Principle vii: Administer Antibiotic Properly

Principle vii: Administer Antibiotic Properly

Once the decision is made to prescribe an antibiotic to .the patient, the drug should be administered in the proper dose and at the proper dose interval. The manufacturer usuallyrecommends the proper dose. It is adequate to provide plasma levels that are sufficiently high to kill the bacteria that
are sensitive to the antibiotic but are not so high as to causetoxicity. The peak plasma level of the drug should usually be at least 4 or 5 times the minimal inhibitory concentration for the bacteria involved in the infection.
Likewise, the clinician must admin ister the antibioticat the proper interval. This interval is usually recommended by the manufacturer and.Is determined by the plasma half-life of the drug. The interval is usually 4
times the plasma half-life of the drug. Strict adherence to this interval is critical with the bacteriostatic antibiotics but is much less important with bactericidal antibiotics, because bacteria exposed to bactericidal antibiotics will die from a defective cell wall, but those exposed to acteriostatic  antibiotics can resume protein synthesis once the antibiotic is gone. It is clear that patients stop taking their antibiotics after acute symptoms have subsided and rarely take their drugs as prescribed after 5 or 6 days. Despite what the pre~ scription says, patients rarely take antimicrobial agents as.  prescribed longer than 3 or 4 days. Therefore the antibiotic that would have the highest compliance would be the drug that could be given once a day for 4 or 5 days. When antibiotics are given, they should be given for an adequate period. The traditional recommendation has been to continue antibiotic therapy for 2 to 3 days after the infection has resolved. In clinical terms this means that the patient, who has been treated with both surgery “and antibiotics, will usually have dramatic improvement in symptoms by the se{ond day, and by the fourth day
.will be reasonably asymptomatic. Antibiotics should then be administered for an additionaf2 0 days, for a total of 6 days. Most mild odontogenic
infections that are treated on an outpatient basis can usually
be managed with a prescription for antibiotics suffident for 6 or 7 days. ,
In some situations no surgical” therapy (i.e., no endodontics or extraction) is provided. In these situations, resolution of the infection willtake longer. Therefore the prescriptton should be written for 9 or lQ days of
antibiotics. Additional administration of antibiotics may be necessary
in some infections that do not resolve as rapidly. It is important for the clinician to make it clear to the patient that the entire prescription should be taken. If for some reason the patient is advised t~ stop taking the
antibiotic early, all remaining pills or capsules should be discarded. Keeping small amounts of unused antibiotics in medicine cabinets for the anticipated sore throat next winter should be strongly discouraged. Casual selfadministration  of antibiotics is not useful and may be hazardous
to the health of the individual and community.

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