Stom infektsioonide lab diagnostika ja ravi.pdf

Stomatoloogiliste infektsioonide 

laboratoorne diagnostika ja ravi 

T.Brilene 

11.03.2010 

Anaeroobne k¸lv (haavaeritis, 

punktaadid, hambajuurekanali 

materjal, koet¸kid) 

N‰idustused: 

ï anaeroobse infektsiooni kahtlus (ebameeldiva 

lıhnaga eritis haavast; kudede nekroos; abstsessid; 

gaasi teke kahjustatud kudedes) 

ï infektsiooni allumatus ravile ainult aeroobidele 

toimivate antibiootikumidega; 

ï infektsiooni tekkekoht l‰hedal normaalselt 

anaeroobidega koloniseeritud limaskestadele, 

ï mikroskoopia leius erineva morfoloogiaga 

mikroobid, mis aeroobselt v‰lja ei kasva. 

T‹ Kliinikum ‹hendlabori k‰siraamat

Abstsessid, punktaadid: 

ï desinfitseerida punktsioonikoha nahk. 

ï Punkteerida, aspireerida materjal s¸stlasse. 

ï Kui abstsessi punkteerimisel on m‰daeritus v‰hene, 

s¸stida sinna steriilset f¸sioloogilist lahust ning 

aspireerida see tagasi s¸stlasse. 

ï Eemaldada katsutilt kork, s¸stida materjal 

katsutisse. 

ï Mida suurem on materjali hulk, seda suurem on 

anaeroobide s‰ilimise ja isoleerimise tıen‰osus. 

T‹ Kliinikum ‹hendlabori k‰siraamat 

M‰da, haavaeritis: 

ï haava pind puhastada steriilse f¸sioloogilise 

lahusega, eemaldada nekrotiseerunud kude 

(sisaldab leukots¸¸tide poolt juba surmatud 

mikroobe ja detriiti). 

ï Parimaks materjaliks haavast on s¸stlaga 

aspireeritud m‰da vıi koet¸kid. 

ï Kui nimetatud materjali pole vıimalik saada, vıtta 

proov tampooniga haavast vıimalikult s¸gavalt. 

ï Suruda tampoon katsutisse nii, et vatiosa ulatuks 

sˆˆtmesse. 


ï Hambajuurekanali m‰da: sondi abil vıtta materjal 

juurekanalist vıimalikult s¸gavalt, suruda sond 

otsapidi transportsˆˆtmesse. 

ï Koet¸kid: suruda steriilsete pintsettidega 

transportsˆˆtmesse. 

ï NB! Anaeroobsete tingimuste s‰ilitamiseks hoida 

katsutit kogu aeg vertikaalasendis, et CO2, mis on 

ıhust raskem, ei voolaks katsutist v‰lja. 

ï S‰ilitamine ja transport: toatemperatuuril (+20-25 C) 

¸ks ˆˆp‰ev. 


ï Anal¸¸simeetod: k¸lv Wilkins-Chalgreni agarile ja 

selektiivsele Wilkins-Chalgreni agarile. 

ï Kultiveerimine anaeroobses keskkonnas. 

ï Tekitaja isoleerimine, samastamine ja 

ravimtundlikkuse m‰‰ramine. 

ï Lıplik vastus: negatiivne 5.-6. p‰eval, positiivne 

koos tundlikkusega 7. p‰eval (Actinomyces spp. 

korral kuni 2 n‰dalat). 

ï Vıimalikud vead: proovi vıtmine antibakteriaalse 

ravi foonil, vead s‰ilitamisel ja transpordil. 


Transportsˆˆde 

Parodontiidi mikrobioloogiline 

diagnostika 

N‰idustused: parodontiit, ravile allumatu parodontiit 

ï Proovide vıtmine 

ï Eelneb lokaalanesteesias mehaaniline biokile 

eemaldamine ning juurepindade silestamine ¸le 

kogu hammaskonna. 

ï Igemetasku kaabe vıetakse kuuest s¸gavamast 

igemetaskust hambapindadelt steriilse k¸retiga ja 

kantakse laboris valmistatud anaeroobsesse 

transportsˆˆtmesse 

ï S‰ilitamine ja transport: toatemperatuuril 

(anaeroobid), materjal peab laborisse jıudma 

proovi vıtmise p‰eval. 


