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Guideline on Use of Antibiotic Therapy for Pediatric Dental Patients
Council on Clinical Affairs
Council on Clinical Affairs
The American Academy of Pediatric Dentistry recognizes the increasing prevalence of antibiotic-resistant micro-organisms. Thisguideline is intended to provide guidance in the proper and judicious use of antibiotic therapy in the treatment of oral conditions.1
This revision was based upon a new systematic literature search of the MEDLINE/Pubmed electronic database using the following parameters: Terms: antibiotic therapy, antibacterial agents in children, antimicrobial agents in children, dental trauma, oral woundmanagement, orofacial infections, periodontal disease, viral disease, and oral contraception; Field: All fields; Limits: within the last 10 years, humans, English, clinical trials, birth through age 18. Papers for review were chosen from this search and from hand searching. When data did not appear sufficient or were inconclusive, recommendations were based upon expert and/or consensus opinion byexperienced researchers and clinicians.
The widespread use of antibiotics has permitted common bacteria to develop resistance to drugs that once controlled them.2-4 At present, there are no antibiotics to which resistance has not appeared.2,5 To diminish the rate at which resistance is increasing, health care providers must be prudent in the use of antibiotics. 1
Oral woundmanagement Factors related to host risk (eg, age, systemic illness, malnutrition) and type of wound (eg, laceration, puncture) must be evaluated when determining the risk for infection and subsequent need for antibiotics. Wounds can be classified as clean, potentially contaminated, or contaminated/dirty. Facial lacerations may require topical antibiotic agents.12 Intraoral lacerations that appear to havebeen contaminated by extrinsic bacteria, open fractures, and joint injury have an increased risk of infection and should be covered with antibiotics.12 If it is determined that antibiotics would be beneficial to the healing process, the timing of the administration of antibiotics is critical to supplement the natural host resistance in bacterial killing. The drug should be administered as soon aspossible for the best result. The most effective route of drug administration (intravenous vs intramuscular vs oral) must be considered. The clinical effectiveness of the drug must be monitored. If the infection is not responsive to the initial drug selection, a culture and susceptibility testing of isolates from the infective site may be indicated. The minimal duration of drug therapy should belimited to 5 days beyond the point of substantial improvement or resolution of signs and symptoms; this is usually a 5- to 7-day course of treatment dependent upon the specific drug selected.13-18 The importance of completing a full course of antibiotic must be emphasized. If the patient discontinues the antibiotic prematurely, the surviving bacteria can restart an infection that may be resistantto the original antibiotic. Special conditions Pulpitis/apical periodontitis/draining sinus tract/localized intraoral swelling Bacteria can gain access to the pulpal tissue through caries, exposed pulp or dentinal tubules, cracks into the dentin, and defective restorations. If a child presents with acute symptoms of pulpitis, treatment (ie, pulpotomy, pulpectomy, or extraction) should be rendered.Antibiotic therapy usually is not indicated
Conservative use of antibiotics is indicated to minimize the risk of developing resistance to current antibiotic regimens.2-11 The following general principles should be adhered to when prescribing antibiotics for the pediatric population.
AmErICAN ACADEmy of pEDIAtrIC DENtIStry
if the dental...