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1st Year PG Department of Oral Medicine and Radiology
KMCT DENTAL COLLEGE ORAL MEDICINE AND RADIOLOGY
• • • • • Introduction Terminology History Classification General Considerations o Routes of administration o Choice of agent o Combined use o Problems with use o Prophylactic use o Failure Commonly used antibiotics in dentistry o Mechanism of action o Uses o Adverse Effects o Interactions o Contra-indications o Dosage and availability Recent Advances Misuse Conclusion References
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it would offer perhaps the greatest hopes for therapeutics“ Term 'antibiosis‘ coined by the French bacteriologist Jean Paul Vuillemin Antibiosis first described in 1877 in bacteria when Louis Pasteur and Robert Koch observed that an airborne bacillus could inhibit the growth of Bacillus anthracis Renamed ‘antibiotics’ by Selman Waksman. which selectively suppress the growth of or kill other microorganisms at very low concentrations. As a class.KMCT DENTAL COLLEGE ORAL MEDICINE AND RADIOLOGY Introduction to Antibiotics The magic word ‘Antibiotic’ inevitably springs to mind whenever an infection has to be dealt with. Their advent changed the outlook of the physician about the power drugs can have on diseases. The term "antibiotic" derived from anti and bios. in 1942 Synthetic antibiotic chemotherapy began in Germany with Paul Ehrlich in the late 1880s In 1928. "staff. He postulated the effect was mediated by an antibacterial compound named penicillin. The term "antibacterial" is derived from Greek anti . Chemotherapy: Treatment of systemic infections with specific drugs that selectively suppress the infecting microorganism without significantly affecting the host Antimicrobial Agent: Synthetic as well as naturally obtained drugs that attenuate microorganisms History of Antibiotics Milestones in History Louis Pasteur observed. and that its antibacterial properties could be exploited. He attempted to use a crude preparation to treat some infections. antibiotics are one of the most frequently used as well as misused drugs. Antibiotics are essential weapon against infection. "if we could intervene in the antagonism observed between some bacteria. an American microbiologist. "life". Antimicrobial drugs are the greatest contribution to 20th century of therapeutics . hence wise use of antibiotics requires the clinician to take the stance that positive indication must be present before antibiotic drugs are prescribed. . but unable to pursue its further development.‘Antibiotic era’. Terminologies Used Antibiotics: Substances produced by microorganisms."against” and baktēria. Alexander Fleming observed antibiosis against bacteria by a fungus of the genus Penicillium. cane".
Paul Ehrlich Modern Era of Antibiotics Domagk (1935) developed Prontosil for use in pyogenic infections. He developed two antibiotics. atoxyl for sleeping sickness and arsphenamine for syphilis. It came to be known as the first commercially available antibiotic.17th Century) Mouldy curd by Chinese on boils Chaulmoogra oil by Hindus in leprosy Chenopodium by Aztecs for intestinal worms Mercury by Paracelsus for syphilis Cinchona bark for fevers Chaulmoogra Chenopodium Phase of Dyes and Organometallic Compounds Paul Ehrlich (1890-1935) coined the term ‘chemotherapy’.KMCT DENTAL COLLEGE ORAL MEDICINE AND RADIOLOGY Period of Empirical Use (16th . Prontosil Domagk .
