Professional Documents
Culture Documents
Antibiotics in Treatment of Oral Maxillofacial Infections
Antibiotics in Treatment of Oral Maxillofacial Infections
ORAL MAXILLOFACIAL
INFECTIONS
PRAVEENA
IV BDS
ROLL NO 38
CONTENTS
INTRODUCTION
HISTORY AND CLASSIFICATION
PRINCIPLES OF CHOOSING APPROPRIATE ANTIBIOTICS
PRINCIPLES OF ANTIBIOTIC ADMINSTRATION
SOME ANTIBIOTICS COMMONLY USED IN DENTISTRY
ANTIBIOTIC PROPHYLAXIS
INDICATIONS FOR USE OF ANTIBIOTICS IN DENTISTRY
CONCLUSION
INTRODUCTION
RATIONALE:-
Additive synergistic effect
Mixed infections
Delay n development of resistance
Decrease the incidence of adverse reactions to an individual drug
reduce the cost of therapy
INDICATIONS
• Penicillin G
• Penicillin VK
NATURAL
• Ampicillin
• Amoxicillin
SEMISYNTHETIC • Methicillin
• Oxacillin
PENICILLIN G( Benzyl penicillin )
• Narrow spectrum
• Primarily against gram +ve bacteria
• Acid labile
• T1/2 – 30 min
• Distributed extracellularly ,reaches most body fluids, but penetration in serous
cavities and CSF is poor.
• Preparations :- benzyl pen 0.5 -1 MU inj , procaine penicillin 0.5-1 MU dry powder
ADVERSE EFFECTS :-
Local irritation
Direct toxicity
Hypersensitivity
Superinfection
Jarisch herxiheimer reaction
DENTAL INDICATIONS
Periapical periodontal , pericoronal abscesses
ANUG
Oral cellulitis
Prophylactically to cover dental procedures in dental pts predisposed to SABE
PENICILLIN V
• Brand name :- CRYSTAPEN ,KAYPEN
• DOSAGE :- 125-250 mg tab ,125mg/5ml syr.
• Acid stable
• Plasma t1/2 :- 30-60 min
• Antibacterial spectrum :- identical to PnG
AMOXICILLIN
• Broader spectrum of action
• Active against gram +ve and –ve aerobic as well as anaerobic bacteria
• Most widely used in dentistry
• Dosage :- 0.25 -1 gm TDS oral /IM
• Brand name :- AMOXYLIN , NOVAMOX, AMOXIL, - 250,500mg caps
• First choice of drug for prophylaxis of local wound infection as well as distant
infection (endocarditis) following dental surgery .
• Safer antibiotic in lactating and pregnant women
BETA LACTAMASE INHIBITORS
• CLAVULINIC ACID :-
Contains a beta lactam ring but no antibiotic activity on its own
given in combination with amoxicillin
Used against β lactamase producing resistant staph.aureus
AMOXICILLIN + CLAVULANIC ACID – 500+ 125 mg TID ,5-7 days
( AUGMENTIN )- used in treatment of odontogenic infections
CEPHALOSPORINS
• They are similar to penicillins ,but more stable to may beta lactamases and so have a broader
spectrum of activity
• Bactericidal drugs
• USES :-
Dental infections
In penicillin/amoxicillin resistant infection
First gen :- popular for surgical prophylaxis
second gen :- cefuroxime , cefaclor – are only ones with good acivity against oral anaerobes
ADVERSE REACTIONS :-
Local reactions may occur
Allergic reactions
Nephrotoxicity , CNS toxicity , Blood tocicity
TETRACYCLINES
• MECHANIS OF ACTION - inhibit protein synthesis by binding to 30s
ribosomes
• ON THE BASIS OF CHRONOLOGY OF DEVELOPMENT :-
1ST GEN :- chlortetracycline, oxytetracycline
2nd GEN :- democycline, methacycline
3rd GEN :- doxycycline ; minocycline SEMISYNTHETIC
TIGECYCLINE newer tetracycline
Uses in dentistry
Drugs of first choice in :-
chronic periodontitis ( not recommended in acute conditions )
Doxycycline polymer gels --- periodontal pockets
Juvenile periodontitis
Refractory periodontitis
Desquamative gingivitis
Conjunction with surgical therapy
