 Antiinfetive agents

 Antimicrobial agents
 Antibacterial agents
 Antibiotic agents

 Bactericidal
 Bacteriostatic

 Blood serum level

 Infection
 Minimal lnhibitory Concentation (MIC)
 Spectrum

 Superinfection
 Suprainfection
 Synergism

 Antagonism


 Antiinfective agents play important role in dentistry

because infection, after pain management, is the
dental problem for which drugs are most often
 Dental infection can be divided into several types as
Caries, Localized and systemic dental

Periodontal disease In adult patient.Caries Cariers produced by Streptococcus mutans. is the first imporant dental infection of the newly erupting teeth of the young patient. the dental health care team’s biggest dental problem is peri0dontal disease .

For more localized dental infections. .Localized dental infections Most localized dental infections are extensions that arise from either periodontic or endodontic related sources. if adequate drainage can be obtain. antiinfective agents are not indicated unless he patient is immunocompromised.

and tachycardia.SYSTEMIC INFECTIONS  Systemic infection can identified because they produce systemic symptoms such as fever. . malaise.

PERIODONTAL MICROBES  Aggregatebacter actinomycetes comitans  Porphyromonas ginggivalis  Prevotella intermedia  Elkenella corrodens  Fusobacterium spp.  Campylobacter rectus (Wolinella recta) .

Conditions and drugs that decrease resistence to infection  Addison’s disease  AIDS-related complex  HIV  Alcoholis  Blood discrasias  Cancer  Cirrhosis of the liver .Diseases.

CLASSIFICATION OF ANTIINFECTIVE AGENTS BACTERICIDAL OR BACTERIOSTATIC  BACTERICIDAL Aminoglycosides Bacitracin Cephalosporins Metronidazole Macrolides Penicillin Polymyxin BACTERIOSTATIC Chloramphenicol Clindamycin Macrolides Spectinomycin Sulphonamide Tetracyclines Trimethoprim .

when this defence lacking the need for antimicrobial agents is more pressing -Infection Invasiveness. spreading.Patient Defence mechanism. tendency of infection  Prophylactic Indications .INDICATIONS FOR ANTIBMICROBIAL AGENTS  Therapeutic Indications Several factor that must be decided: . severity. acuteness.

ANTIMICROBIAL USE IN DENTISTRY INFECTION D.O.C PERIODONTAL DISEASE Acute Necrotizing Ulcerative ginggivitist Penicillin VK Amoxillin Abscess (perio) Penicillin VK IJP Doxycycline Adult periodontitist RAP Not need drug Doxycycline ALTERNATIVE Metronidazole Tetracycline Tetracycline Amoxicillin + Metroidazole Augmentin + Clavulanate Clindamycin Amoxicillin+Metron .

post surgical pericoronitis)  Osteomyelitis .ORAL INFECTION  Soft tissue infection  Abscess (cellulitis.

MIXED INFECTION INTENSIVE TO PENICILLIN  Aerobes  Anaerobes and chronic infection PROPHYLAXIS FOR INFECTIVE ENDOCARDITIS  Prosthetic heart valve  Patent with LJP .

Presence of heart valve prosthesis .PROPHYLACTIC INDICATIONS  Before a dental procedure (recomended) by the American Heart Association and American Dental Association: .Congenital heart disease .History of infective endocarditis .

Oral anticoagulant .GENERAL ADVERSE REACTIONS AND DISADVENTAGES  Superinfection/ Suprainfection  Allergic Reaction  Drug Interaction .Oral contraceptive .Other antiinfective .

. The wider spectrum and the longer administrating the agent the greater chance of superinfection occuring.SUPERINFECTION(SUPRAINFECTION) All antiinfective agents can produce an overgrowth of an organism that is different from the original infecting organism and resistant to the agent beiing used.

 Penicillin and Cephalosporine are more allergenic than other agents. . Many antiinfective agents. such as erythromycin and clindamycin have a low allergenic potential.ALLERGIC REACTIONS  All antiinfective agents have the potential to produce a variety of allergic reactions.

. so interfering with vit K could increase the anticoagulant effect. Antiinfective agents reduce the bacterial flora that produce vit K.DRUG INTERACTIONS Oral contracepties Antibiotics decrease oral contraceptive efficacy by increasing their clearance from the body. Oral anticoagulants Oral anticoagulants are vitamin K inhibitor.

. Pregnancy The antimicrobial agents that can give during pregnancy to treat infections are limited.Gastrointestinal Complaints The most serious gastrointestinal complain of any of the antibiotics i.e erythromycin which linked with clindamycin.

but before any antibiotics are used in the pregnant dental patient. the patient’s obstetrician should be contacted. . have not associated with teratogenicity and are often used. The use of clindamycin probably also acceptable.ERYTROMYCIN Erythromycin.

.Metronidazole and tetracyclines are contraindicated during pregnancy because of their effect on developing teeth and skeleton. Children dose form.  Dose Form Adult dose form of antibiotics are commonly tablets and capsules. contain sugar as their sweetening agent. including liquid and chewable antiabiotic dose form.