Clanthromycin. etc. Tyrothricin Nitrofurantoin. etc. Sodium fusidate. Ethambutol. Teicoplanin Linezolid Polymyxin-B. Clofazimine. Furazolidone Metronidazole. Aminoglycosides. Mebendazole. Amphotericin B. Diethyl carbamazine. etc.KMCT DENTAL COLLEGE ORAL MEDICINE AND RADIOLOGY Classification of Antibiotics Based on Chemical Structure: Sulfonamides Diaminopyridines Quinolones β-lactam Tetracyclines Nitrobenzene derivative Aminoglycosides Macrolide Lincosamide Glycopeptide Oxazolidinone Polypeptide Nitrofuran derivatives Nitroimidazoles Nicotinic acid derivatives Polyene Azote derivatives Others Sulfadiazine. Norfloxacin. Diloxanide. Pyrazinamide. Azithromycin Lincomycin. Chloroquine. Neomycin Erythromycin. Gentamycin. Amphotericin-B. Bacitracin. Amantadine. Sulfones (Dapsone) Trimethoprim. Niclosamide. Cephalosporins. Clindamycin Vancomycin. Griseofulvin. Cycloserine. Pyrimethamine Nalidixic Acid. Pyrantel. Griseofulvin Based on type of organisms against which primarily active: Antibacterial Antifungal Antiviral Antiprotozoal Anthelmintic Penicillins. Viomycin. Amikacin. Thiacetazone. Pyrimethamine. Carbapenems Oxytetracycline. Colistin. Hamycin Miconazole. Doxycycline Chloramphenicol Streptomycin. Clotrimazole. Tinidazole Isoniazid. Ketoconazole. . Erythromycin. Ethionamide Nystatin. etc. etc. Spectinomycin. Ketoconazole. Ciprofloxacin Penicillins. Acyclovir. Zidovudine. Monobactams. Metronidazole. Fluconazole Rifampin.
metabolism and excretion. Tyrothricin. sulfonamides. the infecting organism and the drug. Aminoglycosides. as given below. Polypeptides. Metronidazole. including its absorption. Ethambutol. Polyenes Choice of an Antibiotic Agent Choosing the right antibiotic depends on qualities of patient. b) Genetic Factors: o Primaquine. Chloramphenicol. Tetracyclines. Streptomycin. Cephalosporins. Nalidixic acid. Griseofulvin Polymyxin B. Tetracyclines. Bacitracin. Erythromycin Tetracyclines. Rifampin. Erythromycin. Macrolides. Linezolid Penicillins. Vancomycin. nitrofurantoin. Chloramphenicol.KMCT DENTAL COLLEGE ORAL MEDICINE AND RADIOLOGY Based on spectrum of activity: Narrow-spectrum Broad-spectrum Penicillin G. Clindamycin. Ciprofloxacin. Chloramphenicol Based on type of action: Primarily bacteriostatic Primarily bactericidal Sulfonamides. Cotrimoxazole Based on source obtained from: Fungi Bacteria Actinomycetes Penicillin. chloramphenicol and fluoroquinolones produce haemolysis in Glucose-6-Phosphate Dehydrogenase deficient patient c) Renal and Hepatic Function: o Cautious use and dose modification advised when the organ for disposal of the drug is defective/diseased . Aztreonam Aminoglycosides. Patient Factors a) Age: o The age of the patient affects kinetics of drugs. Colistin. Isoniazid. Pyrazinamide. Cephalosporin.
Carbenicillin. Nalidixic acid. Vancomycin. Clindamycin Erythromycin estolate. Isoniazid. it has to be avoided in that patient. Pefloxacin d) Local Factors: o Pus and secretions decrease the efficacy of sulfonamides and aminoglycosides o Necrotic material or foreign body makes eradication impossible o Haematomas foster bacterial growth o Lowering of pH at the site of infection reduces activity of macrolides and aminoglycosides o Anaerobic environment in the centre of an abscess impairs bacterial transport processes which concentrate aminoglycosides in the cell o Penetration barriers hamper the access to the site of infection o Some drugs like trimethoprim and fluoroquinolones attain high concentration due to ion trapping e) Drug Allergy: o If a drug has caused allergic reaction. Amphotericin B. o Infections by low grade pathogens and intracellular organisms occur if cell-mediated immunity is impaired. Nitrofurantoin (except doxycycline) Liver Disease Dose reduction Drugs to be avoided Chloramphenicol. a bacteriostatic AMA may achieve cure. Tetracyclines. Meropenem. fluoroquinolones. Talampicillin. . Nalidixic acid. Cephalosporins. Metronidazole. o β-lactams. Cotrimoxazole. Flucytosine Metronidazole. nitrofurantoin frequently cause allergy. Pyrazinamide. Aztreonam. sulfonamides. Rifampin. Ethambutol. Fluoroquinolones. o In a patient with normal host defense. Talampicillin. Tetracyclines. Clarithromycin. Imipenem Cephalothin. f) Impaired Host Defense: o Pyogenic infections are common in neutropenic patients.KMCT DENTAL COLLEGE ORAL MEDICINE AND RADIOLOGY Renal Failure Dose reduction in mild failure Dose reduction in moderate-severe failure Drugs to be avoided Aminoglycosides.
