Dental magazine _ journal _ march 201

JOURNAL OF DENTAL SCIENCES
Volume 2 Issue 1
PRESCRIBING ANTIBIOTICS AND
ANALGESICS IN CHILDREN
Dr. Jyoti Mathur
Dr. Amish Diwanji
Abstract
For the purpose of having a standardized prescription practice, it is very necessary for the operators involved in dispensing treatment in a large set up, to have a quick reference system which would minimize chances of errors due to variation. We at the Department of Pedodontics, Faculty of Dental Science, Dharmsinh Desai University, have developed a quick reference chart for the ease of prescription. It contains both adult and pediatric doses of frequently prescribed antibiotics and analgesics. A separate section for contraindications and special precautions to the drugs has also been added to avoid complications.
Key words- prescription, antibiotics, analgesics, orodental infections, children
Introduction
Without specific knowledge about correct pediatric dosage Sir William Osler once said, ``the desire to take medicine is
based on body weight / surface area and other factors such perhaps the greatest feature which distinguishes man from as gestational and postnatal age in neonates, a clinician is animals.” There exist clear cut indications for prophylactic liable to prescribe the drugs in inappropriate suboptimal or antibiotic usage given by renowned medical bodies such as excess dose with undesirable consequences. Therefore, American Heart Association for endocarditis prophylaxis. we at the department of Pedodontics, Faculty of Dental Still, antibiotics are the most widely abused prescribed drugs Sciences, Dharmsinh Desai University, Nadiad have on the basis of inappropriate indications, dosages and developed a quick reference chart for antibiotics and duration of use. Approximately half of all antibiotics used in analgesics displayed on the notice board for the purpose of hospitals are given to patients without signs or symptoms.
standardization in prescription practice by students, interns and teaching staff.
The problem is compounded while prescribing for children. Most of the time 'random' age related prescriptions are given The following chart is based on body weight of the child, based on dosages for adults. The use of inappropriate special notes about various drugs interactions and antimicrobial drugs may result in ineffective therapy or considerations regarding preexisting hepatic and liver contribute to the development of undesirable antibiotic disorders are given subsequently in this paper.
resistance in the causative pathogens in the community. Commonly Prescribed Drugs and Dosages (for orodental infections)
Note: - Total pediatric dose should never exceed adult dose. Neonatal doses not included
Adult Dose
Pediatric Dose
25mg/Kg/day divided in 2 doses (12 hrs each).
To be avoided in children below 18 yrs 250-500mg (stearate or estolate salts) or Address for Correspondence :
Dr. Jyoti MathurDepartment of Pedodontics and Preventive Dentistry, Department of Pedodontics and Preventive Dentistry, Faculty of Dental Science, Dharmsinh Desai University, Dharmsinh Desai University, NADIAD-387001. GUJARAT E-mail : [email protected] Ph. : 079 - 2658 9498 JOURNAL OF DENTAL SCIENCES
Volume 2 Issue 1
7.5mg/Kg twice daily (upto 500mg twice daily) 2 divided doses on day 1 than 2.2 mg/Kg/day (age 8yrs or older)25-50mg/kg/day divided into 6hrly doses 10-15 mg/kg/day divided in 2 doses(every 12 hrs), max. dose 800 mg per day Analgesic dose-10-25/mg/Kg/day (divided into 6 hrly doses)Antipyretic dose-3mg/Kg/dose every 6hrsPrecaution – avoid in children with seizures Antifungals
Antibiotic dosing– Virtually all resistance occurs by
1. Nystatin
transposable element gene transfer promoted by the use of antibiotics, particularly at low doses and for long duration.
Antibiotics should be used aggressively and for as short a Neonate: 100,000 units to each side of mouth X QID time as is compatible with patient's remission of the Infant : 200,000 units to each side of the mouth X QID Many clinicians follow the pattern of continuing Children and Adults: 400,000-600,000 units to each side of antibiotics for a minimum of 48 hours after disappearance of the mouth X QID symptoms. That would mean reevaluating the patient 1-2 days after initiation of antibiotics.
1 Nystatin tablet (500,000) units dissolved in 5 ml glycerin provides 100,000 units/ml The dosage and duration of the therapy depend upon the nature of the infection and the severity of the infection. A 2. Fluconazole
simple urinary tract infection in an adult female may only Neonate >14 days, infants and children require 3 days of oral therapy, but deep seated infections like a. Oropharangeal or oesophageal candidiasis osteomyelitis or endocarditis will require prolonged parenteral therapy for six weeks or more.
Then 3mg /kg/day (max100mg) PO/IV (OD) X 14-21 days Contraindications and special precautions:
Other Topical Antifungal
In patients with blood disorders, active CNS diseases, Hamycin: Better water solubility than nystatin
hypersensitivity, sever hepatic failure, pregnancy, lactation, neonates, active peptic ulcers, asthma etc, it is advisable to For Oral thrush: 2 lac units /ml suspension to be applied to the seek opinion from the concerned physician before affected area with sterile cotton 2-3 times daily for 7-10 days.
