Pediatric  Dental   Health

• First: antibiotic drugs attack bacteria, not viruses.
• Second: antibiotics do not cure a cough. In fact, many patients cough for two to three weeks due to bronchial hyper-responsiveness – and not because of infection.
• Penicillin kills bacteria by attaching to their cell walls – and then destroying a key part of the wall.
• Erythromycin and tetracycline work by binding to the ribosomes of the bacteria. Ribosomes are structures within a cell that manufacture proteins. Binding to the bacterial ribosomes impairs the production of important bacterial proteins.
  
  HOW IS A DENTAL INFECTION TREATED?
• The most important step in treating a dental infection is removing the source and cause of the infection. This often means: removing (extracting) the offending tooth. Extracting the offending tooth has the additional benefit of providing a way to drain accumulated pus.
• Any accumulated pus needs to be drained from the infected area. Sometimes, this means that advanced (surgical) drainage procedures will be needed.
• Antibiotics are of secondary importance in treating a dental infection, and antibiotics are not automatically used to treat dental infections. Antibiotics are used for treating infections involving: rapidly progressive swelling, diffuse swelling, a medically compromised child, or an infection that has invaded the extraoral (fascial) spaces.
• Penicillin remains the antibiotic of choice for mild or early dental infections because of its low cost, low toxicity, and its narrow spectrum of action against aerobic streptococci. Clindamycin is the antibiotic of choice in the hospitalized dental patient.
• If a child with an infection is dehydrated, IV fluids may need to be administered.
• If a child's temperature exceeds 101 degrees F, hospitalization might be required. Most dental infections in children can be prevented by obtaining regular dental checkups, and by prompt treatment of any dental caries.
• Posttreatment antibiotics should be prescribed for patients who have clinical infection, particularly when the infection is associated with fever.
  
  WHAT IS THE TREATMENT FOR STREP THROAT?
• All cases of sore throat need supportive care to increase a child’s comfort and reduce the risk of dehydration.
• Strep throat is the only form of pharyngitis for which antibiotics should be prescribed!
• Penicillin is the treatment of choice for strep (GABHS) throat. A dose of 20mg/kg/day PO is taken three times daily for 10 days. Once-daily amoxicillin 750mg PO for 10 days may also be effective. Treatment with antibiotics for GABHS pharyngitis should be started within 9 days of infection to prevent the possible development of rheumatic fever. A child who has been taking antibiotics for 24 hours for GABHS is no longer contagious.
  
  WHY IS ANTIBIOTIC USE OUT OF CONTROL?
• Patients want antibiotics, and physicians oblige.
• A great portion of the antibiotics prescribed (in outpatient settings) is incorrectly given for viral illnesses, or for bacterial infections which spontaneously resolve themselves. Nevertheless, patients want antibiotics because they want a “cure” for their problems.
• Physicians are pressured to see more patients in less time when they work in a managed-care system. As a result, they sometimes appease their patients by prescribing unnecessary antibiotics.
• Almost 50 percent of physicians’ office visits for colds and upper respiratory tract infections, and 80 percent of visits for acute bronchitis are treated with antibiotics. Unfortunately, antibiotics have absolutely no effect on viral diseases such as the common cold.
  
  PROBLEMS CAUSED BY OVERUSE OF ANTIBIOTICS:
• There has been an increase over the last 20 years in antibiotic resistance among common bacterial causes of infections.
• Antibiotics eradicate not only disease-causing organisms, but also the protective normal bacterial flora.
• Drug-resistant infections increase the risk of death, and are often associated with prolonged hospital stays.
• Other potentially harmful effects of over-prescribing antibiotics include: allergic reactions, adverse reactions, and drug-drug interactions.
  
  WHAT IS ANTIBIOTIC RESISTANCE?
• Antibiotic resistance results from gene action.
• When someone takes an antibiotic, the drug kills the defenseless bacteria, leaving behind (selecting) those which can resist.
• "Selective pressure," caused by overuse of antibiotics, results in the survival of bacteria that are resistant to the original therapy.
• "Selective pressure" occurs when an antibiotic decreases the number of normal bacteria – allowing resistant bacteria to proliferate. The renegade bacteria then multiply, and soon they become the predominant microorganism.
• Bacteria become resistant in one of three ways:
  spontaneous DNA mutation,
  taking-up DNA from resistant bacteria, or
  assimilating a plasmid (a small circular strand of resistance genes).
  
  HOW CAN WE REVERSE ANTIBIOTIC RESISTANCE?
• We can start with common infection control procedures, such as hand-washing and immunization.
• Parents should wash raw fruit and vegetables thoroughly to remove resistant bacteria as well as antibiotic residues.
• Physicians should become more familiar with prescribing the right antibiotic for the right reason.
• Physicians should prescribe "narrow spectrum" antibiotics (which target specific bacteria), so that resistance will be restricted.
• Physicians should withhold antibiotics when their use is not warranted. They should instead provide more education, empathy, and alternative treatments to patients who mistakenly demand antibiotics.
• Antibiotics are almost never necessary for treatment of the common cold, cough, or bronchitis in children.
• Children should complete the full course of any antibiotic therapy, and parents should not "save" medication for later use.
• A panel of World Health Organization consultants has recommended the gradual discontinuation of antibiotics when used as growth promoters in animals. Improved farm hygiene could go a long way to enhance the physical growth and development of livestock.
  
  An article in American Family Physician reviews the topic of antibiotic overuse. It provides steps that a physician can take before prescribing an antibiotic. The article also lists the CDC/AAP principles of judicious antibiotic use.
  
  Colgan R, Powers JH: Appropriate antimicrobial prescribing: approaches that limit antibiotic resistance. American Family Physician September 15, 2001; 64(6); 999-1004.
  
  
  

  |Licensing| |Tell A Friend| |Link To Us| |Disclaimer| |Copyright| |About Us| |Privacy|