Penicillins. Most odontogenic infections (70%) are caused by a mixture of aerobic and anaerobic bacteria.teeth and bone deformities in the offspring d. hence treatment cannot be delayed. SO empirical therapy is usually carried out. but the potential benefits from use of the drug may be acceptable despite the potential risk Studies in animals or humans have demonstrated foetal abnormalities. well defined site and features of the infection enable organisms causing such infections to be reliably deduced. g) Pregnancy: a. but animal studies have failed to demonstrate a risk to the foetus amoxicillin or.KMCT DENTAL COLLEGE ORAL MEDICINE AND RADIOLOGY o But in an impaired host defense. it is not possible to obtain appropriate samples of infected material.acute yellow atrophy of liver. pancreatitis and kidney damage in the mother . many cephalosporins and erythromycin . and potential risk clearly outweighs possible benefit B C D X Organism-related Factors a) Initial Empirical Therapy: Identification of the microorganism and antimicrobial sensitivity testing are time consuming. b) Identification of Causative Organism: Type of bacteria (aerobic/anaerobic) and their specific identification is necessary for proper management of the condition. but potential benefit may warrant use of the drug in pregnant women despite potential risk There is evidence of human foetal risk. expensive & impractical. Aminoglycosides . Sometimes. intensive therapy with cidal drugs is recommended. Cellulitis type of . most dental infections are acute in nature. Furthermore. In addition. All AMAs should be avoided in the pregnant because of risk to the foetus b.foetal ear damage Risk Category of Drugs in Pregnancy Category A Description Adequate studies in pregnant women have failed to demonstrate a risk to the foetus Adequate human studies are lacking. but animal studies have shown an adverse effect on the foetus No adequate studies in pregnant women and animal studies are lacking or have shown an adverse effect on foetus. Adequate studies in pregnant women have failed to demonstrate a risk to the foetus.safe c. Well-circumscribed chronic non-advancing abscesses contain mostly anaerobic bacteria. Tetracyclines .
Serious infections require parenteral antibiotics. b) Type of Activity: Acute infections resolve faster with a cidal drug and reduces the number of bacteria at the site of infection. a bactericidal drug is preferred. lifethreatening infections. When the infection is contained longer & controlled. f) Route of Administration: Less severe infections warrant the use of oral antibiotic. glycopeptides and macrolides produce ‘time-dependent inhibition’ where the antimicrobial action depends on the length of time the concentration remains above MIC. a narrow-spectrum drug which selectively affects the concerned organism is preferred. if available. often a broad-spectrum drug has to be used to cover all likely pathogens.KMCT DENTAL COLLEGE ORAL MEDICINE AND RADIOLOGY lesions show exclusively aerobic bacteria. For empirical therapy. . g) Evidence of Clinical Efficacy: Relative value of different AMAs in treating an infection is decided on the basis of comparative clinical trials. c) Antibiotic Sensitivity for Causative Organism: Antibiotic therapy is initial / empirical or definitive. Abscesses may contain anaerobic bacteria. is the final guide for choice of the antibiotic. depending on whether the organism is identified precisely. For patients with impaired host defence. Drug Factors a) Spectrum of Activity: For definitive therapy. Optimum dosage regimens and duration of treatment are also determined on the basis of such trials. infections at less accessible sites (SABE) or when carrier state is possible (typhoid). only anaerobic flora is evident. c) Sensitivity of the Organism: On the basis of MIC values (if available) and consideration of postantibiotic effect d) Relative Toxicity: Less toxic antibiotic is preferred e) Pharmacokinetic Profile: Antibiotic has to be present at the site of infection in sufficient concentration for an adequate length of time. Reliable clinical trial data. Aminoglycosides and fluoroquinolones produce ‘concentration-dependent inhibition’. where the inhibitory effect depends on the ratio of peak concentration to the MIC. Drug which penetrates better and attains higher concentration at the site of infection is more effective. β-lactams.
