Oral Cutaneous Fistulas Medication

Updated: Mar 06, 2017
  • Author: James E Cade, DDS; Chief Editor: William D James, MD  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to eradicate infection, reduce morbidity, and prevent complications.

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Antibiotics

Class Summary

Therapy must be comprehensive and cover all likely pathogens in the context of this clinical setting.

Penicillin VK (Truxcillin, Veetids)

Penicillin inhibits the biosynthesis of cell wall mucopeptide. It is bactericidal against sensitive organisms when adequate concentrations are reached and is most effective during the stage of active multiplication. Inadequate concentrations may produce only bacteriostatic effects. Penicillin is the drug of choice in treating common orofacial infections caused by aerobic gram-positive cocci and anaerobes. Orofacial infections include cellulitis, periapical abscess, periodontal abscess, acute suppurative pulpitis, oronasal fistula, pericoronitis, osteitis, osteomyelitis, and postsurgical and posttraumatic infections. It is no longer recommended for dental procedure prophylaxis.

Amoxicillin (Amoxil, Larotid, Polymox, Trimox)

Amoxicillin is an analog of ampicillin with broad-spectrum bactericidal activity against gram-positive and gram-negative microorganisms. It interferes with cell wall mucopeptide synthesis during active multiplication, resulting in bactericidal activity against susceptible bacteria.

Amoxicillin and clavulanate (Augmentin)

This drug combination is used to treat bacteria resistant to beta-lactam antibiotics.

In children older than 3 months, base the dosing protocol on amoxicillin content. Owing to different amoxicillin/clavulanic acid ratios in the 250-mg tablet (250/125) versus the 250-mg chewable tablet (250/62.5), do not use the 250-mg tablet until the child weighs more than 40 kg.

Erythromycin (E.E.S., E-Mycin)

Erythromycin inhibits bacterial growth, possibly by blocking the dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. It is used for the treatment of staphylococcal and streptococcal infections.

In children, age, weight, and severity of infection determine proper dosage. When twice-daily dosing is desired, half the total daily dose may be administered every 12 hours. For more severe infections, double the dose.

Clindamycin (Cleocin)

Clindamycin inhibits bacterial growth, possibly by blocking the dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. It is a semisynthetic antibiotic produced by 7(S)-chloro-substitution of the 7(R)-hydroxyl group of the parent compound lincomycin.

Metronidazole (Flagyl)

Metronidazole is an oral synthetic antiprotozoal and antibacterial agent, 1-(beta-hydroxyethyl)-2-methyl-5-nitroimidazole. It is active in vitro against most obligate anaerobes but does not appear to possess clinically relevant activity against facultative anaerobes or obligate aerobes.

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