AntibioticsAnalgesicsinDentistry (2).pptx

Dr. Hala Helmi A. Hazzaa
Assistant professor of Oral Medicine, Diagnosis,
Priodontology & Radiology.
Faculty of Dentistry(Al-Azhar University)

 Terminology
 Indications
 Classification
 Types, uses & side effects
 Guidelines
 Recommendations
Dr.Hala Helmi Hazzaa

Chemotherapeutic Agent:
Antibiotic:
Antiseptic:
Disinfectant:
It is a general term for a
chemical substance that
provides a clinical therapeutic
benefit, either through
antimicrobial actions or
increasing host’s resistance).
It is a naturally occurring,
semisynthetic or synthetic type of
anti-infective agent that destroys
or inhibits the growth of selective
micro-organisms (MO), generally
at low concentrations.
It is a chemical antimicrobial agent
applied topically or sub-gingivally
to mucous membranes, wounds, or
intact dermal surfaces to destroy MO
& inhibit their multiplication or
metabolism.
They are antimicrobial agents
(subcategory of antiseptics)
generally applied to inanimate
surfaces to destroy MO.

 Antibiotics:
o They are a type of antimicrobial drugs used in the
treatment & prevention of bacterial infections.
o They may either kill or inhibit the growth of bacteria.
o A limited number of antibiotics also possess
antiprotozoal activity.
o Antibiotics are not effective against viruses.

o Antibiotics revolutionized medicine in the 20th century,
and have together with vaccination led to the near
eradication of diseases such as tuberculosis (T.B.) in the
developed world.
o Their effectiveness and easy access led to overuse,
prompting bacteria to develop resistance.
o This has led to the most common widespread problem
known as antibiotic resistance.

 To distinguish;
FDA
 No difference
 Triclosan?
 Microflora?
Antibacterials are used in soaps & cleaners Antibiotics are used as medicine

Prophylaxis.
To avoid bacteremia, that is
anticipated following
invasive dental procedures.
Therapeutic
In certain conditions, to treat &
stop the spread of infection.
Host modulation.
To modulate (control) some
immunologic aspects in the
host.

 Different routes:
• Oral (Tablets & Syrup)
• Injection (IV or IM)
 Advantages:
• Rapid action.
• Wide spectrum.
• Availability.
• Affordable cost.
 Disadvantages:
• The undesirable side effects
are the main obstacle????
 Rationale:
A more safe route for antibiotics to
avoid their undesirable side
effects.
 Controlled release device:
It is a system designed to prolong
the retention of chemotherapeutics
in periodontal pockets with a
regular & steady release of the
agent at therapeutic level.
 However, these members are
expensive, sometimes difficult
in application & not easily
available.

Bactericidal:
(penicillins, cephalosporins,
metronidazole, high
concentration of macrolides).
Bacteriostatic:
(tetracycline, chloramphenicol,
low concentration of macrolides).

 Continued periodontal disease activity as measured
by continuing attachment loss, purulent exudate, and
bleeding on probing. Non responding cases to
treatment (refractory periodontitis).
 Aggressive periodontitis.
 NUG or NUP.
 Acute gingival or periodontal abscess.
 Oro-dental infections in medically compromised
patients (e.g.; DM).
 Severe acute peri-apical infections.
 A rapidly spreading or persistent infection.

Pain needs analgesics for relief
Abscess needs drainage to bacteria
It needs antiviral therapy

Dar-Odeh et al., 2010

 Notice that:
Utilization of antibiotic prophylaxis for patients at
risk does not provide absolute prevention of
infection. Post-procedural symptoms of acute
infection may indicate antibiotic failure and need
for further evaluation.
Indications:
 Patients with cardiac conditions ???.
 Patients with shunts, or medical devices.
 Patients with compromised immunity.
 Patients with prosthetic joints.
Dental practitioners should consider prophylactic
measures to minimize the risk of IE in patients
with underlying cardiac conditions.
These non-cardiac factors can place a patient with
compromised immunity at risk for distant-site infection
from a dental procedure. This category includes, but is not
limited to, patients with the following medical conditions:
1. Immunosuppression secondary to:
A. human immunodeficiency virus (HIV).
B. severe combined immunodeficiency.
C. neutropenia.
D. cancer chemotherapy.
E. hematopoietic stem cell or solid organ transplantation.
2. Head & neck radiotherapy.
3. Autoimmune disease (e.g. SLE).
4. Sickle cell anemia.
5. Asplenism or status post splenectomy.
6. Chronic steroid usage.
7. DM.
1. Antibiotic prophylaxis is not indicated for dental patients with
pins, plates, screws, or other hardware that is not within a
synovial joint.
2. It is indicated routinely for most dental patients with total joint
replacements.
3. Antibiotics may be considered when high-risk dental
procedures are performed for patients within 2 years following
implant surgery, immuno-compromised patients with total
joint arthroplasty, or patients who have had previous joint
infections.