To achieve synergism and enhance antimicrobial action To reduce severity or incidence of adverse effects To prevent emergence of resistance To broaden the spectrum of antimicrobial action for polymicrobial infections For empirical therapy of an infection in which the cause is unknown Prophylactic Use Antibiotic prophylaxis with dental procedures is reasonable only for patients with cardiac conditions associated with the highest risk of adverse outcomes from endocarditis.KMCT DENTAL COLLEGE ORAL MEDICINE AND RADIOLOGY h) Cost: Less expensive drugs are to be preferred Principles of Antibiotic Dosing for Orofacial Infections Employ high doses for a short duration Achieve blood levels of antibiotic at 2-8 times the MIC Use frequent dosing intervals Determine the duration of therapy by remission of disease Proper time intervals (four times the T½) Proper route of administration Penetration of drug Routes of Administration Antibiotic Combinations More than one AMAs are frequently used concurrently to treat infections. . iv. v. Objectives: i. ii. iii.
whether placed by surgery or catheter intervention. Antibiotic prophylaxis is NOT recommended for: Routine anesthetic injections through noninfected tissue Taking dental radiographs Placement of removable prosthodontic or orthodontic appliances Adjustment of orthodontic appliances Placement of orthodontic brackets Shedding of deciduous teeth Bleeding from trauma to the lips or oral mucosa . including those with palliative shunts and conduits Completely repaired congenital heart disease with prosthetic material or device. or perforation of the oral mucosa.KMCT DENTAL COLLEGE ORAL MEDICINE AND RADIOLOGY High Risk Patients: Prosthetic cardiac valve or prosthetic material used in valve repair Previous endocarditis Congenital heart disease only in the following categories: Unrepaired cyanotic congenital heart disease. during the first six months after the procedure Repaired congenital heart disease with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device Cardiac transplantation recipients with cardiac valvular disease Dental procedures for which prophylaxis is reasonable: All dental procedures that involve manipulation of gingival tissue or the periapical region of teeth.
or partial. Amphotericin B 2. Complication of IV administration that commonly arises is thrombophlebitis of the injected vein. E. Toxicity a) Local Irritancy: Toxicity that is exerted at the site of administration. tetracycline. Tetracyclines. Erythromycin Aminoglycosides. some Cephalosporins. Hypersensitivity Reactions that range from rashes to anaphylactic shock. cephalosporins. twoway. It occurs by mutation or gene transfer. Gastric irritation. fluoroquinolones. More common culprits include penicillins. to which the organism has not been exposed. It is generally a group or species characteristic. pain and abscess formation are evident. Cross Resistance: Acquisition of resistance to one AMA conferring resistance to another AMA. Practically all AMAs are capable of causing hypersensitivity. Vancomycin. or one-way. It may be complete.g. 3.KMCT DENTAL COLLEGE ORAL MEDICINE AND RADIOLOGY Problems associated with Antibiotic use 1. High Therapeutic Index Low Therapeutic Index Very Low Therapeutic Index Penicillins. sulfonamides. Acquired Resistance: Development of resistance by an organism (which was sensitive before) due to the use of an AMA over a period of time. that are unpredictable and unrelated to dose. Chloramphenicol Polymyxin B. chloramphenicol b) Systemic Toxicity: Dose related and predictable organ toxicities can also occur. Prevention: No indiscriminate and inadequate or unduly prolonged use – prefer symptom determined shorter courses Prefer rapidly acting and selective (narrow spectrum) AMAs . It can be of the following types: Natural Resistance: Microorganisms inherently lack the metabolic process or the target site which is affected by the particular drug. erythromycin. Drug Resistance It is the unresponsiveness of a microorganism to an AMA.
