Dentaltown June 2017 - 44

message board
Continued from p. 42
For antibiotics or no antibiotics, I would rather rely on opinion and advice of legal personnel
than science or literature. This is a brutal reality of our profession. You think you are independent, you are your own boss, you are out there to do good and no harm-forget about this.
Ultimately, your big brother is the judicial system. You have to think of a worst case every time
you make any decision and think how would that play out in legal system.
Having said that, please any attorneys out here chime in. Would love to hear your opinion
on this. ■
2/25/2017

pjmop
Member Since: 02/15/05
Post: 70 and 112 of 123

I try to reserve Clinda for cellulitis. If allergic to "-cillins" (rash) I typically write kflex (cephalexin), which I know they say 1-3% are allergic to but have never had any reported reactions.
If reaction to -cillin is airway (rare), I don't risk kflex. I think the potential for C. diff in elderly
patients is pretty high, so I try to stay away from Clinda and if I do prescribe it, they get strict
instructions about yogurt or probiotics and dosage is usually scaled back.
Anytime a prescription is written, there is a risk/benefit analysis that should be going on in
our heads. Things like potential for: infection vs allergy vs C. diff. Note that I didn't include
resistance though because that's a given.
http://www.medscape.com/viewarticle/870145
Some lit would suggest that hitting it hard at the first sign is a better approach (or even before
there's a sign). Honestly, I really don't know. I think most of us fly by the seat of our pants and
prescribe more on intuition and gut (and lawyers) than science. My point is that those who think
they're saving lives by limiting scripts here and have very little, if any, effect on resistance. There
are other, real, meaningful factors to consider but, in my view, resistance is at the bottom of the
list. I'm not saying resistance isn't a big deal-it is. I just don't think there's much we can do
about it, unless we take a really aggressive systemwide approach where everyone is on the same
page. ■
3/4/2017

Leachman
Member Since: 03/20/08
Post: 113 of 123

Fascinating thread. I give a detailed postop sheet after my assistant gives a detailed explanation after the surgery. I call that night if it was extra difficult and I had beat them like a rented
mule. Also, don't do on a Friday and almost always do a postop check the next day.
I offer A-PRF+ and just do it for free for immune-compromised, geriatric, unhealthy, smokers and PBS (poor biological specimens). Rarely are antibiotics required, but I live in Canada
and worry less about lawyers than our American partners. Since starting routine use of A-PRF+
I can't remember the last dry socket and very rarely get major infections, usually caught the next
day with routine follow-up and patients really, really appreciate the night time call to check and
the follow-up. Feel like they are being taken care off and not in a factory; surprisingly to me,
also helps me sleep at night. ■
3/4/2017

mosesj531
Member Since: 08/01/13
Post: 115 of 123

Interesting article, thanks for reposting it. I thought it was interesting to read through the
comments on the article to see what some MDs have to say about it. There seems to be only
one article that he cites a few times about the "New Antibiotic Mantra-Shorter is Better." I
would need to see more research to come to the conclusion that shorter is better and does not
promote resistance.
In terms of CYA and legality, it is funny that even on the ADA's website they have a disclosure at the bottom of every article about antibiotic resistance, prophylaxis, etc. ■
3/6/2017

JUNE 2017 // dentaltown.com

http://www.medscape.com/viewarticle/870145 http://www.dentaltown.com

Table of Contents for the Digital Edition of Dentaltown June 2017