Viridans streptococci have the
unique ability to synthesize
dextrans from glucose, which
allows them to adhere to fibrin-
platelet aggregates at damaged
heart valves. This mechanism
underlies their ability to cause
subacute valvular heart disease
following their introduction into
the bloodstream (e.g., following
dental extraction)

We should stay friends forever

-This term refers to the use of some drugs in a way to
modulate the host response in the management of
periodontal diseases.
Non-steroidal anti-inflammatory drugs (NSAIDs):
Sub-antimicrobial dose of doxycycline (periostat):
Bisphosphonates:
-They decrease bone loss by modifying host
inflammatory response to bacteria.
-NSAIDs interfere with arachidonic acid
metabolism & inhibits the inflammatory
process.
-Some NSAIDs affect response of PNLs to
inflammation.
-Tetracycline in low dose inhibit tissue
destruction by its anti-collagenase (that of
PNLs) effect i.e. decrease rate of collagen
break down.
-Tetracycline is able to chelate metal ions.
Collagenases are Ca++ dependent enzymes.
- They are chemical analogues of
pyrophsphate known to inhibit bone
resorption (in periodontitis &
following periodontal surgery).

 It is a proprietary product which is composed of a very
low dose of doxycycline.
 It is taken several times a day & is used principally for
its inhibition effect on collagenase since the dose is too
low to effectively act as an antibiotic (i.e. to kill germs).

 Antibiotic is a necessary therapeutic adjunct in
controlling bacterial infection because bacteria can
invade the tissues, making mechanical therapy alone
sometimes ineffective.
 Antibiotics should be used as adjunct to dental
treatment and never used alone as the first line of care.
 Make proper diagnosis & consider using narrow
spectrum antibiotic to minimize disturbing the normal
flora and keep the broad spectrum antibiotic to more
complex infections.

 Currently, no ideal antibiotic for treatment of peri-
apical or periodontal disease, as no single antibiotic at
its achieved conc. in body fluid can inhibit all the
involved pathogens. Thus, combination therapy may
be necessary (avoid bactericidal with bacteriostatic).
 Antibiotics are indicated when systemic signs, that
possibly indicate spread of infection, are evident e.g.;
fever, lymphadenopathy, truisms ...etc…
 Keep in mind the drug interactions and the side effects
of the prescribed type.

 An effective antibiotic regimen should be directed
against the most likely infecting organism, with
antibiotics administered shortly after the procedure.
 The conservative use of antibiotics is indicated to
minimize the risk of developing resistance to current
antibiotic regimens.
 The duration of antibiotics???. Ideally antibiotics are
prescribed for 3-5 days + sufficient loading dose (stress
on the full course of therapy) for proper treatment and
avoiding the infection relapse.

 When procedures involve infected tissues or are
performed in a patient with a compromised host
response, additional doses of antibiotics may be
necessary.
 Avoid the sub-therapeutic doses or long duration to
avoid resistance.
 On treating a patient with hepatitis, Penicillin,
Clindamycin, Metronidazole are the safest antibiotics,
while Tetracycline & Erythromycin should be avoided.

 With renal patients, avoid nephrotoxic drugs
(Tetracycline, aspirin, NSAIDs) & adjust the dosage of
drugs metabolized by the kidney (e.g.; lidocaine,
penicillin V, cephalexin & metronidazole).
 Aggressive management of infections (culture,
sensitivity test & antibiotics).
 Hospitalization is indicated for severe infection or
major procedures as sepsis & febrile illness can lead to
fatal acidosis.

Penicillins
-They are bactericidal broad spectrum
antibiotics (inhibit bacterial cell wall
synthesis) containing a B-lactam ring e.g.
amoxicillin.
-They are considered among the safest
antibiotics.
-Notice that: B-Lactamase are enzymes
secreted by some bacteria e.g.
Staphylococci, leading to inactivation of
B-lactam antibiotics → resistance to these
drugs.
Q- How can we overcome this
problem?
1. Unasyn
2. Augmentin
3. Curam
Q-What about safety with
pregnancy….?
-Side effects:
-Allergy (anaphylactic shock ???)
-Bacterial resistance.

