Antibiotics safe in Liver Disease

SAFE ANTIBIOTICS
Pen VK: Normal dose
Amoxicillin: Normal dose
Augmentin: Normal dose
Keflex: Normal dose
Duricef: Normal dose
Clindamycin: Normal dose with Hepatitis
Clarithromycin: Normal dose with normal kidney function
Metronidazole: Normal dose with mild liver disease
Doxycycline: Normal dose
IV Vancomycin: Normal dose


ANTIBIOTICS WITH ALERTS
Ampicillin: Use caution/avoid
Azithromycin: Avoid
Clindamycin: 50% dose with Cirrhosis
Metronidazole: 50% dose with moderate or severe liver disease
Tetracycline HCL: Avoid


1)Pen VK: No dose alteration needed

2)Amoxicillin: No dose adjustment

3)Azithromycin: Avoid Azithromycin in patients with Liver disease

4)Clindamycin:
a)Hepatitis: Full dose can be used with non-acute, non-fulminant hepatitis
b)Cirrhosis: Decrease Clindamycin total dose by 50%

5)Metronidazole (Flagyl)
a)mild Liver Disease: Prescribe the normal dose
b)moderate & severe Liver Disease: Decrease the total dose by at least 50%
c)Decreased dose of Flagyl used if both liver and kidney are affected: 250 mg q12h

6)Tetracycline HCL: Avoid Tetracycline HCL with Liver Disease

7)Doxycycline: No dose change needed with kidney/live/kidney & liver disease

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Antibiotics and Kidney Disease

SAFE ANTIBIOTICS
Clindamycin: No dose change
Azithromycin: No dose change
Doxycycline: No dose change
Metronidazole: Normal dose for Mild/Mod. disease
Vancomycin Pulvules

ANTIBIOTICS WITH ALERTS
Pen VK: Prolong interval
Amoxicillin: Prolong interval
Augmentin: Decrease dose
Ampicillin: Decrease dose
Dicloxacillin: Decrease dose
Keflex: Prolong interval
Duricef: Prolong interval
Clarithromycin: Avoid
Metronidazole: Prolong interval for severe disease
IV Vancomycin: Avoid
1)Pen VK: INTERVAL PROLONGED; DOSE UNCHANGED

a)Serum Creatinine < 2.0 mg/dL or the CrCl is > 50 mL/minute:
Pen VK is dosed normally at 250-500 mg PO q6h
b)S. Creatinine 2.0 mg/dL to Predialysis or CrCl 10-50 mL/minute:
Pen VK is dosed at 250-500 mg q8-12h
c)Patient on Dialysis:
Pen VK is dosed at 250-500 q12-16h

2)Amoxicillin: DOSE UNCHANGED; INTERVAL PROLONGED

a)Serum Creatinine below 3.3 mg/dL or Cr Cl >30 ml/minute:
Dispense the normal dose of Amoxicillin: 250-500 mg PO q8h
b)Serum Creatinine above 3.3 mg/dL to Predialysis or Cr Cl 10-30 ml/minute:
Prolong the interval and dispense: 250-500 mg PO q12h
Avoid using the 875 mg tablet
c)Cr Cl <10 ml/minute or the Dialysis Patient:
Prolong the interval and dispense: 250-500 mg PO q24h
The dose must be administered after dialysis completion

3)Augmentin:
Decrease the total dosage by 50% in the renal compromised patient

4)Azithromycin:
Use full dose of Azithromycin in the Renal compromised patient
Kidney disease: No dose change is needed with Kidney disease or Renal failure
Used with 50% total dose reduction in patient with both Kidney & Liver disease

5)Metronidazole (Flagyl):
Dose adjustment is required only in the presence of renal failure/dialysis
Metronidazole should be dosed at 500 mg PO q12h instead of q8h after the dialysis

6)Tetracycline HCL:
a. Serum Creatinine between 1.25-2.0 mg/dL or CrCl 50-80 mL/minute:
Dose Tetracycline HCL q8-12h
b. Serum Creatinine between 2.0 mg/dL to Pre-dialysis or CrCl 10-50 mL/minute:
Dose Tetracycline HCL q12-24h
c. In the presence of Dialysis or CrCl <10 mL/minute:
Dose Tetracycline HCL q24h

7)Doxycycline:
No dose change needed with kidney/live/kidney & liver disease


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Allergies in Dentistry

Sulpha Allergy: "Sulfa allergy" is a term used to describe adverse drug reactions to sulfonamides, a group of drugs that includes those with and without antibiotic characteristics.

b) Sulphite/bisulphite Allergy: All dental local anesthetics that contain epinephrine contain metabisulfite which is an antioxidant to prevent breakdown of epi.