Metoodika 

ï Esmask¸lvid 

ï Transportsˆˆtmest tehakse 5 j‰rjestikust lahjendust ja 

k¸lvatakse Brucella agarile ning 

ï A. actinomycetemcomitansíi isoleerimiseks TSBV 

Tryptic Soy Serum Bacitracin Vancomycin Agar 

ï Lıplik vastus: 7.-10. p‰eval. 

ï Tılgendus 

ï Parodontiidi tekitajate samastamine 

(A. actinomycetemcomitans, Porphyromonas 

gingivalis, Bacteroides forsythus, Fusobacterium 

nucleatum, Prevotella intermedia/nigrescensíi grupp, 

Peptostreptococcus micros, Campylobacter rectus, 

enterokokid ja enterobakterid) ja patogeeni(de) 

protsendi arvutamine kogu mikrofloora kasvutiheduse 

suhtes. 

ï Vıimalikud vead: vead materjali vıtmisel (aeroobne 

katsut) ja transpordil (pikk transpordiaeg). 

TSBV agar 

Tryptic Soy Serum Bacitracin 

Vancomycin agar (TSBV) is an 

enriched selective medium for the 

isolation and presumptive 

identification of A. actinomycetemcomitans. 

ïTSBV medium contains bacitracin 

and vancomycin at a concentration 

that inhibits most gram-positive and 

most gram-negative anaerobes, 

except for A. actinomycetemcomitans 

among others. 

ïThis medium is prepared, 

dispensed and packaged under 

oxygen-free conditions to prevent 

the formation of oxidized products 

prior to use.

CANDIDA SPP. JA TEISTE 

PƒRMSEENTE UURING 

ï Candida perekonna p‰rmseened 

pıhjustavad pindmisi ja invasiivseid, 

lokaalseid ja s¸steemseid infektsioone. 

ï Tısise immuunsupressiooniga patsientidel 

(n‰it. hematoloogiliste kasvajatega 

patsiendid, HIV-positiivsed) on n‰idustatud 

uuringud Candida-kolonisatsiooni 

selgitamiseks, et vajadusel saaks teostada 

kandidoosi prof¸laktikat. 


UURITAV MATERJAL, SELLE V’TMINE, 

SAATMINE JA SƒILITAMINE 

Proovinıu 

ï aeroobne transpordisˆˆtmega katsuti; 

ï Bactec MYC pudel; 

ï steriilne proovitops vıi 

koonuspıhjaga katsuti (15 mL) 


ï S‰ilivus 

ï Veri ja punktsioonimaterjalid 

transportida vıimalikult kiiresti 

laborisse! 

ï Tampooniga vıetud materjal, +4 C 

¸ks p‰ev 


ï Suu limaskesta kandidoos - tampooniga 

hıırutakse suu limaskestal asuvaid koldeid. 

ï Haavadñ parimaks proovimaterjaliks on koet¸kk 

transpordisˆˆtmes. 

ï S¸steemne kandidoos (Candida-sepsis) - 

uurimiseks sobivad veri, aspiraadid (pleura-, 

peritoneaal-, perikardiıınest), liikvor. Veri, 

aspiraadid ja liikvor s¸stitakse BACTEC MYC 

pudelisse (rohelise korgiga) sarnaselt verek¸lviga 

mikrobioloogiliseks uuringuks. 

ï Anal¸¸simeetod: k¸lv Sabouraudí agarile, 

p‰rmseente samastamine. Tundlikkuse m‰‰ramine 

minimaalse inhibeeriva kontsentratsiooni meetodil 

(E-test). Positiivne vastus 2.-7. p‰eval, negatiivne 7. 

p‰eval. 


N‰idustus ja kliiniline t‰hendus 

ï Kahtlus Candida-infektsioonile. 

ï P‰rmseente hulk v‰ljak¸lvis sıltub eelkıige 

proovivıtu kvaliteedist, mitte niivırd patogeeni 

tegelikust arvukusest haiguskoldes. 

ï Seetıttu tuleb seenevastase ravi m‰‰ramisel 

arvestada patsiendi kliinilist tausta ja s¸mptomeid. 

