Analgesics and Antibiotics

1. 1
NAVODAYA DENTAL COLLEGE
DEPARTMENT OF PEDODONTICS
STAFF NAME – Dr NAVEEN KUMAR
Professor
TOPIC NAME –ANTIBIOTICS AND ANALGESICS IN
PEDIATRICDENTISTRY

2. Definitions
• Antimicrobials: Are substances that kill or suppress the growth or
multiplication of microorganisms, either bacteria, viruses, fungi, or
parasites.
• Antibiotics: These are substances produced by microorganisms or by
synthetic chemical methods, which selectively suppress the growth of
or kill other microorganisms (bacteria) at very low concentrations.
• Chemotherapy: is a treatment of the disease process by the use of a
chemical agent.
• Antibiosis: is the inhibition of growth of one organism by another.
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3. Bactericidal vs bacteriostatic antibiotics
 Bactericidal: actually kill the microorganisms.
Penicillins
Cephalosporins
Ciprofloxacin
Metronidazole
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Vancomycin
Aminoglycosides
Quinolones
Nalidixic acid

4.  Bacteriostatic: inhibits bacterial growth or multiplication, and depend on
the normal host defense mechanisms (immune system) to eliminate the
microorganism.
Macrolides
Tetracyclines
Chloramphenicol
Sulfonamides
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Linezolid
Erythromycin
Clindamycin
Ethambutol

5. Selection of antibiotics
Various factors should be considered:
• Age of the patient.
• Host defence status: if impaired, more powerful antibiotics or higher doses of them
are needed.
• Site of infection: prime factor that guides the choice of drug and its route of
administration.
• Renal and hepatic function: impairment of kidney and liver functions means higher
plasma level and more toxicity.
• Allergy: previous exposure to the antibiotics can result in allergy. If allergy is known,
such antibiotics should be avoided and an alternative is used.
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6. Physiologic difference will alter the drug
dosage
Gastro-intestinal system:
• As drugs are absorbed and metabolized by the gut, these changes
must be considered when administering medications to children.
• Low acidity in infant’s gut favors absorption of weakly acidic drugs.
Eg: penicillins and cephalosporins.
And delay the abosorption of weakly basic drugs.
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7. Hepatic system:
• Many drugs are metabolized by liver.
• Hepatic enzymes may act to detoxify a drug or
alter it into a more potent metabolite.
• Children are relatively deficient in these enzymes.
• They are high risk of toxicity if not dosed correctly.
Renal system:
• Although drugs can be excreted by a number of
physiologic roots.
• Eg: sweat, bile and feces while vast majority
undergo renal excretion 7

8. Calculation of Pediatric dose:
Drug dose used in children varies from adults, primarily with respect to age,
metabolic activity, body surface area and excretory capacity of the child.
• Appropriate dose of the drug can be calculated by the following formulae:
• Clark’s rule:
• Weight in pounds*adult dose /150
• Dubois formula:
• Child dose= Child’s BSA(m2)/1.7 * average adult dose.
• Young’s rule:
• Child dose = age/age+12*adult dose.
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9. PENICILLIN G (Naturally occurring)
Also called as benzyl penicillin.
• Penicillin G is the first drug of choice for the odontogenic infections.
• Effective against gram positive organisms and
selective gram negative bacteria.
• Poorly absorbed orally.
• Penicillin G rapidly destroyed by penicillinase producing
organisms.
• Dosage :15-350mg/kg/day or 20,000-500,000 IU/kg/day; 9

10. • Adverse reactions :
• Hypersensitivity: rash, itching, urticarial and fever.
• Anaphylaxis is rare but may be fatal.
• Wheezing, serum sickness, angioneurotic edema, exfoliative
dermatitis.
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11. • Amoxicillin:
• Semi-synthetic penicillin.
• Broad spectrum anti microbial activity.
• Commonly used antibiotic for odontogenic infections.
• Dosage: Adult- 250-500 mg every 8 hourly.
• Children- 20-40 mg/kg/day (in divided doses every 8 hours).
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12. • Amoxicillin + clavulanic acid:
- Synergistic effect.
- Addition of clavulanic acid re-establishes activity of
amoxicillin against β- lactamase producing
resistant organisms.
-Amoxicillin sensitive strains are not affected by the
addition of clavulanic acid .
• Dosage:
• Adult dose:500-875mg every 12 hours.
• Children dose: 25-45mg/kg/day in doses divided every
12hours.
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13. • Ampicillin
• Has broader spectrum than penicillin G or penicillin V
• More effective against gram negative bacilli.
• Less effective against some gram positive organisms.
• Bactericidal in action.
• Acid resistant.
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14. • Hypersensitivity reactions immediate or delayed
• Immediate:
1. It is also called anaphylactic reaction.
2. Characterized by signs of profound shock secondary to vasomotor collapse.
Impalpable pulse.
Difficulty with respiration.
Facial laryngeal edema.
Generalized rashes.
Specific therapy- 0.2-0.5cc. Of 1:1000 aqueous adrenaline IV
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15. CEPHALOSPORINS
• Β- lactam antibiotic.
• Structurally and functionally related to penicillin.
• Effective against gram positive.
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• First generation:- Cephalothin, Cefadroxil
• Second generation:- Cefuroxime, Cefaclor
• Third generation:- Cefoperazone, Cefixime
• Fourth generation :- Cefepime, Cefpirome.
Classification of Cephalosporins

