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For dentists
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As we all know we don’t have enough info about medications to use in our field coz
we just take pharma in 2nd year and not take applied info about how to use it
And I hope from this article to help us solving that problem .I will give few guideline
about how to use antibiotic and analgesic according to needed plus some trade
names for the most widely used medication in dental field (note the following info
not from my own search but its is from course that I took few months ago in Alrazy
center for science and development on the hand of specialist pharmacology
professor
First I will start with antibiotic and its different types acc.to mode of
action
Quinolone
3-course of antibiotic should be continue for 5 to 7 days even if the sign of infection
has been resolved with exceptions in cases of macrolides which the course should
only be from 3 to 5 days and not ever exceed it
4-dose of antibiotic should be considered acc to the type of antibiotic dose for
example
5-dose should be adjusted in patient with liver disease and renal disease and switch
between drugs that not excreated by the diseased organ is much better
7-antibiotic injection should be used on cases of sever infection as its fase action over
oral antibiotic but with an precautions and allaerg test should be done even the
injection is IV or IM
9-its preferred to write medications as general in few times daily to ensure patient
wil take them for example single dose or twice daily better than 4 times daily and
the patient will not miss a dose
10-antibiotics begin to work in 1 to 3 days but after that time pass and no result
appear u should switch to another antibiotic
11-antibiotic dose for children should be calculated acc to the equotion by the age or
by the weight
And finally to ensure good result u should avoid as long as possible the widely used
un prescriped medications that unwisely taken by patient as bacteria may be
resistant
We will start with short list of trade name of the 1st generations of cephalosporine
that is widely used in dental field
2-duricef 250,500mg cap & 1gm tab and 125,250,500mg susp and 100mg drops
3-biodroxil 500mg cap& 1gm tab and 250,500mg susp
4-velosef 250,500 mg cap &1gm tab and125, 250mg susp and 250,500mg ,1gm vial
Part 2:
It has some effect on g +ve aerobic bacteria ex streptococcus but some bacteria ex
staph. aures synthesis Beta-lactamase enzyme and can resist certain types of
penicillin
1-penicillin V oral sensitive penicillin and bacteria can resist it so it may be used as
prophylactic ex ospen 1000,1500IU and 400IU susp dose 1000IU /8hrs
Note patient on long acting penicillin still need antibiotic coverage in cases of
infection as penicillin G is weak and bacteria can resist it
IU = international unit
3-ampicillin
examples
4-amoxicillin
examples
Note due to resistant of bacteria to ampicillin and amoxicillin its used become
mainly as prophylactic before extraction in patient with heart problem to avoid
bacterial endocartditis
5-compination penicillin
a-(amoxicillin+flucloxacillin) ex
c-(ampicillin+dicloxacillin)ex
1gm/12hrs or 500mg/8hrs but in cases of staph infection which can resist ampicillin
and amoxicillin we can use the combined penicillin in modified dose of 1gm/8hrs to
avoid the destruction of half of combined penicillin by the staph bacteria
Beta lactamase inhibitor ensure complete effect against bacterial resistance (staph)
also increase effect on anaerobic bacteria
this type have very potent effect and also its expensive
b-(ampicillin + sulbactam )
Notes
augmentin and its group is know to produce cholestasis ( jaundice – nausea –itching
) in healthy patient after 2 weeks of use so it is completely contraindicated in patient
with liver disease and used in caution with pregnant after consulting with physician
penicillin is as general safe to use with pregnant ,lactating women and children
part 3 :
there is 4 types of cephalosporine generation but the most widely used in dental
field is the 1st and 3rd generation
a-first generation has same effect like penicillin and widely used
examples of 1st generation antibiotic are previously mention in part 1 of this topic
b-third generation has great effect against -ve bacteria and some effect against +ve
bacteria , there is main four subtypes of 3rd generation
1-cefotaxime ex :
2-cefoperazone
3-ceftazidime
Fortum 250,500mg,1gm vial ( IM vial form contain L.A , IV vial form without
L.A )
4-ceftriaxone
Ceftriaxone 250,500mg,1gm vial ( IM vial form contain L.A , IV vial form without
L.A )
Cefaxone 250,500mg,1gm vial
Cephalosporine is generally safe to use even with neonate, also safe in pregnancy
and lactation (put in mind previous precaution concerning pregnancy) ,most safe
cefadroxil
a-clindamycin
b-lincomycin
note clindamycin can be used as prophylactit antibiotic in dose of 600 mg one hour
before treatment for adult
lincosamide is excreated through liver and so it can be used in cases of reanal
failure also can be used in case of patient is allergic to penicillin and cephalosporine
Not more widely used because its side effect specially concerning teeth discoloration
