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6  beta lactum drugs dental

6 beta lactum drugs dental




Third Year



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    6  beta lactum drugs dental 6 beta lactum drugs dental Presentation Transcript

    • Beta lactam antibiotics
    • β LACTAM ANTIBIOTICS Have a β-lactam ring in their structure •Penicillins •Cephalosporins •Carbapenems •Monobactams all are bactericidal
    • PENICILLINS Mechanism of Action • Bind to penicillin binding proteins on the cytoplasmic membrane and Inhibit the enzyme transpeptidase that is essential for the bacterial cell wall rigidity. • This results in the formation of bacteria with weak cell wall & undergo lysis. Mechanism of Resistance: • Beta lactamase (penicillinase) enzyme produced by the bacteria inactivate penicillins (most common cause)
    • PENICILLINS A. Narrow Spectrum Penicillins Penicillinase sensitive (Natural Penicillins) • Benzyl penicillin (Penicillin-G ) • Benzathine penicillin • Penicillin V (oral) Penicillinase Resistant (Antistaphylococcal penicillins) • Methicillin • Nafcillin • Cloxacillin B. Extended Spectrum Penicillins Penicillinase sensitive  Aminopenicillins • Ampicillin, • Amoxycillin,  Antipseudomonial penicillins • Ticarcillin • Pipercillin
    • ANTIMICROBIAL SPECTRUM & USES BENZYLPENICLLIN (Penicillin G): • Infections caused by Streptococcus pyogenes (pharyngitis, otitis media, oral infections) Streptococcus pneumoniae (pneumonia) • Enterococcus ( bacterial endocarditis) –synergistic when combined with gentamicin • Actinomycetes israelii ( Actinomycosis) Bacillus anthracis (Anthrax) • Clostridium tetani, (tetanus) Cl. Perfringes ( Gas gangrene), Bacteroides oropharyngeal strains, Treponema pallidum (syphillis)
    • BENZATHINE PENICILLIN • Prophylaxis against reinfection with β haemolytic streptococcal pharyngitis (Rheumatic fever) PENICILLIN V • Used in Oropharyngeal infections CLOXACILLIN, NAFCILLIN (Antistaphylococcal ) • Used in Staphylococcal infections like osteomyelitis, septicaemia, endocarditis • Dental uses : Endodontic infections, Periodontitis, Gingivitis, Odontogenic infections, Periodontal abscess, Acute necrotizing ulcerative gingivitis.
    • EXTENDED SPECTRUM PENICILLINS AMOXYCILLIN & AMPICILLIN • Amoxycillin is better absorbed orally and food does not interfere with its absorption. • Diarrhea & rash is more common with ampicillin and rare with amoxycillin • Ampicillin ( four times daily) Amoxicillin ( thrice daily) • Their antibacterial activity is enhanced if used in combination with beta lactamase inhibitors USES • H influenzae (pneumonia, otitis media, sinusitis) • E. coli (UTI) • Enterococcal infections • Oropharyngeal infections • Helicobacter pyroli eradication in peptic ulcer.
    • Antipseudomonal penicillins • TICARCILLIN & PIPERACILLIN • Pseudomonal infections it is combined with Clavulanic acid Adverse effects of Penicillins Hypersensitivity reaction • Mild urticarial skin rash to a serious anaphylactic shock ( severe hypotension, bronchospasm & laryngeal edema) Maculopapular rash - Ampicillin Diarrhea , pseudomembranous colitis- Ampicillin Interstitial Nephritis : Methicillin
    • BETA LACTAMASE INHIBITORS • β lactamase inhibitors are drugs that inhibit β-lactamases - enzymes produced by bacteria that inactivate the β-lactam antibiotics. • Drugs are Clavulanic acid, Sulbactam • Clavulanic acid is combined with Amoxycillin • Sulbactam is combined with Ampicillin Uses: • Effective against β lactamase producing bacteria eg Strep. Pneumoniae , H influenzae (otitis media, sinusitis, orofacial infections) • Neisseria gonorrhoeae (gonorrhoea) • Anaerobes ( Intra abdominal abscess)
    • CEPHALOSPORINS I Generation – Active against Gm+ve,(staphylo & streptococci) but a moderate effect on Gm-ve bacteria ( klebsiella & E coli) . • Cephalexin, Cefadroxil II Generation- Resistant to beta-lactamase, active against almost all Gm-ve bacilli— • Cefaclor , Cefprozil III Generation- More active than either of two generations against certain Gm-ve bacteria- • Ceftibuten and Cefixime IV Generation - More resistant to some beta-lactamase producing species. • Cefepime
    • Therapeutic uses of Cephalosporins I Generation Cephalosporins : • Infections caused by G +ve cocci such as, Staphyl aureus, strepto pneumoniae, strepto pyogenes, Anaerobic streptococci. II Generation Cephalosporins: • Strepto pneumoniae, strepto pyogenes, Neisseria gonorrhoeae, E coli, H influenzae, Klebsiella pneumoniae. Infections caused by anaerobes Bacteroides fragilis & H influenza III Generation Cephalosporins : • Neiseria gonorrhoeae, E coli, Salmonella, H influenzae, Proteus & Pseudomonas aeruginosa, penicillin resistant pneumococci
    • Adverse effects of Cephalosporins • Hypersensitivity reactions – Less compared to Penicillins • Superinfection: • Pseudomembranous enterocolitis • Diarrhoea • Hypoprothrombinemia (Bleeding)
    • Carbapenems Imipenem &Meropenem • Effective against Gm+ve, Gm-ve including pseudomonas, anaerobes & β lactamase producing organisms. Uses • Mixed aerobic & anaerobic infections • Penicillin resistant pneumococci • Enterobacter infections • Pseudomonal infections Adv effects • Vomiting, diarrhoea, Seizures
    • Monobactams Eg: Aztreonam • Resistant to β-lactamases & active against pseudomonas • No activity against G+ve or anaerobes. • Uses: • Patients allergic to penicillins • Pseudomonal and other Gm-ve infections .