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SEMINAR
ON
ANTIBIOTICS
PRESENTED
BY
Dr. AMIT BYATNAL
(POST GRADUATE STUDENT)
DEPT. OF ORAL MEDICINE AND RADEIOLOGY,
SIBAR ...
CERTIFICATE
This is to certify that the Seminar entitled, “ANTIBIOTICS” being
submitted by Dr. Amit Byatnal, under the gui...
CONTENTSCONTENTS
Introduction.Introduction.
History of AntibioticsHistory of Antibiotics
Classification of antimicrobial d...
•• INTRODUCTIONINTRODUCTION
•• Antimicrobial agentsAntimicrobial agents: Substances that will suppress the growth/: Substa...
•• ClassificationClassification
Chemical structure:Chemical structure:
•• Sulfonamides and related drugs.Sulfonamides and ...
•• TetracyclinesTetracyclines
•• OxytetracyclineOxytetracycline
•• Doxycycline etcDoxycycline etc
•• Nitrobenzene derivati...
•• TeicoplaninTeicoplanin
•• OxazolidinoneOxazolidinone
•• LinezolidLinezolid
•• Nitrofuran derivativesNitrofuran derivati...
•• OthersOthers
•• RifampinRifampin
•• LincomycinLincomycin
•• ClindamycinClindamycin
•• SpectinomycinSpectinomycin
•• Sod...
•• KetoconazoleKetoconazole
•• AntiviralAntiviral
•• IdoxuridineIdoxuridine
•• AcyclovirAcyclovir
•• AmantadineAmantadine
...
•• CephalosporinsCephalosporins
•• MetronidiazoleMetronidiazole
•• VancomycinVancomycin
•• PenicillinsPenicillins
•• Cipro...
•• -Therapeutic index- high, low, very low-Therapeutic index- high, low, very low
•• Hypersensitivity reactions :Hypersens...
•• Sulfonamides displace bilirubin from PBS- kernicterusSulfonamides displace bilirubin from PBS- kernicterus
•• Tetracycl...
•• Microorganisms isolated from pulpal/periapical infectionsMicroorganisms isolated from pulpal/periapical infections
•• A...
•• Gram -Gram -veve
baccillibaccilli
•• BacteriodesBacteriodes
•• FusobacteriaFusobacteria
•• PorphyromonasPorphyromonas
•...
•• PRINCIPLES OF ANTIBIOTIC ADMINISTRATIONPRINCIPLES OF ANTIBIOTIC ADMINISTRATION
•• Proper dose :Proper dose :
•• DRUG DO...
•• Parenteral administration will produce the necessary serum level ofParenteral administration will produce the necessary...
•• 2 bacteriostatic drugs are never inhibitory. (1+1=2)2 bacteriostatic drugs are never inhibitory. (1+1=2)
•• Results :Re...
•• Post-antibiotic effectsPost-antibiotic effects
•• MINIMAL INHIBITORY CONCENTRATIONMINIMAL INHIBITORY CONCENTRATION
•• I...
•• Long time of exposure of theLong time of exposure of the
 organismsorganisms
•• Better the bactericidal activityBette...
•• Replantation procedureReplantation procedure
•• Implant placementImplant placement
•• Initial placement of orthodontic ...
•• Extended spectrum penicillins :Extended spectrum penicillins :
•• Carboxypenicillins : Carbenicillin, ticarcillinCarbox...
•• Prolonged IV administration may cause thrombophlebitisProlonged IV administration may cause thrombophlebitis
•• Acciden...
•• GonorrhoeaGonorrhoea
•• SyphilisSyphilis
•• DiphtheriaDiphtheria
•• Tetanus and gas gangreneTetanus and gas gangrene
••...
•• Effective in staphylococciEffective in staphylococci
•• It is given IM or IV (slow) in the dose of 1 gm every 4-6 hours...
•• Dose : 0.5-2 gm oral/IM or IV depending on severity of infection every 6Dose : 0.5-2 gm oral/IM or IV depending on seve...
•• AMOXICILLIN :AMOXICILLIN :
•• This is a semisynthetic penicillin.This is a semisynthetic penicillin.
•• (amino-p-hydrox...