if taken during pregnancy and in children up to age of 8 to 12yrs and so it is
contraindicated in those previous cases
doxymycin 100mg
vibramycin 100mg
c-tetracycline used as mouth bath in cases of aphthous ulcer also some dentist use
it as topical antibiotic in irrigation solution in RCT
a-azithromycin ex:
note azithromycin can be used as prophylactic antibiotic in dose of 500mg one hour
before treatment for adult
adult dose 500mg /24hr (once daily) one hour before eating or 2hours after eating
as it is affected by food for 3 to 5 days not more than that
note It can be used for 7 days for severe infection in some cases that not related to
c-clarithromycin ex:
-both of azithromycin ,erythromycin and spiramycin are excreated from liver but
clarithromycin is excreated from kidnay
- data present are not enough to be sure if it is completely safe during pregnancy
and lactation so it is wisely to avoid it as possible at least in infection related to
dental field
When you prescribe macrolide you should put in your mind the following
interaction with other medications
Not widely used in dental field ,most of it use in renal and pulmonary infection
It shouldn’t be used under age of 18 yrs old as it may cause cartilage defects also
shouldn’t be used beyond age of 60yrs old
1- Second generaion
adult dose from 250mg up to 750mg per day used twice daily ex:
2-third generation
Adult dose from 400 to 500mg per day used once daily ex:
They previous mentioned types of quinolone are manily excreated from kidnay
It use limited only in treatment of TB infection also it have some antiviral effect
It is always called drug of tuberculosis and also can be used as moth bath in cases
of herps simplex due to its antiviral effect but as second choice as it is preferred to
limit its use to TB infection only
2-tinidazole
3-secnidazole
3-secnidazole most safe and less metallic taste (not widely used in dental field )
also shouldnt be taken with anti-acid as it may affect its absorption from GIT
How to write the prescription ?
tablets = tabs.
syrup= syrp.
suspention = susp.
capsules = caps.
suppositories = sup.
ampules = amp.
vial = vial
ointment = oint.
gel = gel
drops=dp.
Gargle=gargle
sachets =sach.
effervescent =eff.
Ex –by write the dose :-three time daily or cap every 8hrs (most known )
Ex
6-in case of prescriping injection s we should write the No. of inject and also you
should ask for sensitivity test specially before IV injection
Ex
Note : the all four parts of this topic contain most of the widely used antibiotic in
dental field , and so there are plenty of antibiotic that not mention here (not related
to dental field )
All the previously mention drugs are in the market but some concentration is not
widely handed so you better check the present form of drugs in the nearest
pharmacy
You can also search for the different concentration of drugs from the website
part 5 :
-Anti-edematous drugs
Used in cases of swelling either from infection or after minor surgery to decrease
swelling also have anti-inflammatory effect and also increase effect of antibiotics
Ex
sensitivity against this drug has been reported in some patient so it is better to ask
for sensitivity test if you prescribe it
alphintern tab dose 3 times daily on empty stomach (1hr before meal )
reparil gel –N gel topical use not widely used in dental field
-Anti-viral drugs ( mode of action by inhibiting viral replication ex acyclovir)
Ex
acyclovir 200,400,800mg tab & 100,250,500mg amp & skin cream &eye cream
zovirax 200,400mg tab & syrup for children & vial & skin cream &eye cream
(it is very expensive and mainly the only form prescriped is the syrup form for
children )
-Anti-fungal drugs
Fungistatin oral-drops
a-miconazole
note the previous drugs also supplied in cream form which used topically only on
skin also may be supplied with hydrocortisone like daktacort and miconaz –H
dose of systemic antifungal about one tab once in a week for two weeks or
one tab daily for two days only in a week for two weeks
-Anti-hemorrhagic drugs
Children dose : 2 to 5 mg
Note that it can be given IV but slow infusion but not preferred as it may cause
complications
In patient with liver disease it should be taken from about 30 to 60minute before
extraction and put in mind that even with vit.K amp patient with liver disease may
still bleeding so you may need to ask the patient to make INR,CBC,bleeing
time,clotting time,before extraction
Vitamin K cant be used topically coz some dentist may crush amp in cotton and
applied it topically and that is completely unuseful
Ex : A-ethamsylate
The ampoule may be crushed in gauze or cotton and applied in the socket after
extraction
In minor surgery it may used 500 mg as loading dose and continue 250 mg every 6
hrs till bleeding stop also it may be used as prophylactic 2 amp 2hrs before surgery
The ampoule may be crushed in gauze or cotton and applied in the socket after
extraction
Dose acc. to case prophylactic 2 amp IM 2hrs before extraction or for treatment of
bleeding 2 amp IM them 250to 500 mg every 6hrs
We can also use local anaethesia with epi. as v.c on cotton to decrease bleeding from
small vessels
ex:
Rutin –C caps
Ruta–C 60 tab
Rutalex-C tab