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
BILL TEXT: STATE OF NEW YORK ________________________________________________________________________ IN ASSEMBLY ON RULES -- (at request of M. of A. Dinowitz,Aubertine, Reilly, John, Lentol, Lupardo,Bing, Bradley, Canestrari, Carrozza, Cusick, DelMonte, Destito,Lavelle, Lavine, Lifton, Magnarelli, Paulin, Ramos, Schroeder, Tokasz,-- read once and referred to the Committee onand reco
Economic aspects of deep sternal wound infections Karolin Graf, Ella Ott, Ralf-Peter Vonberg, Christian Kuehn, Axel Haverich and Iris Eur J Cardiothorac Surg 2010;37:893-896 This information is current as of January 1, 2012 The online version of this article, along with updated information and services, ishttp://ejcts.ctsnetjournals.org/cgi/content/full/37/4/893The European Journal o