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Uses Short, painful procedures requiring intense analgesia and blunting of stress responses. Remifentanil for longer neurosurgical procedures where rapid emergence from anesthesia is important.
Commercial forms ALFENTA (Alfentanil) ULTIVA (Remifentanil
Tramadol
Cont..
Preschool Age group Oral flora resembles that of an adult except that Bacteriodes melanogenics and spirochetes are uncommon.
Antibiotics do not cure the patient, but function to provide time for the normal host defenses, initially overwhelmed by microbes, to gain control and eliminate the infectious process. a) Antibiotics are not a substitute for surgical drainage: the drainage of pus thus established, increases the efficacy of antibiotics in a particular case. Antibiotic dosages for children are similar to those in adults(as adjusted by body weight).The exceptions, however, are the neonates who have reduced gastric acid, plasma protein binding ,blood flow to muscles ,renal and hepatic activity and body fat and increased extracellular fluid compared to older infants and adults. Hence, a lower antibiotic dosing is required in neonates.
Dentists seldom treat infant, but doses for pediatric patient require an adjustment from usual adult dose, as determined by body surface area for calculating dosages: 1. CLARKS RULE Childs weight in lb x adult dose = childs dose 150 2. YOUNGS RULE: Age of child x adult dose = childs dose Age+ 12
Anders in 1992 Administration of the drug used on infants weight is seldom appropriate.
Dosep = dosea x wt. pd wt. ad
wt. pd
o.7
wt. ad
Dose = dose of child Dose = dose of adult Wt. pd = weight of child Wt. ad = weight of adult
p a
Antibiotic Resistance
Sooner or later the microorganisms may develop resistance to any antimicrobial agent. This could be attributed to either improper dose or duration. Thus, only practical method to delay or restrict microbial resistance would be limit the antibiotic use to proper indication, dosages and duration. Following the manufacturers instructions and/or physicians instructions would reduce the chances of misuse and prolong or prevent antibiotic resistance
Antibiotic Prophylaxis
It is the administration of antibiotics to the patients without the evidence of infection to prevent bacterial colonization, to reduce subsequent postoperative complications, e.g., antibiotic prophylaxis to prevent infective endocarditis. It is also required in case of immunosupressed patients with blood disorders, cancer chemotherapy and graft recipients.
Fluoroquinolones
Cont
Newer Macrolides
Roxithromycin Semi-synthetic, long-acting ,acid-stable with antimicrobial spectrum resembling erythromycin. Indication Respiratory infections ENT infections Skin and soft tissue infections Genital tract infections
Dosage 250 mg BD for 7 days Severe cases 500mg BD for 14 days Commercial Forms CLARIBID CELEX CLARMAC
Antibacterial spectrum expanded as compared to erythromycin Active against H.influenzae High activity on respiratory pathogens Good activity against Mycobacterium avium complex in AIDS patients Indications Pharyngitis Tonsillitis Sinusitis Staphylococcus and streptococcal skin and soft tissue infections