Adult dose
 500-1000 mg/ 6-8 hours.
 The available capsule
either 250 or 500 mg.
 The available vial
either 250, 500 or 1000
mg.
 Other market names:
Epicocillin.
Children dose
 50-100 mg/ kg / 3
times /day.
 The available form
is:
 125-250 mg/ 5 ml. susp.
 Other market names:
Epicocillin.

 Certain added preparations are used to
increase the effectiveness of the drug by
resisting the action of B- lactamase enzyme:
 Ampiflux (Ampicillin + Dicloxacillin):
 Available dose is; 250 mg (either capsule or
suspension).
 Cloxapen: as 250 or 500 mg capsules,
250 mg syrup.

 Adults or children over 10 years: 3 × 500 mg
daily.
 Children 5 - 10 years: 3 × 250 mg daily.
 Children 2-5 years: 3 × 125 mg daily.
 0 - 2 years: 3 × 100 mg daily.
Amoxycillin
1. 125 – 250 mg (suspension).
2. 250 – 500 mg (capsule).
Amoxil
2. 500 mg (capsule).
3. 250 – 500 (vial).
E-Mox
2. 500 mg (capsule).
3. 500 – 1000 (vial).

 Certain added preparations are used to
increase the effectiveness of the drug by
resisting the action of B- lactamase enzyme:
 Flumox (Amoxycillin + Flucloxacillin):
 Available dose is; 250 mg (suspension) or 500
mg (capsule).

AMPICILLIN +
SULBACTAM
AMOXICILLIN +
CLAVULINIC ACID
 Names: Unasyn,
Sulbin, Ampictam.
 Available as:
375 mg tablets, or: 750-
1500 mg vials.
 Augmentin, available
as:
(375-625 mg tablets,
156 mg suspension,
600-1200 mg vials)
 Curam , available as:
(625 -1000 mg tablets,
156 -312 mg suspension).
Although they are more effective formulas,
safety with pregnancy may be questionable.

They are B-lactam antibiotics similar to
penicillins in their mode of action, but are more
resistant to B-lactamase.
- Clinically, they’re not used to treat dental
infections (Why?)
- As the penicillins are more superior in their
range of action against dental / periodontal
pathogenic bacteria.
Notice that, 1ST generation Cephalosporins may
be used clinically with some benefits e.g.
DURICEF, CURISAFE, VELOSEF (against
G+ve & some G-ve).
-Side effects:
1. Urticarial rashes, fever & GIT disturbance.
2. There’s cross-allergy & cross-resistance with
penicillin.

 It is available as:
1. 125 – 250 - 500 mg syrup.
2. 500 mg capsule.
3. 1 gm tablet.
 Clinical use:
 In adult it can be used 500 mg – 1 gm (twice
daily),
 1 - 6 years: 250 mg (twice daily),
 Under 1 year: 25 mg / kg (twice daily).

-It is a bactericidal … (How?)
-It disrupts (the bacterial DNA) of
anaerobic MO e.g. P. gingivalis & P.
intermedia.
-It can be as a monotherapy or
combined, with root planing or
with other antibiotics.
It offers some benefit in the treatment
of refractory periodontitis,
particularly when combined with
amoxicillin.
Side effects:
1. Ant-abuse effect when alcohol is ingested.
2. Drug interactions (with oral anticoagulants & oral
hypoglycemic drugs).
3. Metallic taste, sometimes CNS-manifestations & rash.
4. Several trials have suggested an increased risk for
preterm birth among women given metronidazole
during pregnancy. However, the current scientific
evidence accepted its clinical use at the recommended
doses, without an elevated risk of birth defects.
Market names:
Flagyl, Amrizole, Anazole.
Dosage:
250 or 500 mg tablets.
250 mg suspension.

-They are bacteriostatic i.e effective against
rapidly multiplying bacteria.
-They act against A. actinomycetemcomitans,
being good adjuncts in treatment of LAP.
-They exert an anticollagenase effect (esp.
against host neutrophil collagenases which is
more dangerous), when used in a
subantimicrobial dose,
-Thus it can inhibit tissue destruction & aid in
bone regeneration (arrest bone loss).
-Its conc. in GCF is 2-10 times that in
serum.
-It also binds to the tooth surface from
where they can release (substantivity).
Side effects:
1. Gastric irritation & pain
2. Containdicted in pregnancy, lactation & less
than 8 years (it causes bone & teeth
discoloration).
3. Hepatotoxicity & phototoxicity.