•• CLAVULANIC ACIDCLAVULANIC ACID
•• Obtained from STREPTOMYCES CLAVULIGERUSObtained from STREPTOMYCES CLAVULIGERUS
•• Bet...
•• Act by inhibiting bacterial cell was synthesis and are bactericidal.Act by inhibiting bacterial cell was synthesis and ...
•• Second generation cephalosporins :Second generation cephalosporins :
•• Increased activity against gram –ve organism.In...
•• Fourth Generation CephalosporinsFourth Generation Cephalosporins
•• Similar to 3Similar to 3rdrd
generation ,but is hig...
•• Surgical prophylaxisSurgical prophylaxis
•• Meningitis, gonorrhoeaMeningitis, gonorrhoea
•• TyphoidTyphoid
•• Mixed aer...
cells will be unable to divide. Hence the sulfonamide antibacterials exhibit acells will be unable to divide. Hence the su...
gram –ve aerobic bacilli.gram –ve aerobic bacilli.
•• Microbiological features :Microbiological features :
•• Rapid bacter...
•• Bone, soft tissue, wound infection.Bone, soft tissue, wound infection.
•• Combinations- gram –ve septicaemiasCombinatio...
bronchitis, and other respiratory tract infections.bronchitis, and other respiratory tract infections.
-- Used in urinary ...
•• Pharmacokinetics :Pharmacokinetics :
•• Completely absorbed from the small intestine.Completely absorbed from the small...
•• Activity similar to Metronidazole but it is slowly metabolised .Activity similar to Metronidazole but it is slowly meta...
••
TETRACYCLINESTETRACYCLINES
•• Napthacene derivatives made up by fusion of 4 partially unsaturatedNapthacene derivatives...
•• Used in the treatment of Localised aggressive periodontitis.Used in the treatment of Localised aggressive periodontitis...
•• Not to be used in pregnancy, lactation and in childrenNot to be used in pregnancy, lactation and in children
•• Avoided...
•• MACROLIDESMACROLIDES
•• Macrocyclic lactone ring with attached sugarsMacrocyclic lactone ring with attached sugars
•• E...
•• Adverse effects :Adverse effects :
•• GIT – epigastric painGIT – epigastric pain
•• On high doses – hearing impairmentO...
•• Most active against gram+ve cocci, C.diphtheriae, ActinomycesMost active against gram+ve cocci, C.diphtheriae, Actinomy...
•• Protective layers of the fungal cell make the organism resistant to antibioticsProtective layers of the fungal cell mak...
•• 10mg -3-4times a day. Gel or lotion-denture stomatitis10mg -3-4times a day. Gel or lotion-denture stomatitis
•• Angular...
•• Indications:Indications: Herpes simplex virus (HSV) 1 and 2 infections; HSVHerpes simplex virus (HSV) 1 and 2 infection...
 Children20-40mg/kg body weight-tidChildren20-40mg/kg body weight-tid
 -125,250mg-125,250mg
•• Cephalexin(sporidex)Cep...
•• List of referencesList of references
•• Essentials of medical pharmacology :Essentials of medical pharmacology :
•• KD ...
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Antibiotics/rotary endodontic courses by indian dental academy

  1. 1. SEMINAR ON ANTIBIOTICS PRESENTED BY Dr. AMIT BYATNAL (POST GRADUATE STUDENT) DEPT. OF ORAL MEDICINE AND RADEIOLOGY, SIBAR INSTITUTE OF DENTAL SCIENCES, TAKKELLAPADU, GUNTUR.
