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difficile infection may be a complication associated with amoxicillin and cephalosporins as well. Antifungal Agents Nystatin was formerly the most common antifungal agent used for oral candida infections but today the azole derivatives are preferred. These agents inhibit the synthesis of ergosterol, an essential component of the fungal cell membrane. Although a variety of agents are available, clotrimazole (Mycelex) troches are generally preferred based on cost and little risk for side effects and drug interactions. Clotrimazole can be

Adverse events, 54 Agitation, 67 Analgesics, 178 Antibiotic prophylaxis, 111 Antibiotics, 111 Anticoagulants, 72 Antifungals, 111 Antiplatelet drugs, 72 Articaine, 42 Benzodiazepine, 162 Children, 54, 60 Continuous veno-venous hemofiltration, 21 Cut nasotracheal tube, 11 Delayed recovery, 153 Delirium, 67 Dental anesthesia sonophoresis device, 37 Dental anxiety, 46 Dental Anxiety Scale, 46 Dental

interactions with certain antimicrobials that may be prescribed by the dentist. 1 Macrolide antibiotics such as erythromycin and azole antifungal agents such as ketoconazole should be avoided in patients taking any of the statins. These antimicrobials elevate the serum levels of statins, which increases their risk for myopathy and possible hepatotoxicity. Tetracycline preparations will be absorbed poorly in patients taking bile acid sequestrants. Antithrombotic Agents Antithrombotic drugs are prescribed extensively in medical practice

* Potential drug interactions must always be considered when managing anticoagulated patients, especially those using warfarin. The principal isomer of warfarin is metabolized by CYP2C9 microsomal enzymes. Drugs that inhibit this system should be avoided, including metronidazole, the macrolide antibiotics, and the azole antifungals such as ketoconazole. 22 , 23 Antibiotics having a wide spectrum may diminish gut flora responsible for vitamin K synthesis, and this reduction may further enhance the anticoagulant effect of warfarin. 23 Of those classes implicated, only the

into the vaginal tract. When infection occurs, the patient can obtain an over-the-counter antifungal, or the dentist may prescribe a course of fluconazole. Antibiotic-Associated Diarrhea The incidence of diarrhea attributed to those antibiotics commonly used in dentistry ranges from 2 to 10%, and may be as high as 25% with amoxicillin/clavulanic acid (Augmentin). 31 In general, diarrhea is related to an imbalance in the normal intestinal flora favoring opportunists. The use of probiotics to prevent or manage antibiotic

(Xanax) are substrates for CYP3A4, which provide their elimination. Drugs that inhibit these enzymes can elevate serum concentrations and prolong the elimination of these benzodiazepines. The risk for this potentiation is most significant with the HIV protease inhibitors and azole antifungals. Large amounts of grapefruit juice have also been implicated, but in amounts under 1 quart per day any influence is probably insignificant. 22 This interaction is not likely to influence the amount of sedative required to achieve satisfactory sedation but will most certainly