16. • MOA: interferes and inhibits the synthesis of cell wall.
• Dosage:
• Adults: 250-1000mg every 6 hours.
• Children : 25-100mg/kg/day in divided doses every 6-8
hours.
• Adverse effects:
• Pain after IM injection and thrombophlebitis can occur on
IV injection.
• Diarrhoea.
• Hypersensitivity.
• Nephrotoxicity.
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17. ERYTHROMYCIN-MACROLIDE
• Obtained in 1952 from a strain of Streptomyces erythreus.
• Bacteriostatic and narrow spectrum.
• Effective against gram positive organisms and some penicillinase producing
organisms.
• Well absorbed orally.
• Acid liable.(enteric coating)
• MOA: by interfering with protein synthesis of bacteria.
• Adult dose: 250-500 mg orally every 6 hrs.
• Children 30-60 mg/kg of body weight /day divided into 4 doses.
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18. • Preparation can be given IM or IV – to attain more immediate effect.
• Adverse effects: GI disturbances, nausea, vomiting, diarrhoea, and
epigastric distress.
• It is an excellent substitute for those who are sensitive to penicillin.
• Azithromycin and clarithromycin are structural
derivatives of erythromycin possessing broader
spectrum of activity and improved bioavailability with
less gastric disturbances.
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19. TETRACYCLINES
• Broad spectrum antibiotic.
• Bacteriostatic.
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• Tetracycline have chelating property-
• Forms insoluble and unabsorbable complexes with calcium and other
metals.
Adverse effects:
• GI irritation, nausea, vomiting.
• Renal toxicity, Hepatotoxicity, Phototoxicity.
Dose:
• Adult: 250mg orally every 6 hrs
• Children: 20-40 mg/kg body weight/day, divided into four doses.

20. METRONIDAZOLE
• Nitro imidazole derivative.
• Effective against penicillin resistant anaerobic gram negative bacilli.
• Used in treatment of odontogenic infections.
• Bactericidal in action.
• Dosage: adult: 250-750 mg every 8 hrs not to exceed 4 g/day
• children: 30-50 mg/kg/day in 3-4 divided doses
• Adverse effects:
• Nausea, metallic taste in mouth, head ache, peripheral neuropathy
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21. ANALGESICS IN PEDIATRICS
• Algesia (pain) is an ill-defined, unpleasant bodily sensation
usually evoked by an external or internal noxious stimulus.
• Analgesic: a drug that selectively relieves pain by acting in the
CNS or on peripheral pain mechanism without significantly
altering consciousness.
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22. Nonsteroidal Anti-inflammatory drugs{NSAIDs}
• All drugs grouped in this class have
• Also called as non –narcotic, non-opioid or aspirin like analgesics.
• They act mainly on peripheral pain mechanism, but also
in the CNS to raise pain threshold.
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Analgesic Antipyretic
Anti-
inflammatory

23. Classification:
Non-selective COX inhibitors (traditional NSAIDS)
Salicylates - Aspirin
Propionic acid derivatives - Ibuprofen.
Fenamate - Mephenamic acid.
Enolic acid derivatives - Piroxicam.
Acetic acid derivatives - Ketorolac.
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24. It is Acetylsalicylic acid.
• It is rapidly converted in the body to salicylic acid which is
responsible for most of the actions.
• Weaker analgesic.
• Effectively relieves inflammatory, tissue injury related,
connective tissue & integumental pain.
• Ineffective in severe visceral and ischaemic pain.
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SALICYLATES
ASPIRIN

25. Paracetamol
• Has analgesic and anti-pyretic action and weak anti-inflammatory activity.
• It is unable to inhibit cyclo-oxygenase enzyme in the presence of peroxides present
at the site of inflammation. Hence poor anti-inflammatory action.
• Well absorbed orally, uniformly distributed in body and
excreted rapidly in urine.
• t1/2 is 2-3 hrs.
• Effects after oral dose lasts for 3-5 hrs.
• Not recommended in premature infants(<2yrs) for fear of
hepatotoxicity. 25

26. • Indications:
• Fever due to infection.
• Pain due to trauma or odontogenic infections.
• Head ache, musculoskeletal pain.
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27. • Dosage:
• Determined according to the age of the patient.
• Adult- 0.5-1g TDS, infants 50mg; children 1-3yrs 80-
160mg; 4-8 yrs 240-320mg; 9-12 yrs 300-600mg.
• Adverse effects:
• Hypersensitivity
• Renal or hepatic impairment
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28. Diclofenac sodium
• Potent anti-inflammatory, analgesic and anti-pyretic
actions.
• It inhibits PG synthesis.
• Available as sodium or potassium salt
• Available in the form of tablets, syrups and injections
• Well absorbed orally, 99% protein bound
metabolised and excreted both in urine and
bile.
• t1/2 is 2 hrs.
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29.  Indications:
 Inflammatory and degenerative arthritis
 Dental pain
 Musculo skeletal conditions like lower back pain
Dosage:
Adult: 50mg TDS, then BD oral, 75mg deep
 For children over 1 year: 2-3 mg/kg/day in divided doseicon D
 Adverse effects:
 Perforation of gastric ulcer, epigastric pain, nausea, headache, dizziness,
rashes.
 Gastro-intestinal haemorrhage
 Blood dyscrasias
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30. Ibuprofen
• It has anti-inflammatory, analgesic and anti-pyretic effects.
• It is a potent inhibitor of cyclo-oxygenase and prostaglandin synthesis.
• It prevents the formation of thromboxane A by platelets.
• Available as tablets, capsules and suspensions.
• Indications:
• Musculo-skeletal pain
• Inflammatory and degenerative arthritis
• Dental pain
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31.  Dosage:
 ADULT : 400-600 mg/day
 CHILDREN :5-10 mg/kg every 4-6 hrs
 Should not be given to children less than 7 kgs
 Adverse effects:
 Hematemesis
 Agranulocytosis
 Gastro-intestinal disturbances
 Thrombocytopenia
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