Tetracycline
-250 mg (4 t/day), the half life is 6-10 hr.
-It shouldn’t be given for patients with
impaired renal function, (excreted in urine).
-Absorption is reduced with milk & antacids
(GIT absorption).
Minocycline
-100 mg twice daily for 1 week, as half life is
16-18 hr., thus it facilitates compliance.
-It’s a broad spectrum & suppress spirochetes
up to 3 months posoperatively.
-It can be used with less renal toxicity
(Why?)… As it’s excreted in feces.
 Doxycycline
-100 mg twice daily in 1st day then, 100 mg once
daily (i.e pt. is more compliant), the same spectrum as
Minocycline & not affected by antacids.
-Its use with surgery for 2 weeks in refractory
periodontitis, with significant reduction of A.a. up to
12 months as well as PD reduction & CAL gain.

-They can be bacteriostatic or bactericidal, depending on the
concentration of the drug & the nature of MO.
-They inhibit protein synthesis at ribosomal level (bind to
bacterial but not to human ribosomes).
-Their spectrum is similar but not identical to penicillin, useful
for patients allergic to penicillin.
-Orally, 250-500 mg/8 h. in adults (20-50 mg/kg/day).
-It’s not effective against most periodontal putative pathogens
(PPP) & doesn’t concentrate in GCF, so, it’s not indicated as an
adjunct to periodontal therapy.
Side effects:
1. Mild GIT upset: nausea, vomiting & diarrhea.
2. Reversible hepatotoxicitytatic in form of cholestatic
jaundice with eosinophilia (contraindicated in liver
diseases).

II)Azithromycin
-It is effective against anaerobes & G-ve bacilli.
-It penetrates fibroblasts & phagocytes (actively
transporting the drug to the sites of inflammation
to be directly released when they ruptured) in
concentration 100-200 times > extracellular
compartment.
-Long t ½, allowing once-daily dosing . After an
oral dose of 500 mg for 3 days, significant level of
azithromycin can be detected in most tissues for 7 –
10 days.

It’s used specifically against anaerobic
infections & effective in situations in which the
patient allergic to penicillin.
-Dose: 150 & 300 mg capsules.
-Side effects:
1. Skin rash, diarrhea & liver dysfunction.
2. Pseudomembraneous colitis. (How?) (it kills
intestinal Flora→ flourishment of
colistridium dificile & its toxins→colitis).
III)Clindamycin

They’re contraindicated in
pregnancy, lactation &
patients less than 18 years
(may lead to arthropathy).
Ciprofloxacin:
-It is bactericidal (inhibits DNA synthesis).
-Active against G-ve rods (including all facultative
& some anaerobic PPP).
-It is the only antibiotic in periodontal therapy to
which, all strains of A. actinomycetemcomitans are
susceptible.
-It enhances the effect of warfarin & other
anticoagulants. In addition to, nausea, headache &
metallic taste.

Don’t forget that:
Given the increasing number of organisms
that have developed resistance to current
antibiotic regimens, as well as the potential for
an adverse anaphylactic reaction to the drug
administered, it is best to be judicious in the use
of antibiotics for the prevention of IE and other
distant-site infections.

The decision making-tree in the
different causes of oral problems
Pulpal Periodontal
**Non-plaque
induced gingivitis
*Plaque induced
gingivitis
**Gingival
abscess
**Periodontal
abscess
**Pericoronitis
*Chronic
periodontitis
**Aggressive
periodontitis
*localized
dento-alveolar
abscess
*Periapical
periodontitis
**Facial
cellulitis
*Irreversible
pulpitis
*Reversible
pulpitis
Miscellaneous
*Cysts
**Osteomyelitis
*Operative intervention is needed, e.g.; filling, root canal treatment, local
irrigation, incisional drainage, removal & oral hygiene measures.
**Antibiotic prescribing is needed as an initial treatment. Operative
intervention(s) may be initiated on the same visit or later. Oral hygiene
measures are mandatory.
Care should be taken with immuno-comporomized patients. Dr.Hala Helmi Hazzaa
**Infected
socket
*Dry socket
*Tumors
**NUG/P/S

 Although the use of prophylactic antibiotics in implant
dentistry is controversial,
 Antibiotics are generally considered beneficial for reducing
failure of dental implants placed in ordinary conditions to
minimize infections, (2 g or 3 g of amoxicillin given orally, as a
single administration, one hour preoperatively significantly
reduces failure of dental implants).
 The use of postoperative antibiotics is still controversial. (Esposito et
al., 2013)
However, special attention should be paid to
immediate implant placement especially on
replacing peri-apically infected teeth.