  2. 2. CERTIFICATE This is to certify that the Seminar entitled, “ANTIBIOTICS” being submitted by Dr. Amit Byatnal, under the guidance and supervision and completed to our full satisfaction. SIGNATURE OF HEAD OF THE DEPARTMENT
  3. 3. CONTENTSCONTENTS Introduction.Introduction. History of AntibioticsHistory of Antibiotics Classification of antimicrobial drugsClassification of antimicrobial drugs Problems with AMAProblems with AMA Choice of AMAChoice of AMA Principles of administrationPrinciples of administration Indications for antimicrobial agents used in dentistryIndications for antimicrobial agents used in dentistry Beta lactam antibioticsBeta lactam antibiotics QuinolonesQuinolones TetracyclinesTetracyclines MacrolidesMacrolides NitroimidazolesNitroimidazoles Antifungal drugsAntifungal drugs ConclusionConclusion ReferencesReferences
  4. 4. •• INTRODUCTIONINTRODUCTION •• Antimicrobial agentsAntimicrobial agents: Substances that will suppress the growth/: Substances that will suppress the growth/ multiplication of bacteria and prevent their action.multiplication of bacteria and prevent their action. •• Antibiotic agentsAntibiotic agents: Chemical substances produced by microorganisms that: Chemical substances produced by microorganisms that have the capacity, in dilute solutions, to produce antimicrobial action.have the capacity, in dilute solutions, to produce antimicrobial action. HISTORYOF ANTIBIOTICSHISTORYOF ANTIBIOTICS •• 1877 Louis Pasteur Inhibition of some microbes by others; anthrax1877 Louis Pasteur Inhibition of some microbes by others; anthrax ((Bacillus anthracis)Bacillus anthracis) •• 1908 Gelmo Synthesized sulfanilamide (1st sulfonamide1908 Gelmo Synthesized sulfanilamide (1st sulfonamide •• 1928 Fleming…1928 Fleming… •• Penicillin notatumPenicillin notatum inhibits growthinhibits growth •• ‘PENICILLINS’‘PENICILLINS’ •• 1941 Chain n Florey1941 Chain n Florey •• Discovered properties of penicillinDiscovered properties of penicillin •• 1932 Domagk Prontosil1932 Domagk Prontosil •• Therapeutic value sulfonamidesTherapeutic value sulfonamides •• 1943, Selman Waksman isolated,1943, Selman Waksman isolated, Streptomyces griseusStreptomyces griseus …Streptomycin…Streptomycin
  5. 5. •• ClassificationClassification Chemical structure:Chemical structure: •• Sulfonamides and related drugs.Sulfonamides and related drugs. •• Sulfadiazine and others.Sulfadiazine and others. •• Sulfones – Dapsone (DDS), Paraaminosalicylic acid (PAS).Sulfones – Dapsone (DDS), Paraaminosalicylic acid (PAS). •• DiaminopyrimidinesDiaminopyrimidines •• TrimethoprimTrimethoprim •• PyrimethaminePyrimethamine •• QuinolonesQuinolones •• Nalidixic acidNalidixic acid •• NorfloxacinNorfloxacin •• Ciprofloxacin etcCiprofloxacin etc •• ββ-lactam antibiotics-lactam antibiotics •• PenicillinsPenicillins •• CephalosporinsCephalosporins •• MonobactamsMonobactams •• CarbapenemsCarbapenems
  6. 6. •• TetracyclinesTetracyclines •• OxytetracyclineOxytetracycline •• Doxycycline etcDoxycycline etc •• Nitrobenzene derivativeNitrobenzene derivative •• ChloramphenicolChloramphenicol •• AminoglycosidesAminoglycosides •• StreptomycinStreptomycin •• GentamicinGentamicin •• Neomycin etcNeomycin etc •• Macrolide antibioticsMacrolide antibiotics •• ErythromycinErythromycin •• RoxithromycinRoxithromycin •• Azithromycin etcAzithromycin etc •• Polypeptide antibioticsPolypeptide antibiotics •• Polymyxin-BPolymyxin-B •• ColistinColistin •• BacitracinBacitracin •• TyrothricinTyrothricin •• GlycopeptidesGlycopeptides •• VancomycinVancomycin
  7. 7. •• TeicoplaninTeicoplanin •• OxazolidinoneOxazolidinone •• LinezolidLinezolid •• Nitrofuran derivativesNitrofuran derivatives •• NitrofurantoinNitrofurantoin •• FurazolidoneFurazolidone •• NitroimidozolesNitroimidozoles •• MetronidozoleMetronidozole •• TinidazoleTinidazole •• Nicotinic acid derivativesNicotinic acid derivatives •• IsoniazidIsoniazid •• PyrazinamidePyrazinamide •• EthionamideEthionamide •• Polyene antibioticsPolyene antibiotics •• NystatinNystatin •• Amphotericin-BAmphotericin-B •• HamycinHamycin •• Azole derivativesAzole derivatives •• MiconazoleMiconazole •• ClotrimazoleClotrimazole •• KetoconazoleKetoconazole •• FluconazoleFluconazole