Preparations :-
• TERRAMYCIN : 250,500 mg ( oxytetracyclines ) t1/2 :- 6-10 hr
• TETRADOX,NOVADOX 100mg ( doxycylines ) t1/2 :- 16-24hr
• CYNOMYCIN 50- 100 mg ( minocyclines ) t1/2 :- 18- 24hr
ADVERSE EFFECTS
TEETH & BONE :-
• binds to ca deposited in newly bone or teeth
mid pregnancy – 5 months :- deciduous dentition
3 months – 5 yrs :- crowns of permanent anteriors
late pregnancy or childhood temporary suppression of bone growth
OTHERS :-
• Gastric irritation and local toxicity
• Liver & kidney damage
• Photosensitivity
• Vestibular reactions
• Hypersensitvity
• Superinfection
AMINOGLYCOSIDES
• NATURAL :- streptomycin , gentamycin , kanamycin , amikacin
• SEMISYNTHETIC :- neomycin , framycein
MECHANISM OF ACTION :- binds at several sites at 30s and 50s ribosomes
Effective against gram negative bacteria
Bactericidal
Uses :-
• Gentamycin 2mg/kg im /iv single dose to supplement amoxicillin /vancomycin in
endocarditid prophylaxis
• Hard & soft tissue trauma
• Orthognathic & reconstructive maxillofacial surgery
• Odontogenic infection
• Pericorinitis
• Osteomyelitis
SHARED TOXICITIES
OTOTOXICITY
NEPHROTOXIXITY
NEUROMUSCULAR BLOCKADE
MACROLIDES
• MACROCYCLIC RING WITH ATTACHED SUGARS
• Bacteriostatic
• Erythromycin, azithromycin , vanamycin, clarithromycin
• MECHANISM OF ACTION :- bind to 50s ribosomes and interfere with
translocation
FLOUROQUINOLONES
• BACTERICIDAL ,but not as potent as beta-lactams and aminoglycosides
• MECHANISM OF ACTION :- Inhibits bacterial DNA gyrase
• Active mainly against gram –ve
Uses
• Osteomyelitis
• ANUG
• Recurrent periodontitis
ADVERSE EFFECTS :-
GI symptoms :- nausea ,vomiting
hypersensitivity reaction
arrhythmias
LINCOSAMIDE
• CLINDAMYCIN
• Bacteriostatic effect
• Primarily active against anaerobes
• MECHANISM OF ACTION :- inhibit protein synthesis
• Preparations :- DALCAP , CLINCIN ( 300mg qid – 7 days )
• Second choice in patients allergic to pencillins
• High oral absorption , significant tissue penetration, stimulatory effects on host
immune system
METRONIDAZOLE
• Effective against anaerobic bacterial infections
• MECHANISM OF ACTION :- converted to highly reactive nitroradical form
by reduction of nitro group exerts cytotoxicity by damaging DNA
and other biomolecules .
USES :-
ANUG
Orodental infections
• PREAPARATIONS :- metrogyl, flagyl, aristogyl
• Orally :-400mg 8 hrly
• IV –inj 500mg/100ml
ADVERSE REACTIONS:-
GI symptoms
glossitis , dryness of mouth
unpleasant metallic taste
furry tongue
‘’disulfiram like reaction’’
ANTIBIOTIC PROPHYLAXIS
Infective endocarditis
Prosthetic joints
Neurosurgical shunts and implants
Prevention of local infection in surgical or operative sites
Prevention of generalized spread of infection in patients with compromised
immune systems
Prophylactic antibiotic regimen
INDICATIONS FOR USE OF
ANTIBIOTICS IN DENTISTRY
CONCLUSION
Antibiotic selection remains as much as an art as it is a science .
Although antibiotics do not prevent all post operative infections,
they can reduce the incidence significantly when administered correctly .
Future treatment strategies will not only include aggressive use of traditional
management methods but also understanding normal immune system and
associated defects, new antimicrobials .
ultimately, we should provide a shorter course of treatment and
improved outcomes for our patients.
THANK YOU