 There are two main types of NSAIDs,
nonselective & selective.
 The terms nonselective and selective refer to
different NSAIDs’ ability to inhibit specific
types of cyclo-oxygenase (COX) enzymes.
Nonselective NSAIDs:
They inhibit both COX-1 and COX-2 enzymes to a
significant degree.
Selective NSAIDs:
They inhibit COX-2, an enzyme found at sites of
inflammation, more than the type that is normally
found in the stomach, blood platelets, and blood
vessels (COX-1).

Their general mechanism of action:
The inhibition of prostaglandin synthesis
(Cyclo-oxygenase Enzyme inhibitors).

Figure (2)

 Blood pressure may rise with use of NSAIDs.
 If NSAIDs are required, they should be used at the lowest
effective dose and for the shortest duration necessary for the
given indication.
 If chronic use of NSAIDs is anticipated, control of treated
hypertension may be adversely affected.
 Therefore, changes in blood pressure medications may be
required.
 Anyone who is at risk for or who has cardiovascular disease
(coronary artery disease) may have a further increase in risk of
heart attacks when taking an NSAIDs (especially with COX2-
inhibitors).

 Short-term use of NSAIDs can cause stomach upset.
 Long-term use of NSAIDs, especially at high doses, can lead to
peptic ulcer disease and bleeding from the stomach.
 Inhibitor of stomach acid production:
High doses of antacid histamine blockers, such as famotidine (Pepcid®),
can reduce the risk of developing an ulcer (related to use of an NSAID).
 People with platelet disorders, such as von Willebrand disease,
with abnormal platelet function from uremia, and with a low
platelet count (thrombocytopenia) are advised to avoid
NSAIDs.

 Most clinicians recommend stopping all NSAIDs approximately
one week before elective surgery (e.g. tooth extraction) to
decrease the risk of excessive bleeding. This usually includes
aspirin, ibuprofen, naproxen.
 Use of NSAIDs, even for a short period of time, can harm the
kidneys, in people with underlying kidney disease (???).
salts that block further
chemical activity for the rest
of the life of that platelet (7-
14 days).

 Selective NSAIDs have less potential to cause ulcers or
gastrointestinal bleeding.
 Selective NSAIDs are sometimes recommended for people who
have had a peptic ulcer, gastrointestinal bleeding, or
gastrointestinal upset when taking nonselective NSAIDs.

 Rofecoxib (Vioxx®) & valdecoxib (Bextra®) were taken off the
market in 2004 when it was discovered that people who took
these medications had a slightly increased risk of heart attack
and stroke.
 People with known coronary artery disease (e.g.; past history of
heart attack, angina [chest pain due to narrowed heart arteries],
history of a stroke, or narrowed arteries to the brain) should
avoid using COX-2 inhibitors.
 Of the nonselective NSAIDs, naproxen may be the safest for
people with coronary artery disease, but a clinician should be
consulted before use of this or any other NSAID.

• People using anticoagulant medications such as warfarin
or heparin should generally not take NSAIDs or
aspirin because of an increased risk of bleeding when
both classes of drugs are used (Both will increase the
prothrombin time & INR).
• Taking an NSAID & phenytoin (Dilantin) can increase
the phenytoin level. As a result, people who take
phenytoin should have a blood test to monitor the
phenytoin level when starting or increasing the dose of
an NSAID.

• People who take cyclosporine (e.g.; to prevent rejection
after an organ transplant or for a rheumatic disease, such
as rheumatoid arthritis) should take particular care when
taking an NSAID ……………… Why??
 There is a theoretical risk of kidney damage when
cyclosporine and NSAIDs are taken together. To monitor
for this complication, blood testing may be recommended.
• People taking one NSAID should not take a second
NSAID at the same time because of the increased risk of
side effects.