only when a specific one cannot be determined or is not suitable Use combination of AMAs for prolonged therapy Infection by organisms notorious for developing resistance treated intensively 4. Poor host defense v. Nutritional Deficiencies Some of the B complex group of vitamins and Vitamin K are synthesized by the intestinal flora.KMCT DENTAL COLLEGE ORAL MEDICINE AND RADIOLOGY Broad-spectrum drugs . but will manifest later in a severe form. Failure of Antibiotic Therapy Success of therapy measured either clinically in terms of improvement in symptoms/signs or microbiologically as eradication of the infecting organism. Other infection will be masked initially. Improper selection of drug. the diagnosis and therapy should be reviewed. When a real or apparent failure of the antimicrobial regimen occurs. dose. Masking of an infection Short course of an AMA may be sufficient to treat one infection but only briefly suppress another one contacted concurrently. 6. Infecting organism present behind barriers vi. Sites involved are those that normally harbor commensals. or there may be relapses. route or duration ii. It is commonly associated with the use of broad/extended-spectrum antibiotics. Causes of failure: i. To minimize superinfections: Use specific (narrow-spectrum) AMA Do not use antimicrobials to treat trivial. Failure to take necessary adjuvant measures iv. Treatment begun too late iii. Prolonged use of antimicrobials which alter this flora result in vitamin deficiencies. Presence of dormant or altered organisms which later give rise to a relapse . selflimiting or untreatable (viral) infections Do not unnecessarily prolong antimicrobial therapy 5. Antimicrobials may fail to cure an infection/fever. It is more common when the host defense is compromised. They are generally more difficult to treat. Superinfection Appearance of a new infection as a result of antimicrobial therapy. Trying to treat untreatable infections or other causes of fever vii.
Dental infections: periodontal abscess.6. PENICILLINS Classification: Natural penicillin Acid resistant penicillin Penicillinase resistant penicillin β lactamase inhibitors Penicillin active against pseudomonas Extended spectrum penicillins Penicillin G Penicillin V Methicillin Clavulanic acid Carboxy and ureidopenicillins Aminopenicillins: Ampicillin Carboxypenicillin: Carbenicillin Ureidopenicillin: Piperacillin a) Penicillin G Antibacterial Spectrum: Streptococci. Medicinal uses: Gonorrhoea. 2.5.: Procaine penicillin G inj.2.: Benzathine penicillin G: Benzyl pen 0.: Fortified procaine penicillin G inj.KMCT DENTAL COLLEGE ORAL MEDICINE AND RADIOLOGY Common Antibiotics in Dentistry 1.4 MU as dry powder in vial Contraindications: Allergies Poor renal function .5.1 MU inj. anthracis Mechanism of Action: Interfere with the synthesis of bacterial cell wall Adverse Effects: Local irritancy and direct toxicity Hypersensitivity reactions Super infections Jarisch-Herxhemier reactions Uses: i. actinomyces israeli.1 MU dry powders in vial 3+1 lac U vial Penidure LA 0. tetanus Preparations and Dose: Sodium penicillin G inj. pulpitis ii. syphilis. gonorrhoea. pneumococci. M. B. N. 1. periapical abscess. clostridia. spirochaetes. TB. 0.
AMPI-500. v. AMPILIN. septicemias Contraindications: Allergies Poor renal function Dosage: 0. coli. proteus. ii. influenzae Dosage: 250-500mg TDS given for 5 days .5-2g oral/I. typhoid fever Bacillary dysentery. iii. PENTIDS. shigella and many Gram positive organisms like cocci. Mechanism of Action: Interfere with the synthesis of bacterial cell wall Adverse Effects: Diarrhoea Rashes Drug Interactions: Oral contraceptives Uses: i. salmonella. AMPICILLIN c) Amoxicillin Similar to ampicillin in all aspects except: Oral absorption is better Incidence of diarrhea It is less active against Shigella and H. ALFACILLIN. Urinary tract infection Respiratory tract infection Meningitis. SODICILLIN b) Ampicillin Antibacterial Spectrum: E. iv.V every 6 hrs for adults 25-50 mg/kg/day for children Trade Names: AMPISYN.M/I.KMCT DENTAL COLLEGE ORAL MEDICINE AND RADIOLOGY Drug Interactions: Oral contraceptives Pregnancy category: B Trade Names: PENCIP. gonorrhoea SABE. bacilli etc.