Sulfites are added to injectable epinephrine (such as in the Epi-Pen) to prevent browning, which decreases the effectiveness of the drug. However, epinephrine has not been reported to cause adverse reactions in people with sulfite allergy, and should not be withheld in an allergic emergency. Injectable epinephrine may prove life saving in people with sulfite allergy experiencing anaphylaxis.

Patients who are allergic to sulpha are not allergic to bisulphites and vice-versa. It is safe to give epi containing local anesthetics with sulpha allergy

c)Penicillin : Allergic to Penicillin means allergy to all members of penicillin family. If its a simple rash type of reaction then we can use cephalosporins but in case of severe anaphylaxis type reaction even cephalosporins are contraindicated. Even for rash type reactions it is advisable not to give cephalosporins because of other choice available at disposal.

d)Codeine : A patient allergic to codeine is usually allergic to morphine due to cross reactivity. Before giving out prescription make sure you not only ask "Are you allergic to codeine/morphine but ask have you taken codeine/morphine before" ?

e)Local Anesthetics: Allery to amide anesthetics is very rare. Allergy to one amide does not contraindicate the use of other amides. There is definite cross reactivity with ester anesthetics ie allergy to one ester anesthetic means allergy to all ester anesthetics

f) Latex Allergy: Children with spina bifida are at extraordinary high risk of latex hypersensitivity.

Screening: Have you experienced hives, wheezing, rashes, coughing, or difficulty in breathing when handling items like balloons and rubber balls?”

“Have you experienced any of these symptoms after contact with medical or dental products like rubber gloves or dental dams?”
“Have you ever worked in a health care setting? In the rubber industry?”

Dental Management: There are two main sources of latex exposure to our patients. The primary source is latex gloves. The practitioner must wear nonlatex gloves for the latex-sensitive patient. The second source is aerosolized latex. Latex proteins adhere to the cornstarch powder added by manufacturers to assist in donning and removal. It is a common misconception that it is the powder to which a person is allergic; rather, it is the protein sticking to the powder.

Each time powdered gloves are used, latex is introduced into the air, where it can remain up to 12 hours.(14) This “latex dust” acts as a sensitizing aeroallergen, and in sensitive people has caused serious, asthmatic life-threatening reactions. Therefore, merely wearing nonlatex gloves while treating an allergic patient may be an inadequate precaution when powdered latex gloves are being used elsewhere in the office.

If there is any question of safety, it is often advisable to have an allergic patient come to your office and simply sit in your waiting room. If there is any risk, it may be prudent to refer the patient to a latex-safe office.

For the latex-allergic patient, the following are recommended:

the patient should be the first patient of the day (low “latex dust”);
no direct contact with latex is allowed;
nonlatex substitutes for patient care must be used: prophy cups, dental dam, N20 mask, etc.;
latex in the room must be ALARA (As Low As Reasonably Achievable);
any latex items that cannot be removed must be covered;
the room should be close to the entrance (in case of emergency);
personnel setting up the room must wear nonlatex gloves;
instruments must be handled only with nonlatex gloves;
lab work must be handled with nonlatex gloves and thoroughly rinsed before placement;
multi-dose glass vials of anesthetic or glass ampules should be used;
if the patient is taking beta blockers, a medical consult must be done (these drugs interfere with the medications needed to resuscitate a patient should an emergency arise);
use nonlatex blood pressure cuffs;
wear minimal perfume and aftershave;
gutta percha has a potential for cross-allergencity (an alternative is Ketac-Endo fill).

Original Author for latex topic By Lawrence D. Duffield, DDS
Journal of the Michigan Dental Association
June 1998 href="http://www.latexallergylinks.org/MDA.html">http://www.latexallergylinks.org/MDA.html

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