ï S¸steemse kandidoosi kahtluse korral tuleks 

vıimalusel anal¸¸sida ka punktsioonimaterjali, sest 

verek¸lv vıib j‰‰da negatiivseks. 

ï Candida krusei, Candida glabrata ja Candida 

tropicalis on sageli flukonasool-resistentsed 


ANTIBAKTERIAALNE RAVI

ANTIBAKTERIAALSE RAVI POLIITIKA 

ñ Antibiootikumi (ab) optimaalne kasutamine 

(empiiriline, prof¸laktiline, esmavaliku 

preparaadid ja reserv) resistentsuse 

v‰ltimiseks 

ñ Ab kasutamise piiramine 

ñ Kitsa toimespektriga ab eelistamine 

ñ Antibiootikumide rotatsioon 

ñ Kombineeritud ab ravi kasutamine 

ñ Resistentsuse j‰lgimine 

ñ Hea infektsioonikontroll, k‰tepesu 

ODONTOGEENSED INFEKTSIOONID, MILLE 

PUHUL ON VAJALIK S‹STEEMNE S STEEMNE AB RAVI 

ï Pulpiit 

ï Streptokokiline 

gingiviit 

ï Periodontiit 

ï Abstsessid 

ï Perikoroniit 

ï Periimplantiit 

Tısised sised fastsia ja 

kaela infektsioonid 

ƒge ge Herpes simplex 

infektsioon 

Candida infektsioon

S‹STEEMNE STEEMNE AB RAVI EI OLE VAJALIK 

ï Hambajuure kaaries 

ï Dry socket s¸ndroom s ndroom 

ï Gingiviit 

1. Penitsilliinid 

Esimene valik odontogeensete 

infektsioonide puhul 

ï G(+) kokkid, batsillid,spiroh 

batsillid, spiroheedid did, , anaeroobid 

anaero id 

ï 0.7~10% h¸persensiti 

h persensitiivsus sus 

ï Penicillin enicillin G (IV), Penicillin enicillin V (PO) 

ï Penicillinaas-resist 

Penicillina resistentsed entsed: : oxacillin, dicloxacillin 

ï Extended spectrum: ampicillin, amoxicillin 

ï Kombineeritud ‚-la laktama tamaas inhibiitor inhibi toriga iga : 

augmentin

2. Cephalosporin 

ï V‰hemtundlik penicillinaasi suhtes 

ï G(+) kokk , suurem osa G(-) bakteritest 

ï 3 generatioon: Pseudomonas aeruginosa 

ï Teine valik (v‰hem efektiivne anaeroobidele 

First generation Second generation Third generation Forth generation 

Cefazolin 

U-SAVE-A 

Tydine 

Keflor 

Ucefaxim 

3. Clindamycin 

ï G(+) kokid 

Claforan Cefepime 

ï Bakteriostaatiline -> bakteritsiidne 

ï Teise rea preparaat : reserv AB 

resistentsete anaeroobide raviks

4. Aminoglycoside (Gentamicin, 

Amikacin, Amikin) 

ï G(-) aeroobid, mıned G(+) aeroobid (S. 

aureus) 

ï Halvasti imendub seedetraktist 

ï Annuste reguleerimine neeru 

puudulikusega patsiendil 

ï Kombineeritud penitsilliiniga vıi 

tsefalosporiinidega 

5. Metronidazole*(Anegyn, Flagyne) 

ï Ainult obligaatsed anaeroobid 

ï L‰bib hematoentsefaaset barj‰‰ri 

ï Tısiste infektsioonide raviks kombineeritud 

‚-laktaam A/B 

ï Efektiivne Bacteroides spp., vastu eriti 

periodontaalsete infektsioonide suhtes 

ï V‰lja arvatud raseduse aeg

6. Vancomycin 

ï G(+), suurem osa anaeroobe, mıned G(-) 

kokid (Neisseria) 

ï Intravenoosne, 

ï Annuste reguleerimine neeru puudulikusega 

patsiendil 

ï Kasutatakse kui penitsilliini aseaine 

prof¸laktiliselt s¸damerikke puhul 

7. Chloramphenicol 

ï Laia spektri, efektiivne anaeroobidele 

ï Piiratud kasutamine raskete 

odontogeensete silma /aju 

infektsioonide puhul 

ï Toksiline

8. Erythromycin 

ï G(+) kokk, suu anaeroobid 

ï Bakteriostaatiline 

ï Teine valik odontogeensete 

infektsioonide jaoks 

ï Kergematele ambulatoorsetele 

infektsioonidele 

ï Resistentsus: 