. Long term administration of antibiotics could increase the child’s caries rate. especially in the pits. Chewable can stick to the teeth. After the use of these agent sensititation has erupted the dental health care worker should encourage the parent or child to brush the child’s teeth after the use of these agents.

then poor result are likely. . If the perfect antibiotic is chosen and prescibed but the patient does not purchase the medication because it is too expensive. The best inexpensive antibiotic that can be taken will be more effective than an expensive one that cannot be purchased.Cost  Cost is an important factor in choosing an antibiotic for a patient.

Penicillinase-resistant penicillin (Ampicillin) 3. Extended-spectrum penicillins(Carbenicillin) In dentistry. Third group (Amoxicillin) 4. the first and the third groups are commonly used. .PENICILLIN Divided in four major group: 1. Penicilin G and V 2.

 Disadvantages of using oral rather than parenteral route are that the blood levels rise slower.PHARMACOKINETICS  ROA : p.o.e. . and p. and some penicillin are degraded by gastric acid. the blod levels are less predictable because of variable absorption or lack of patient compliance (biggest problem).

. Penicillin taken 1 or 2 hours after meals. with the exception of CSF. and abscess. but penicillin V and amoxillin can be taken without regard to meals.  Penicillin cross the placenta and appears in breast milk. bone.  Distribution : Penicillin is distributed throught out the body.

PENICILLINS  Source and Chemistry  Pharmacokinetics  Mechanism of Action  Spectrum  Resistance  Adverse Reaction  Toxicity  Allergiy and Hypersensitivity .

MACROLIDES  Erythromycin  Azithromycin  Clarithromycin They are bacteriostatic Spectrum : Against Bordetella. Legionella and Actinomyces. Mycoplasma p. . Entamoeba histolytica Chlamydia sp and Diphteria.

ERYTHROMYCIN ROA : Po and pe (i. digoxin. warfarin. Drug Interaction: Theophyllin. carbamazepine and cephalosporine .diarrhea and abdominal cramp then other i. nausea. vomitus.v and i.m) Adverertse Reaction: Stomatitis.e cholestatic jaundice. triazolam.

. implicated in many dental infections.USES  As alternative therapy for patient with Penicillin allergy and it is not effective against anaerobic Bacteiodes sp.

digoxin and triazolam but does not effect either warfarin or theophyllin. . Drug interaction with some drugs by reduction metabolism : astemizole. loratadine.Azithromycin And Clarythromycin They are bacteriostatic and indicated as alternative antibiotics in the treatment of common orofacial infections caused by azithromycin and clarythromycin as compared to erythromycin. carbamazepine.

carbamazepine. digoxin omeprazole and astemizole.CLARYTHROMYCIN  Increases the level of drugs metabolized in liver such as theophyllin. .

TETRACYCLINE  Bacteriostatic  Pharmacokinetic  Spectrum  Adverse Rection: GIT. vomitus. diarrhea. diarrheal patient could occurs entteritis. . even candidiasis. xerostomia. stomatitis. glossitis. On. Nauesa. moniliasis.

 Pseudomembranous colitis (Cl difficile)  Effect on teeth and bones  Hepatotoxic  Nephrotoxic  Hematologic effect  Super infection  Photo sensitivity  Allergy  Drug interaction .

.Sulfonylurea .Digoxin. lithium and theophyllin DOXYCYCLINE reduced its action by barbiturat and phenytoin.Enhanced effect of other drugs: .

 USES : Tentracycline as drug of choice or alternative drug for dental infection and often used for periodontal conditions. .

a Distribution throughout body exc : CSF Spectrum : Gram positive and some Gram negative. . Pharmacokinetics : r. Effective against Gram positive and     anaerobic Bacteriodes sp.CLINDAMYCIN  Bacteriostatic. Allergy.o. Adverse Reaction : Git (PMC) possible. super infection.

Renal toxic.  Uses.  Bactericidal. .  For anaerobic bacteria.o.  Medical. CNS (Central Nerve System).METRONIDAZOLE  Antiparasit.  Pharmacokinetics: p. Oral effect  Drugs interaction.  Adverse Reaction : GIT (Gastro Intestinal Tract).

DENTAL  Because of its anaerobic efficacy. .metronidazole is useful in the treatment of many periodontal infection.

CEPHALOSPORINE  Structurally related to penicillin.O. Nephrotoxicity.  Active for Gram positive and Gram negative bacteria. Local Reaction and allergy. Super infection. .  ROA : P. IV.. I.M.  Adverse Effect : GIT.  MOA : Inhibit cell wall synthesis of bacteria.

 Alternative drug when other agents cannot be used. .USES  Their dental use includes prophylaxis for patients with “risk” joints who are undergoing dental procedures likely to produce bleeding.

. the mixed stage (Penicillin qdd for 5-7 days).  Stage 2 Mixed infection (aerobes and anaerobes).RATIONAL USE OF ANTIINFECTIVE AGENTS IN DENTISTRY  There are 3 stage  Stage 1 : Primary Gram positive. (Clindamycin.  Stage 3 Exclusively anaerobes. metronnidazole and Penicillin).

. PharmD. BS al .Referensi Elene Bablenis Heveles.