  8. 8. •• OthersOthers •• RifampinRifampin •• LincomycinLincomycin •• ClindamycinClindamycin •• SpectinomycinSpectinomycin •• Sod. fusidateSod. fusidate •• CycloserineCycloserine •• ViomycinViomycin •• EthambutolEthambutol •• ThiacetazoneThiacetazone •• ClofazimineClofazimine •• GriseofulvinGriseofulvin •• Type of organisms against which primarily activeType of organisms against which primarily active •• AntibacterialAntibacterial •• PenicillinsPenicillins •• AminoglycosidesAminoglycosides •• Erythromycin etcErythromycin etc •• AntifungalAntifungal •• GriseofulvinGriseofulvin •• Amphotericin BAmphotericin B
  9. 9. •• KetoconazoleKetoconazole •• AntiviralAntiviral •• IdoxuridineIdoxuridine •• AcyclovirAcyclovir •• AmantadineAmantadine •• Zidovudine etcZidovudine etc •• AntiprotozoalAntiprotozoal •• ChloroquineChloroquine •• PyrimethaminePyrimethamine •• MetronidazoleMetronidazole •• Diloxanide etcDiloxanide etc •• AnthelminticAnthelmintic •• MebendazoleMebendazole •• PyrantelPyrantel •• NiclosamideNiclosamide •• Diethyl carbamazine etcDiethyl carbamazine etc •• BactericidalBactericidal •• AminoglycosidesAminoglycosides •• BacitracinBacitracin
  10. 10. •• CephalosporinsCephalosporins •• MetronidiazoleMetronidiazole •• VancomycinVancomycin •• PenicillinsPenicillins •• CiprofloxacinCiprofloxacin •• StreptomycinStreptomycin •• CotrimoxazoleCotrimoxazole •• BacteriostaticBacteriostatic •• ChloramphenicolChloramphenicol •• ClindamycinClindamycin •• ErythromycinErythromycin •• SulfonamidesSulfonamides •• TetracyclineTetracycline •• TrimethoprimTrimethoprim Spectrum of activitySpectrum of activity •• Narrow spectrumNarrow spectrum •• Broad spectrumBroad spectrum Mechanism of actionMechanism of action •• Problems with use of AMAProblems with use of AMA •• ToxicityToxicity •• Local irritancy:Local irritancy: •• -Systemic toxicity:-Systemic toxicity:
  11. 11. •• -Therapeutic index- high, low, very low-Therapeutic index- high, low, very low •• Hypersensitivity reactions :Hypersensitivity reactions : •• Drug resistanceDrug resistance -- Natural- lack of metabolic process or target siteNatural- lack of metabolic process or target site -- Acquired – due to use over a period of time, mutations or geneAcquired – due to use over a period of time, mutations or gene transfertransfer •• Preventing Resistance to DrugsPreventing Resistance to Drugs •• Limit the use of antimicrobial agents to the treatment of specific pathogensLimit the use of antimicrobial agents to the treatment of specific pathogens sensitive to the drug being usedsensitive to the drug being used •• Notorious-Make sure doses are high enough, and the duration of drugNotorious-Make sure doses are high enough, and the duration of drug therapy long enough , combination therapytherapy long enough , combination therapy •• Be cautious about the indiscriminate, inadequate or unduly prolonged use ofBe cautious about the indiscriminate, inadequate or unduly prolonged use of anti-infectivesanti-infectives •• SuperinfectionSuperinfection •• Nutritional deficienciesNutritional deficiencies •• Masking of an infectionMasking of an infection •• Choice of AMA agent- patient factorsChoice of AMA agent- patient factors •• 1.Age : affect kinetics of drug.1.Age : affect kinetics of drug. •• Conjugation and excretion of chloremphenicol- gray baby syndromeConjugation and excretion of chloremphenicol- gray baby syndrome