50% S. aureus, S.viridans t¸vedest 

ï Side Effect of Commonly Used Antibiotics 

1. Penicillin hypersensitivity 

2. Cephalosporin hypersensitivity 

3. Clindamycin diarrhea, pseudomembrane colitis 

4. Aminoglycoside damage to kidney, 8th neurotoxicity 

5. Metronidazole* GI disturbance, seizures 

6. Vancomycin 8th neurotoxicity, thrombophlebitis 

7. Chloramphenicol bone marrow suppression 

8. Erythromycin mild GI disturbance 

9. Tetracyclin* tooth discoloration, photosensitivity 

VGH-TPE

ODONTOGEENSETE INFEKTSIOONIDE 

FARMAKOTERAAPIA 

ï Kitsa toimespektriga 

pen, amoxi, cephalexin, makroliidid 

(erythro-, (erythro , clarithro-,azitromycin). 

clarithro ,azitromycin). 

NB! Piiratud aktiivsus. 

ï Laia toimespektriga- toimespektriga Clindamycin 

ï Eelistatud on kombineeritud metronidazole + 

amoxi- amoxi vıi i makroliidi ravi 

ï Clindamyciníil 

Clindamycin il ja Augmentiníil Augmentin il on paremad 

farmokokineetilised ja 

farmakod¸naamilised farmakod naamilised n‰itajad n itajad 

LAIA SPEKTRI ANTIBIOOTIKUMID 

ANAEROOBIDELE 

1.Esimene valik (alati aktiivsed): 

metronidazole, imipenem, chloramphenicol,lactam/ 

-lactamase inhibiitor 

2. Teine valik(variaabelselt aktiivsed): 

cefoxitin, clindamycin 

3. Reserv e. vastuolulise toimega: 

cefotetan,cefmetazole,ceftizoxime jne. 

4. Mitteaktiivsed: 

aminoglycosides,aztreonam,sulphonamides, 

fluoro-quinolones...

Mikroobide AB tundlikkus I 

II.

Main antibiotics used in dentistry, mechanism of action, their 

spectrum, and main bacterial resistance mechanisms 

involved. 

Drug Mechanism of 

action 

Phenoxymethyl 

penicillin 

Amoxicillin, 

Ampicillin 

inhibition of cell wall 

synthesis 

inhibition of cell wall 

synthesis 

Spectrum Main resistance 

mechanism(s) 

aerobic G+, anaerobic 

G+, anaerobic G ñ 

(narrow-spectrum 

as above plus 

haemophilus spp 

(broad-spectrum) 

Metronidazole inhibition of RNA synthesis strict anaerobic 

bacteria, some 

facultative anaerobes 

Erythromycin inhibition of protein 

synthesis 

Clindamycin 

inhibition of protein 

synthesis 

Tetracycline inhibition of protein 

synthesis 

enzymatic (‚-lactamases), 

alteration of the target site 

(mosaic PBP) 

as above 

enzymatic (5- nitroimidazole 

reductase) 

mainly G + target site modification, 

enzymatic inactivation, 

andactive efflux 

as above plus 

additional activity on 

anaerobes 

as above 

many G + and G ñ active efflux, enzymatic 

inactivation, ribosomal 

protection proteins 

Principles to choose Antibiotics 

ï Once the decision has been made to use 

antibiotics as an adjunct to treating 

infections the antibiotics should be properly 

selected. 

The following guide lines are useful 

1. Identification of causative organism 

2. Determination of antibiotic sensitivity 

3. Choice of antibiotics 

4. Method of administration

Identification of causative organism 

ï Causative organism can be isolated from 

pus blood, or tissue fluids. 

ï Based upon the knowledge of pathogenesis 

and clinical presentation of specific 

infection,antibiotic therapy will be either 

initial or definitive depending upon whether 

or not the organism is diagnosed previously 

Determination of antibiotic 

sensitivity 

When treating an infection that has not 

responded to initial antibiotic therapy or 

when treating a postoperative wound ,the 

causative agent must be previously 

identified and the antibiotic sensitivity must 

also be determined.