• People with medical conditions that require diuretics,
including heart failure, liver disease, and kidney damage, are at
increased risk of developing kidney damage while taking
NSAIDs.
• NSAIDs can worsen kidney function in people whose kidneys
are not functioning normally. Therefore, most people with
chronic kidney disease are advised to avoid all types of NSAIDs.

• NSAIDS are not generally recommended for
pregnant women during the third trimester due to
an increased risk of complications in the newborn
(persistent pulmonary hypertension of the
newborn).
• NSAIDs are safe for use during breastfeeding.
Fetal exposure to a NSAIDs was
confirmed by meconium analysis

 Meconium drug testing is a sensitive method for identifying
infants who have been exposed to drugs in utero. Meconium
represents the first series of green stools, which the infant excretes
after birth.
 The concept was based on initial research in animals, which
showed, that a high concentration of the drugs, which the
pregnant animal was exposed to, were present in the meconium
of their fetuses. Drugs, which the fetus is exposed to during
pregnancy, are metabolized by its liver into water-soluble
metabolites and excreted into the bile or urine.
 It is postulated that drug deposition in meconium occurs either
through bile secretion or through swallowing by the fetus of its
urine via the amniotic fluid.

Recently, analysis of the infant's hair for drugs has been
used. Technical problems in the analysis and sample
collection make this method not practical in the neonate.

 Unfortunately, the drug-exposed neonate is not easy to recognize.
Many of the drugs which the fetus was exposed to do not produce
immediate, recognizable effects.
 Even with maternal cooperation, information on the type and/or
extent of drug usage is often inaccurate.
 One alternative is to test the infant's urine for drugs, but this
procedure has its limitations since the successful detection of
drug metabolites in the infant's urine is dependent on time of the
last drug intake by the mother or when after birth the infant's
urine was collected.
 The high rate of false negative urine test often arises from the
mother's abstention from the use of the drug a few days before
she delivers or to the inability to obtain a sample of the infant's
urine soon after birth.

Diclofenac Sodium
-It is an analgesic & anti-inflammatory
NSAID.
-25 mg supp… (Baby relief or Dolphin).
- 25 or 50 mg tab…… (Declofenac).
-75 mg amps……. (Epifenac).
-Contra-indicated with hypertension.
Diclofenac Potassium
-It is an analgesic & anti-inflammatory
NSAID.
-25 or 50 mg tab…… (Cataflam).
-75 mg amps……. (Cataflam, Dolphin-K).
-Its use is safe with hypertension, with
avoidance of gastric side effect.
Ibuprofen
-It is an analgesic, antipyretic & anti-
inflammatory NSAID.
-200, 400 or 600 mg tab…… (Brufen).
Ketoprofen
-It is an analgesic, antipyretic & anti-
inflammatory NSAID.
-75, 100 or 150 mg tab…… (Biprofenid).
-25 mg tab. or 50, 75, 200 mg cap…..(Ketofan).
-150 mg supp……..(Ketofan).

Celecoxib
-It is a NSAIDs, acting selectively to inhibit
COX2 , not COX1.
-It is contraindicated in case of patients with
ischemic heart & cerebrovascular diseases.
-capsules : 100 - 200 mg.
Meloxicam
-It is a NSAIDs, acting selectively to inhibit
COX2 , not COX1.
-It is contraindicated in case of hepatic
impairment, bleeding disorders or renal
failure.
-Tablets : 7.5 or 15 mg.

 Paracetamol, also known as acetaminophen.
 Paracetamol is generally safe at recommended doses.
 It is on the WHO Model List of Essential Medicines, the most
important medications needed in a basic health system.
 Paracetamol is available as a generic medication with trade
names including Panadol with low cost.
 Safe with pregnancy, lactation, children, hepatitis and kidney
affected patients.

 In contrast to aspirin, paracetamol does not prevent blood
from clotting (it is not an antithrombotic).
 It does not cause gastric irritation.
 Paracetamol is generally considered safe for children, as it
is not associated with a risk of Reye's syndrome in
children with viral illnesses.
 Compared to ibuprofen, paracetamol has fewer adverse
gastrointestinal effects.
Disadvantages
• If paracetamol is taken with opioids, there is weak evidence that it
may cause hearing loss.
• Paracetamol does not help reduce inflammation, while aspirin does.
• Although it is well tolerated and safe for use in patients with hepatic
disease, acute overdoses of paracetamol can cause potentially fatal
liver damage.
• Serious skin rashes can rarely occur.

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