  12. 12. •• Sulfonamides displace bilirubin from PBS- kernicterusSulfonamides displace bilirubin from PBS- kernicterus •• Tetracycline accumulates in bone and teethTetracycline accumulates in bone and teeth •• 2. Renal and hepatic failure: cautious use and dose reduction2. Renal and hepatic failure: cautious use and dose reduction •• 3. Local factors:3. Local factors: •• presence of pus and secretions- AMAs, surgical drainage reduces causativepresence of pus and secretions- AMAs, surgical drainage reduces causative bacteria and suppresses anaerobic bacteriabacteria and suppresses anaerobic bacteria •• Presence of necrotic material and infectionPresence of necrotic material and infection •• Hematomas – foster growthHematomas – foster growth •• 4.Drug allergy4.Drug allergy •• 5.Impaired host defense5.Impaired host defense •• 6.Pregnancy6.Pregnancy •• 7.Genetic factors7.Genetic factors •• Organism related considerationsOrganism related considerations •• Drug factorsDrug factors •• Spectrum of activitySpectrum of activity •• Type of activityType of activity •• Sensitivity of the organismSensitivity of the organism •• Relative toxicityRelative toxicity •• Pharmacokinetic profilePharmacokinetic profile •• Route of administationRoute of administation •• Evidence of clinical efficacyEvidence of clinical efficacy •• CostCost
  13. 13. •• Microorganisms isolated from pulpal/periapical infectionsMicroorganisms isolated from pulpal/periapical infections •• AerobicAerobic •• Gram +Gram +veve coccicocci •• StaphylococciStaphylococci •• Gram +Gram +veve BacciliBaccili •• LactobacciliLactobaccili •• CorynebacteriumCorynebacterium •• Eikenella corrodensEikenella corrodens •• AnaerobicAnaerobic •• Gram +Gram +veve coccicocci •• PeptostreptococcusPeptostreptococcus •• Gram –Gram –veve coccicocci •• VeillonellaVeillonella •• Gram +Gram +veve baccillibaccilli •• ActinomycesActinomyces •• EubacteriumEubacterium •• ClostridiaClostridia •• PropionibacteriumPropionibacterium
  14. 14. •• Gram -Gram -veve baccillibaccilli •• BacteriodesBacteriodes •• FusobacteriaFusobacteria •• PorphyromonasPorphyromonas •• PrevotellaPrevotella •• TreponemasTreponemas •• Treponema denticolaTreponema denticola •• Treponema macrodentiumTreponema macrodentium •• Treponema oralisTreponema oralis •• Treponema vincentiTreponema vincenti •• PRINCIPLES OF ANTIBIOTIC THERAPYPRINCIPLES OF ANTIBIOTIC THERAPY •• PRINCIPLE 1: TO DETERMINE THE SEVERITY OF INFECTIONPRINCIPLE 1: TO DETERMINE THE SEVERITY OF INFECTION •• PRINCIPLE 2: TO EVALUATE STATE OF PATIENT’S HOSTPRINCIPLE 2: TO EVALUATE STATE OF PATIENT’S HOST DEFENSE MECHANISMSDEFENSE MECHANISMS •• PRINCIPLE 3: TO TREAT INFECTION SURGICALLYPRINCIPLE 3: TO TREAT INFECTION SURGICALLY •• PRINCIPLE 4: TO SUPPORT THE PATIENT MEDICALLYPRINCIPLE 4: TO SUPPORT THE PATIENT MEDICALLY •• PRINCIPLE 5: CHOOSE AND PRESCRIBE APPROPRIATEPRINCIPLE 5: CHOOSE AND PRESCRIBE APPROPRIATE ANTIBIOTICANTIBIOTIC •• PRINCIPLE 6: PROPER ANTIBIOTIC ADMINISTRATIONPRINCIPLE 6: PROPER ANTIBIOTIC ADMINISTRATION
  15. 15. •• PRINCIPLES OF ANTIBIOTIC ADMINISTRATIONPRINCIPLES OF ANTIBIOTIC ADMINISTRATION •• Proper dose :Proper dose : •• DRUG DOSAGEDRUG DOSAGE -- ‘Dose’ is the appropriate amount of a drug needed to produce a‘Dose’ is the appropriate amount of a drug needed to produce a certain degree of response in a patient.certain degree of response in a patient. •• Body size :Body size : -- Individual dose =Individual dose = BW(kg)/70 x average adult doseBW(kg)/70 x average adult dose -- Individual dose =Individual dose = BSA(m2BSA(m2 ) /1.7x average adult dose) /1.7x average adult dose •• NEONATES AND INFANTSNEONATES AND INFANTS •• Greater percentage of body weight compared with body waterGreater percentage of body weight compared with body water •• Greater volume of distributionGreater volume of distribution •• Increased serum half livesIncreased serum half lives •• Reduced gastric emptyingReduced gastric emptying •• Reduced plasma protein bindingReduced plasma protein binding •• Reduced GFRReduced GFR •• 2) Proper time interval :2) Proper time interval : •• 3) Proper route of administration :3) Proper route of administration :