General medical uses like meningitis. AMOXIPEN. including penicillinase producing staph. But it has less activity against strep. cefoperazone d) Fourth Generation: Examples are: Cefepime. increased activity against H. abdominal sepsis and septicemias Examples are: Cefpodoxime proxetil. most anaerobes and community acquired infections caused by E. Cefadroxil b) Second Generation: Show increased antibacterial activity Cefmandole has markedly increased activity. Cefactor. AUGMENTIN (Amoxicillin and clavulanic acid) d) Methicillin MRSA (methicillin resistant staph. aureus) are organisms resistant to methicillin. CEPHALOSPORINS Mechanism of Action: Interfere with the synthesis of bacterial cell wall Classification: a) First Generation: Effective against gram positive cocci. AMOXIL. typhoid etc . Proteus and klebsiella Examples are: Cefalexin.coli. multi resistant typhoid fever.KMCT DENTAL COLLEGE ORAL MEDICINE AND RADIOLOGY Uses: Choice of drug for prophylaxis of local wound infection as well as distant infection following dental surgery Trade Names: MOX. Drug of choice: vancomycin/linezolid. Ciprofloxacin can also be used 2. AMOX. cefpirome Dosage: 250-1000 mg q 6 h x 7-10 days Uses: i. complicated urinary tract infections. Dental infections ii.influenzae c) Third Generation: Ceftriaxone shows high efficacy in bacterial meningitis.
ducreyi Some spirochetes.prevent aminoacyl transfer RNA from entering the acceptor sites on the ribosome Uses: i.KMCT DENTAL COLLEGE ORAL MEDICINE AND RADIOLOGY Adverse Effects: Pain after I. H. actinomyces Mechanism of Action: Inhibit protein synthesis by binding to 30S ribosomes . dental caries. gonorrhoea and N. Periodontal ligament related diseases Adverse Effects: Irritative effects Liver damage Kidney damage Phototoxicity Teeth and bones: Enamel hyperplasty. Gingivitis iii. formation of calcium tetracycline crystals Antianaboilic effects Increased intracranial pressure Diabetes insipidus Vestibular toxicity Hypersensitivity Superinfection Dosage: 100 mg qd-bid x 7-14 days . mycoplasma. menigitidis Bacilli: Clostridia and anaerobic bacilli. brown discolouration. TETRACYCLINES Antibacterial Spectrum: Cocci: N. Orodental infections ii.M injection Diarrhoea Hypersensitivity reactions Nephrotoxicity Bleeding Neutropenia and thrombocytopenia Contraindications: Allergies Poor renal function Drug Interactions: Probenecid Pregnancy Category: B 3. inhibition of fibula growth.
Enteric fever H. ii. influenzae meningitis Anaerobic reactions Intraocular infections Adverse Effects: Bone marrow depression Hypersensitivity reactions Irritative effects Superinfections Gray baby syndrome Dosage: Daily dose not to exceed 2–3 g. rifampin enhance metabolism Antagonize the cidal action of β-lactams/aminoglycosides on certain bacteria Pregnancy category: D . phenytoin. influenzae. iii. duration of therapy to be < 2 weeks. chlorpropamide. total dose in a course < 28 g Contraindications: Pregnancy Drug Interactions: Inhibits metabolism of tolbutamide.KMCT DENTAL COLLEGE ORAL MEDICINE AND RADIOLOGY Contraindications: Food Pregnancy Drug Interactions: Anti-epileptics Pregnancy category: D 4. CHLORAMPHENICOL Antibacterial Spectrum: H. cyclophosphamide and phenytoin Phenobarbitone. warfarin. salmonella. klebsiella along with those sensitive to tetracycline Mechanism of Action: Inhibit protein synthesis binding to 50S subunit Uses: i. iv.