1. Patient`s history of allergy 

Allergic reaction to drugs should be considered 

first. When it exists, alternative drugs must be used. 

Example erythromycin or clindamycin is usually use if 

the patient is allergic to penicillin 

2. Antibiotics with narrow spectrum 

The only major indication for use of broad 

spectrum antibiotics coverage is in severe life 

threatening infection where identification of 

causative agent is obsure. 

Each time bacteria are exposed to antibiotics, the 

opportunity for development of resistant strains is 

present. 

If narrow spectrum antibiotics are used ,fewer 

organisms have the opportunity to become resistant. 

3. Drug that cause fewest adverse reactions 

The goal of antibiotic therapy is to provide an effective 

drug that causes least problem to the patient 

4. Drug which is least toxic 

Toxicity reactions are those that occur as a 

result of excessive dose or duration of therapy, but 

can occur in individual patients with normal doses 

5. The well established still effective antibiotics 

Since its initial availability, penicillin, has been 

used for oral infection and it has been very 

effective, with low incidence of adverse reaction. 

Newer antibiotics should be used only when they 

have proved advantage over the older ones . 

6. Bactericidal rather than bacteriostatic drug 

Bactericidal drugs are effective during the log 

phase of bacterial growth the time . If growth is 

slowed or brought to stop,cidal drugs have a 

greately diminished effect. As a result, in these 

situations, when combination drug therapy is to be 

used,cidal and static combination should not be 

used in combination.

7. The less expensive still effective antibotic 

Most effective but less expensive drug should 

be considered first. 

8. Combination antibiotics 

There are situations in which the use of 

antibiotic combination is clearly indicated. Example 

is when it is necessary to increase the antibacterial 

spectrum in patients with life threatening sepsis of 

unknown cause. 

Imaging Studies 

ï Panorex and periapical dental films are used to 

identify involvement of tooth and surrounding bone 

in the infectious process. 

ï A limited facial series may also be performed to 

help visualize the offending area if these studies are 

not available; cooperation and communication 

with the radiology technician and radiologist is 

necessary. 

ï A soft-tissue radiograph of the neck can be used to 

identify gas-producing infections and determines 

any mass effect that may potentially compromise 

the airway.

ï CT scan may be used for severe fascial 

plane infections to determine the extent, 

size, and location of the infectious process. 

ñ Soft tissue planes may be seen; with 

increasing infection, inflammation, and fat 

streaking, the planes may be difficult to 

differentiate from adjacent muscle. 

ñ CT scan helps elucidate abscesses, 

venous thrombosis, and lymph node 

involvement. 

ï MRI is not yet favored because of cost and 

limited availability. 

ï CT scan is preferred for rapid visualization of 

odontogenic infections. 

Prophylaxis

Current recommendations 

by the American Heart Association 2007 

for dental, oral, respiratory tract, or 

esophageal procedures, if the patient has 

one of the following conditions 

Prophylactic regimens are for patients 

ï with prosthetic heart valves, 

ï previous bacterial endocarditis, 

ï congenital cyanotic heart disease, 

ï pulmonary shunt placement, 

ï cardiac myopathies, 

ï acquired valvular disease, 

ï and mitral prolapse with regurgitation 

ï Cardiac transplantation recipients who develop 

cardiac valvulopathy 

Only 25% of patients who should receive prophylactic 

antibiotics actually receive them. 

With 100% compliance, estimates suggest that the 

incidence of bacterial endocarditis would be 

reduced 3-6%.

ï For adults, administer 

amoxicillin 2 g PO 1 hour before procedure. 

Administer amoxicillin 50 mg/kg PO for pediatric 

patients. 

If by IV, administer ampicillin 2 g for adults and 50 

mg/kg for children within 30 minutes before the 

procedure. 

ï For patients allergic to penicillin, 

ï give clindamycin 600 mg PO/IV 1 hour before the 

procedure. 

ï For pediatric patients, administer clindamycin 20 

mg/kg PO/IV. 

ï Alternatively, azithromycin or clarithromycin 500 mg 

PO 1 hour before the procedure may be 

administered for adults and 15 mg/kg PO may be 

administered for pediatric patients. 