  16. 16. •• Parenteral administration will produce the necessary serum level ofParenteral administration will produce the necessary serum level of antibiotics.antibiotics. •• Oral route results in the most variable absorption.Oral route results in the most variable absorption. •• For maximum absorption is taken in fasting stage.For maximum absorption is taken in fasting stage. •• 4) Consistency in regard to route of administration :4) Consistency in regard to route of administration : •• When treating a serious, established infections, parenteral antibiotic therapyWhen treating a serious, established infections, parenteral antibiotic therapy is frequently the method of choice.is frequently the method of choice. •• Combination antibiotic therapy :Combination antibiotic therapy : •• The rationale for the use of 2 or more drugs together is to minimizeThe rationale for the use of 2 or more drugs together is to minimize •• the emergence of antibiotic resistant microorganismsthe emergence of antibiotic resistant microorganisms •• to increase the certainty of a successful clinical outcometo increase the certainty of a successful clinical outcome •• to treat mixed bacterial infectionsto treat mixed bacterial infections •• to prevent superinfectionto prevent superinfection •• to treat severe infections of unknown etiologyto treat severe infections of unknown etiology •• to decrease toxicity without decreasing efficacyto decrease toxicity without decreasing efficacy -- Examples :Examples : •• Isoniazid + ethambutol + streptomycin in treatment of tuberculosis.Isoniazid + ethambutol + streptomycin in treatment of tuberculosis. •• Rules :Rules : •• 2 bactericidal drugs produce, supraadditive effects, not antagonism. (1+1>2)2 bactericidal drugs produce, supraadditive effects, not antagonism. (1+1>2) •• The combination of a bacteriostatic and a bactericidal drug generally resultsThe combination of a bacteriostatic and a bactericidal drug generally results in diminished effects. (1+1<2)in diminished effects. (1+1<2)
  17. 17. •• 2 bacteriostatic drugs are never inhibitory. (1+1=2)2 bacteriostatic drugs are never inhibitory. (1+1=2) •• Results :Results : •• Indifference when the effect is equal to the single most active drug or equalIndifference when the effect is equal to the single most active drug or equal to the arithmetic sum of the two, use is not justified.to the arithmetic sum of the two, use is not justified. •• Antagonism : when the combined drug effect is less than the algebraic sumAntagonism : when the combined drug effect is less than the algebraic sum of the effects on the individual drugs in the mixture.of the effects on the individual drugs in the mixture. •• Synergism : ability of two antibiotics acting together to markedly increasesSynergism : ability of two antibiotics acting together to markedly increases the rate of bactericidal action compared to either drug alone.the rate of bactericidal action compared to either drug alone. •• Disadvantages :Disadvantages : •• Adds nothing to therapeutic efficacy and may even reduce it (antagonism).Adds nothing to therapeutic efficacy and may even reduce it (antagonism). •• Increase antibiotic toxicity and allergy.Increase antibiotic toxicity and allergy. •• Increase the likelihood of superinfectionIncrease the likelihood of superinfection •• Discourages specific etiologic diagnosis and promote false security.Discourages specific etiologic diagnosis and promote false security. •• Encourage inadequate doses, particularly with fixed dose combinationEncourage inadequate doses, particularly with fixed dose combination therapy.therapy. •• Increased costIncreased cost •• Emergence of resistant bacterial strainsEmergence of resistant bacterial strains •• Increase the environmental spread of antibiotic resistant bacteria.Increase the environmental spread of antibiotic resistant bacteria. •• FACTORS INFLUENCING ANTIBIOTIC THERAPYFACTORS INFLUENCING ANTIBIOTIC THERAPY •• Minimal Inhibitory ConcentrationMinimal Inhibitory Concentration •• Concentration-dependent Vs Time-dependent antibioticsConcentration-dependent Vs Time-dependent antibiotics