Available as 10 ml suspension which gives 200,000 units /ml.
Interesting fact – Fluorides, Ibuprofen, Iron Salts, Iodine
Contraindications for all antifungals- hypersensitivity, drugs, tetracycline ingestion may discolor stools black Greenish grey or white/speckling is seen with many oral antibiotics.
JOURNAL OF DENTAL SCIENCES
Volume 2 Issue 1
Important Interactions between Antibiotics and other drugs
Interacting drug
Ciprofloxacin (and
most other quinolones)
Decrease absoption of quinolones (ciprofloxacin) Increase effect of theophyline, cyclosporine, warfarin Increase risk of CNS stimulation seizures Clindamycin
Erythromycin
Inceases serum levels of carbamazepine causesnystagmus, ataxia, vomitting, (avoid this combination) Metronidazole
Phenobarbitones, hydantoins Decreases effect of metronidazol Tetracyclines
Increases toxicity of digoxin (may persist for several months in 10% patients) For Patients with Liver Disorders
Phenobarbitone(&OtherSedatives) Sedation
In the presence of hepatic diseases, dosage adjustment may Tetracycline: Teeth pigmentation, enamel hypoplasia,
be indicated for several drugs which are metabolised in the cataract, skeletal growth retardation
liver
Streptomycin: deafness
Antimicrobials – clindamycin, metronidazole, Alcohol Congenital cardiac, CNS, limb anomalies,
-Prednisone is less effective in hepatic disease as it Vitamin D analogues (alfacalcidol, calcitriol): Aortic
stenosis (supraclavicular), hypercalcemia (avoid high doses) Drugs in Renal Failure
Conclusion:
In broad terms potentially nephrotoxic drugs need careful For the conclusion, it would be prudent to refresh the topic of modification in dosing pattern in patients with renal 'selection of appropriate antibiotic therapy' The selection of insufficiency so as to prevent toxicity while maintaining their antibiotic therapy for an infection requires a knowledge of 1) adequate therapeutic levels. This is done based on the the infecting organism including the pathogen most likely to patients GFR (glomerular filtration rate) in ml/min. The be present in given clinical or geographical circumstances, 2) the local patterns of antimicrobial resistance in common Extension of interval between dosages or pathogens, 3) an understanding of pharmacokinetics of the Reduction of dosage keeping the interval between antimicrobials selected. 4) The physiology of the patients, doses normal, metabolic upsets, renal or hepatic dysfunction, age and (iii) In some case both reduced dosage along with extension References:
For further details, reference of the topic from the concerned 1. Yagiella, Dowd and Neidle. Pharmacology & text book is must as most of the commonly prescribed Therapeutics for Dentistry, 5 edition, Delhi, Elsevier, Penicillins, Metronidazole along with NSAIDs like 2. Yagiella, Dowd and Neidle. Pharmacology & acetaminophen require specific dose and interval adjustment Therapeutics for Dentistry, 5 edition, Delhi, Elsevier, Maternal drugs to be avoided or used with great caution 3.
R.K Suneja. Handbook of Pediatric Drug Therapy and during breastfeeding
Immunization, 2nd edition, Delhi, Elsevier 2004, pg: Preface to the first edition.
Possible effect on infant
Advanced Drug Review, issue-4,Aug-Nov 2006, Aspirin: Avoid high dose as there is risk of bleeding, Reye's
Lucknow, The Arora Medical Book publishers Pvt. Ltd. 5. Lange, Basic& Clinical Pharmacology, Editor -Bertram Estrogens: Gynaecomastia in male infants
G Katzung, 9 edition (international edition) Singapore, Metronidazole : Suspend breast feeding for 12hrs after
single dose as it is secreted in large amounts in breast milk.
JOURNAL OF DENTAL SCIENCES
Volume 2 Issue 1
R.K Suneja. Handbook of Pediatric Drug Therapy and 11. Yagiella, Dowd and Neidle. Pharmacology & Immunization, 2nd edition, Delhi, Elsevier 2004, pg: Therapeutics for Dentistry, 5 edition, Delhi, Elsevier, Preface to the first edition. Pg 247-299.
IDR(Indian drug review) triple i ,vol XIII' no.6, Nov 07- 12. Yagiella, Dowd and Neidle. Pharmacology & Jan 08, Bangalore,CMP Medica India Pvt Ltd Therapeutics for Dentistry, 5 edition, Delhi, Elsevier, Levy SB: The antibiotics paradox, New York 1992, 13. Davidson's principles &practice of medicine, Pallasch TJ: Global antibiotics resistance and its impact international editor-John A.A. Hunter, 20 edition, on the dental community, J calif Dent. Assoc 28:215- 10. Pallasch TJ: How to use antibiotics effectively,J calif

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