iv. AMINOGLYCOSIDES Antibacterial Spectrum: Gram negative bacilli. gram positive cocci. v. GENTYCIN.M injection Contraindications: Pregnancy (risk of foetal ototoxicity) Concurrent use of other ototoxic drugs. high ceiling diuretics. clostridia . GENTAMICIN 6.g. vancomycin Precautions: Patients past middle age Kidney damage Drug Interactions: Cautious use of muscle relaxants Trade Names: GENTACIL. yersinia pestis. iii. vi. ii.5-1 gm by I. H. e. amphotericin B.ducreyi. Tuberculosis Plaque Tularemia Brucellosis Enterococcal infections Subacute bacterial infections Adverse Effects: Ototoxicity Nephrotoxicity Neuromuscular blockade Allergy Superinfection Dosage: 0.g. Concurrent use of other nephrotoxic drugs. MACROLIDES Antibacterial Spectrum: Streptococcus. e. gonorrhea. enterococci Mechanism of Action: Inhibit protein synthesis Uses: i.KMCT DENTAL COLLEGE ORAL MEDICINE AND RADIOLOGY 5. staphylococcus. minocycline.
Orodental infections Drug of choice in acute necrotizing ulcerative gingivitis Periodontitis. like clostridium. periapical abscess. dryness of mouth. rashes. iv. nausea.4g/day). acute dysentery. tonsillitis. Dental infections: Periodontal. General medical uses: Pharyngitis. rheumatic fever Adverse Effects: Gastrointestinal problems Hypersensitivity Reversible hearing impairment Dosage: Erythromycin: 250-500 mg 6 hourly (max. spirochetes. peptococcus Mechanism of Action: Reduced intermediate interacts and breaks the bacterial or parasitic DNA Adverse Effects: Anorexia. anaerobic bacteria. v. liver abscess Drug of choice for intestinal giardiasis and trichomonas vaginitis . gingival cellulites ii. pericoronitis. brain abscess Drug of choice for all forms of anaerobic infections.KMCT DENTAL COLLEGE ORAL MEDICINE AND RADIOLOGY Mechanism of Action: Act by inhibiting protein synthesis by binding to the bind to the 23S rRNA of 50S ribosomal subunits Uses: i. metallic taste. necrotizing ulcerative gingivitis. ii. abdominal cramps Headache. giardia lamblia. and Glossitis (rare) Thrombophlebitis of the injected vein Uses: i. children 30-60-mg/kg/day Azithromycin: 500 mg once daily 1hr before or 2hrs after food for 3 days Precautions: Poor hepatic function Drug Interactions: Cytochrome P-450 Pregnancy category: B 7. METRONIDAZOLE Antibacterial Spectrum: Entamoeba histolytica. iii. acute apical infections.
FLAGYL Contraindications: Pregnancy Chronic alcoholism Precautions: Poor hepatic function Drug Interactions: EtOH Warfarin Li+ Pregnancy category: D 8. mycobacterium Mechanism of Action: Bind to A subunit of DNA gyrase with high affinity and interfere with strand cutting and resealing functions Adverse Effects: GIT: Nausea. headache. iv. CIP. bone and joint infections especially gram negative organisms Community acquired pneumonia Dosage: Ciprofloxacin 250-500 mg QD x 7-10 days Trade Names: BIOCIP. FLUOROQUINOLONES Antibacterial Spectrum: All organisms are susceptible except some strep. ii. anorexia CNS: Dizziness. vomiting. CIPLOX. bad taste. anxiety Skin/hypersensitivity Uses: i. iii. restlessness. CIPLO Contraindications: Children (damage of the cartilage in weight bearing joints) Pregnancy Drug Interactions: Probenacid Warfarin . anaerobic cocci. Urinary tract infections Gonorrhea Soft tissue.KMCT DENTAL COLLEGE ORAL MEDICINE AND RADIOLOGY Dosage: 200-400 mg TDS (15-30mg/kg/day) Trade Names: METROGYL.