Medication 

ï The goals of therapy are to treat the 

dental infection and prevent further 

complications. 

ï Amoxicillin is still the first-line drug of choice 

but with 34% of Prevotella species resistant 

to amoxicillin, the alternatives of 

amoxicillin/clavulanate, clindamycin, and 

metronidazole need to be considered.

Antibiotics 

ï Therapy must cover all likely 

pathogens in the context of the clinical 

setting. 

Penicillin 

ï Inhibits biosynthesis of cell wall mucopeptide and is 

effective during active replication. 

ï Inadequate concentrations may produce only 

bacteriostatic effects. 

ï Adult 

ï 250-500 mg PO q 6h 

ï Pediatric 

ï 50 mg/kg/d PO divided qid 

ï Interactions: Probenecid may increase 

effectiveness by decreasing clearance; 

tetracyclines are bacteriostatic, causing a 

decrease in the effectiveness of penicillins when 

administered concurrently

Amoxicillin and clavulanic acid 

(Augmentin) 

ï Drug combination that extends the antibiotic 

spectrum of this penicillin to include 

bacteria normally resistant to beta-lactam 

antibiotics. Indicated for skin and skin 

structure infections caused by betalactamaseñproducing 

strains of 

Staphylococcus aureus. 

ï Administer for a minimum of 10 d. 

ï Adult 

ï 500/125 mg PO tid 

ï Pediatric 

ï 40 mg/kg/d PO divided tid 

ï Coadministration with warfarin or heparin 

increases risk of bleeding

Erythromycin (EES, E-Mycin, Ery-Tab 

ï DOC in patients who are allergic to 

penicillin. 

ï Inhibits RNA-dependent protein synthesis, 

possibly by stimulating dissociation of 

peptidyl tRNA from ribosomes, inhibiting 

bacterial growth. 

ï Adult 

ï 250-500 mg PO q6h 

ï Pediatric 

ï 30-50 mg/kg/d PO divided qid 

ï Coadministration may increase toxicity of 

theophylline, digoxin, carbamazepine, and 

cyclosporine; may potentiate anticoagulant 

effects of warfarin; coadministration with 

lovastatin and simvastatin increases risk of 

rhabdomyolysis

Clindamycin (Cleocin) 

ï Lincosamide useful to treat serious skin and 

soft tissue infections caused by most 

staphylococci strains. 

ï Effective against aerobic and anaerobic 

streptococci, except enterococci. 

Inhibits bacterial protein synthesis by 

inhibiting peptide chain initiation at the 

bacterial ribosome, where it preferentially 

binds to the 50S ribosomal subunit, causing 

bacterial growth inhibition. 

ï Adult 

ï 600-900 mg IV q8h 

ï Pediatric 

ï 20-40 mg/kg/d IV divided q6-8h 

ï Interactions:Increases duration of 

neuromuscular blockade induced by 

tubocurarine and pancuronium; 

erythromycin may antagonize effects of 

clindamycin; antidiarrheals may delay 

absorption of clindamycin

Ampicillin and sulbactam 

(Unasyn) 

ï Combination antimicrobial agent that utilizes a 

beta-lactamase inhibitor with ampicillin. Gives 

better anaerobic coverage. 

ï Adult 

ï 1.5-3 g IV q6h 

ï Pediatric 

ï 12 years: Administer as in adults; not to exceed 4 

g/d sulbactam or 8 g/d ampicillin 

ï Probenecid and disulfiram elevate ampicillin 

levels; 

ï allopurinol decreases ampicillin effects and 

has additive effects on ampicillin rash; 

ï may decrease effects of PO contraceptives

Ticarcillin and clavulanate 

(Timentin) 

ï Used for deep space infections. 

ï Inhibits biosynthesis of cell wall 

mucopeptide and is effective during stages 

of active growth. 

ï Antipseudomonal penicillin plus a betalactamase 

inhibitor that provides coverage 

against gram-positive, gram-negative, and 

anaerobic organisms. 

ï Adult 

ï 3.1 g IV q6h 

ï Pediatric 

ï 75 mg/kg IV q6h 

ï Interactions: Tetracyclines may decrease 

effects of ticarcillin; high concentrations of 

ticarcillin may physically inactivate 

aminoglycosides if administered in same IV 

line; effects when administered concurrently 

with aminoglycosides are synergistic; 

probenecid may increase penicillin levels

Metronidazole (Flagyl) 

ï An imidazole ring-based antibiotic active 

against various anaerobic bacteria and 

protozoa. 

