have the potential of causing pseudomembranous colitis which manifests itself as severe diarrhea. The patient should be instructed to discontinue use of medication and seek treatment from their physician.
    • In dentistry, antibiotic use should be limited to 7–10 days. Patients should be encouraged to seek treatment for their dental problems or return if their symptoms persist. Short term use of antibiotics will also prevent superinfections with fungal growth.

    22.2.1.1 Guidelines for Antibiotic Prophylaxis

    • For current guidelines on antibiotic prophylaxis for prevention of infective endocarditis, visit the American Dental Association(ADA) and the American Heart Association website at: ​www.​ada.​org/​en/​member-center/​oral-health-topics/​antibiotic-prophylaxis and ​www.​heart.​org/​HEARTORG/​Conditions/​CongenitalHeartD​efects/​TheImpactofConge​nitalHeartDefect​s/​Infective-Endocarditis_​UCM_​307108_​Article.​jsp#.​Vmrz1LgrK7Q.

      Cardiac Conditions for Which Prophylaxis with Antibiotics for Dental Procedures Is Recommended (AHA Guidelines Published May 2007):
      • Prosthetic heart valve
      • Previous infective endocarditis
      • Congenital heart disease (CHD)

        • Unrepaired cyanotic CHD, including palliative shunts and conduits
        • Completely repaired congenital heart defect with prosthetic material or device whether placed by surgery or by catheter intervention, during the first 6 months after the procedure (endothelialization occurs within 6 months of procedure)
        • Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or adjacent or prosthetic device (which inhibits endothelialization)
      • Cardiac transplant recipients who develop cardiac valvulopathy
    • Patients with any of the above conditions who are scheduled to undergo a dental procedure that is at risk of bleeding should be given antibiotics prior to initiation of procedures.
    • For current guidelines on antibiotic prophylaxis in patients with prosthetic joints who may be at risk of developing infections following dental procedures, the ADA is a good site as well or the American Association of Orthopedic Surgeons Guidelines.

      ADA 2014 Clinical Recommendation
      • In general, for patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection. For patients with a history of complications associated with their joint replacement surgery who are undergoing dental procedures that include gingival manipulation or mucosal incision, prophylactic antibiotics should only be considered after consultation with the patient and orthopedic surgeon. To assess a patient’s medical status, a complete health history is always recommended when making final decisions regarding the need for antibiotic prophylaxis.
    • The most recent evidence-based guideline was published in the Journal of the American Dental Association (JADA) in 2015. This is accessible on: ​jada.​ada.​org/​article/​S0002-8177(14)00019-1/​fulltext?​nav=​rotatorJanmain.
    Antibiotic indication
    First choice: non-penicillin-allergic patients
    Second choice: penicillin-allergic patients
    Patients unable to take oral medication
    Prophylaxis for patients at risk for developing bacterial endocarditis
    aAmoxicillin 500 mg tabs
    Disp: dependent on the anticipated number of appointments
    Sig: Take 4 tabs (2 g) an hour before dental procedure
    Also available in suspensions
    bClindamycin
    150 mg tabs
    Disp: dependent on the anticipated number of appointments
    Sig: Take 4 (150 mg) tabs = 600 mgs; 1 h before dental procedure
    Also available in suspensions
    Ampicillin 2 g IM or IV
    For penicillin or ampicillin-allergic patients: clindamycin (600 mg IM or IV; 1 h before dental procedure)
    Prophylaxis for patients at risk for developing bacteremia in prosthetic joints
    Amoxicillin 500 mg tabs
    Dispense 12 tabs
    Sig: Take 4 tabs(2 g) 1 h before procedure
    Clindamycin 150 mg tabs
    Dispense 12 tabs
    Sig: Take 4 tablets = 600 mg an hour before procedure
    Note: AAOS has no official recommendation for penicillin-allergic patients, this would be a reasonable alternative
     
    Acute dental infections where organism is unknown
    aPenicillin VK 500 mg tabs
    Disp: 21 (twenty-one) tabs
    Sig: Take 1 g = 2 tablets stat; followed by 500 mg q.6.h for 7 days
    bClindamycin can also be considered depending on the severity of the infection or if no response is obtained after use of penicillin for 48 h
    bClindamycin 150 mg tabs
    Disp: 21(twenty-one) tabs
    Sig: Take 2 tabs = 300 mg stat; 1 tab q.6.h for 7 days
    Referral to emergency room for IV antibiotics
    aPen VK and amoxicillin contraindications: allergy to Penicillin, hypersensitivity to cephalosporins
    bClindamycin contraindications: allergy to clindamycin, clindamycin notes
     Most pharmacies carry clindamycin only in 150 mg tabs
     Most prominent antibiotic to cause pseudomembranous colitis
     Cautious use in elderly patients, patients with renal or hepatic disease or colitis
    Augmentin
    500 mg (500 mg amoxicillin, 125 mg clavulanic acid)
    Dispense: 21 (twenty-one) tabs
    Sig. 1 tab po q.8. h until gone
    Note
    Augmentin is another option for non-penicillin-allergic patients; presence of clavulanic acid allows medication to be taken with or without meals.

    22.2.1.2 Antibiotics for Upper Respiratory Tract Infections

    Dec 11, 2016 | Posted by in General Dentistry | Comments Off on Common Dental Prescriptions
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