stomatitis. enterobacter Mechanism of Action: Inhibit bacterial dihydrofolate reductase Uses: i. Tonsillitis. vomiting.KMCT DENTAL COLLEGE ORAL MEDICINE AND RADIOLOGY Pregnancy category: C 9. Pneumocystis carnii pneumonia in AIDS patients ii. klebsiella. orodental infections Adverse Effects: Methamoglobinemia Blood dyscarasis Nausea. headache and rashes Neonatal hemolysis Contraindications: Pregnancy . Urinary tract infections. CLOTRIMOXAZOLE Combination of trimethoprim and sulfamethoxazole (1:20) Antibacterial Spectrum: Same as sulfonamide but include salmonella typhi. sinusitis iii. Pharyngitis.
Ceftolozane/tazobactam: Antipseudomonal cephalosporin/β-lactamase inhibitor combination (cell wall synthesis inhibitor) Ceftazidime/avibactam: Antipseudomonal cephalosporin/β-lactamase inhibitor combination (cell wall synthesis inhibitor) Ceftaroline/avibactam: Anti-MRSA cephalosporin/ β-lactamase inhibitor combination (cell wall synthesis inhibitor) Plazomicin: Aminoglycoside (protein synthesis inhibitor) Eravacycline: A synthetic tetracycline derivative / protein synthesis inhibitor targeting the ribosome Brilacidin: Peptide defense protein mimetic (cell membrane disruption) Misuse in Dentistry Treatment of Nonresponsive Infections: Diseases caused by viruses are self-limited Therapy of Fever of Unknown Origin: Fever persisting for 2 or more weeks – only 1/4th are due to infections Require treatment with agents that are not used commonly for bacterial infections.KMCT DENTAL COLLEGE ORAL MEDICINE AND RADIOLOGY Newer Antibiotics i. vi. and removal of foreign body Misuse in Dentistry Improper Dosage: Dosing errors (wrong frequency of administration or use of either an excessive or a subtherapeutic dose) Excessive amounts can result in significant toxicities Too low a dose may result in treatment failure or resistance Lack of Adequate Bacteriological Information: Bacterial cultures and Gram stains of infected material Frequent use of drug combinations or drugs with the broadest spectra Agents are selected more likely by habit than for specific indications Dosages employed are routine rather than individualized . iv. iii. and prevent identification of the infectious pathogen Noninfectious causes Inappropriate Reliance on Chemotherapy Alone: Drainage. debridement. v. ii. surgical drainage or prolonged courses of pathogen-specific therapy May mask an underlying infection. delay the diagnosis.
virulence of the infection. There are so many confounding variables (such as suspected pathogen. 2007. iii. that it is not possible to make antibiotic therapy into a mechanistic technologic science. 11th Edition Pharmacology and Pharmacotherapeutics . ability to establish drainage. 1(1):20-25. the current health status of the host. mechanism of action of the antibiotic. and host defense mechanisms). 116: 1736-1754. Endocarditis. Satoskar Manoj Kumar Jain. Annals of Dental Specialty 2013. 6th Edition – K.KMCT DENTAL COLLEGE ORAL MEDICINE AND RADIOLOGY Conclusion Antibiotic therapy is an art and a science. Prevention of Infective Endocarditis: Guidelines From the American Heart Association.org/wiki/Antibacterial . Tripathi Goodman & Gilman’s The Pharmacological Basis of Therapeutics.medclik. ii. iv. by the Committee on Rheumatic Fever. pharmacokinetic properties of the drug. Antibiotics in Dentistry – An Art and Science. S. Sheetal Oswal K.com http://en. References i. and Kawasaki Disease. Online sources: http://www.R. v. The most important decision for the dental practitioner to make is not only which antibiotic to use but whether to use one at all. Circulation.wikipedia. D. Essentials of Medical Pharmacology.
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