ï Usually used in combination with other 

antimicrobial agents except when used for 

Clostridium difficile enterocolitis in which 

monotherapy is appropriate. 

ï An addition for treating Ludwig angina. 

ï Adult 

ï 1 g loading dose IV; then 500 mg IV q6h 

ï Pediatric 

ï 15 mg/kg loading dose IV; then 7.5 mg/kg q6h 

ï Interactions: May increase toxicity of 

anticoagulants, lithium, and phenytoin; cimetidine 

may increase toxicity of metronidazole; disulfiram 

reaction may occur with orally ingested ethanol

ï Systemic therapy: 

Actinomycosis 

ï penicillin or tetracycline in large doses for 

3ñ6 mo 

ï Wide excision of infected tissue 

ï Systemic therapy 

Acute Herpetic 

Gingivostomatitis 

Valacyclovir 500 mg; 1 tablet twice daily 10 d 

Acyclovir 400 mg; 1 tablet 5 times daily 10 d 

ï Fluids 

ï Analgesia

Acute Necrotizing Ulcerative 

Gingivitis 

ï DÈbridement of necrotic tissue 

ï Aggressive oral hygiene and plaque control 

ï Metronidazole 250 mg; 1- 4 times daily 10 d 

Bechetís Disease 

ï Treat as for aphthosis 

ï Refer to a dermatologist, a rheumatologist, 

or an ophthalmologist, 

ï depending on organ involvement, for 

ongoing care,which may include systemic 

immunosuppressive and/or antiinflammatory 

drugs.

Candidiasis 

ï Identify and correct provocative factors. 

ï Topical therapy 

ï Nystatin oral suspension (100,000 units/mL); 

rinse 5 mL and swallow 4 times/d 

ï Clotrimazole solution 1%; rinse 5 mL and 

swallow 4 times/d 

ï Clotrimazole troches (Mycelex) 10 mg; dissolve 1 

troche in mouth 5 times/d 

ï Systemic therapy 

ï Fluconazole (Diflucan) 100 mg; 

ï 2 tablets on the first day, 

ï 1 tablet days 2ñ7, 1 tablet every other day for days 

8ñ21 

ï Ketoconazole (Nizoral) 200 mg; 1 tablet every day 

with breakfast 21 d 

ï Itraconazole (Sporanox) 200 mg; 1 tablet every day 

with breakfast 21 d 

ï May use shorter duration for less severe infections

Herpes Zoster 

ï Topical therapy 

ï ï Calamine lotion for wet, oozing cutaneous 

lesions 

ï ï Doxepin cream for pain relief of acute 

lesions 

ï ï Systemic therapy 

ï ï Acyclovir 400 mg tablets; 2 tablets 5 times 

daily 7ñ10 d 

ï ï Famciclovir 500 mg tablets; 1 tablet 3 

times daily 7 d 

ï ï Valacyclovir 500 mg tablets; 2 tablets 3 

times daily 7 d 

Impetigo 

ï Topical therapy: mupirocin ointment applied 

twice daily 

ï ï Systemic therapy 

ï ï Penicillin V potassium 250 mg tablets; 1 

tablet 4 times 

ï daily 10 d 

ï ï Erythromycin base 250 mg tablets; 1 tablet 

4 times daily 10 d 

ï ï Dicloxacillin 250 mg tablets; 1 tablet 4 

times daily 10 d

tselluliit 

Impetigo and Cellulitis 

Cellulitis due to Hemophilus 

influenza. 

Prominent edema of the 

upper and lower eyelids with 

faint erythema. 

Ill-defined erythema on the 

cheek of an infant

Clint's abscess - with light reflecting 

off of it 

Post-surgical 

complications! 

An abscess formed 

within a month of gettng 

gum cyst removed. 

It was painful, 

swelleding up to over the 

size of a pea in just a 

few hours. 

Gingival abscess: A tender erythematous 

fluctuant gingival enlargement is present 

facial to the maxillary first and second 

molars.

Stom infektsioonide lab diagnostika ja ravi.pdf

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