  18. 18. •• Post-antibiotic effectsPost-antibiotic effects •• MINIMAL INHIBITORY CONCENTRATIONMINIMAL INHIBITORY CONCENTRATION •• Is the lowest antibiotic concentration that prevents growth of microorganismIs the lowest antibiotic concentration that prevents growth of microorganism after an incubation period of 18 – 24 hours with a standard inoculum of 104after an incubation period of 18 – 24 hours with a standard inoculum of 104 to 105 cu/mlto 105 cu/ml •• MINIMAL BACTERICIDAL CONCENTRATIONMINIMAL BACTERICIDAL CONCENTRATION •• Is the lowest concentration of drug that causes the complete destruction ofIs the lowest concentration of drug that causes the complete destruction of the organisms or permits survival of less than 0.1% of the inoculumthe organisms or permits survival of less than 0.1% of the inoculum •• RULE OF THUMBRULE OF THUMB •• The concentration of the antibiotic in the blood should exceed the MIC by aThe concentration of the antibiotic in the blood should exceed the MIC by a factor of 2-8 times to offset the tissue barriers that restrict access to thefactor of 2-8 times to offset the tissue barriers that restrict access to the infected siteinfected site •• CONCENTRATION DEPENDENTCONCENTRATION DEPENDENT VsVs TIME DEPENDENT ANTIBIOTICSTIME DEPENDENT ANTIBIOTICS •• Aminoglycosides, metronidazole, fluoroquinolonesAminoglycosides, metronidazole, fluoroquinolones  Concentration dependentConcentration dependent •• Bactericidal activity depends on theBactericidal activity depends on the •• drug concentrationdrug concentration •• Beta-lactams and vancomycinBeta-lactams and vancomycin
  19. 19. •• Long time of exposure of theLong time of exposure of the  organismsorganisms •• Better the bactericidal activityBetter the bactericidal activity •• POSTANTIBIOTIC EFFECTSPOSTANTIBIOTIC EFFECTS •• Is the persistent supression of microbial growth after short time exposure toIs the persistent supression of microbial growth after short time exposure to an antimicrobial agent.an antimicrobial agent. •• MECHANISM :MECHANISM :  Is the time necessary to recover from sublethal structural andIs the time necessary to recover from sublethal structural and metabolic alterations that prevents resumption of bacterialmetabolic alterations that prevents resumption of bacterial regrowth.regrowth. •• Indications for antimicrobial agents in dentistryIndications for antimicrobial agents in dentistry •• Therapeutic indicationsTherapeutic indications •• Prophylactic indicationsProphylactic indications •• Dental procedure for which antibiotic prophylaxis is recommended toDental procedure for which antibiotic prophylaxis is recommended to prevent infective endocardititisprevent infective endocardititis •• (AHA recommendation)(AHA recommendation) •• Dental extractionsDental extractions •• Periodontal proceduresPeriodontal procedures
  20. 20. •• Replantation procedureReplantation procedure •• Implant placementImplant placement •• Initial placement of orthodontic bandsInitial placement of orthodontic bands •• Intra ligamentary local anesthetic injectionIntra ligamentary local anesthetic injection •• Incision and drainageIncision and drainage •• Not recommended :Not recommended :  1.Restorative dentistry1.Restorative dentistry  2.LA injections2.LA injections  3.Intracanal endodontic treatment3.Intracanal endodontic treatment  4.Post-op suture removal4.Post-op suture removal  5.Oral radiographs5.Oral radiographs •• CLASSIFICATION OF PENICILLINCLASSIFICATION OF PENICILLIN •• Natural penicillins :Natural penicillins : •• Penicillin G (Benzyl penicillin)Penicillin G (Benzyl penicillin) •• Acid resistant penicillins :Acid resistant penicillins : •• Phenoxymethyl penicillin (penicillin V)Phenoxymethyl penicillin (penicillin V) •• Penicillinase – resistant penicillins :Penicillinase – resistant penicillins : •• Acid labile : Methicillin, naficillin, cloxacillin, dicloxacillinAcid labile : Methicillin, naficillin, cloxacillin, dicloxacillin
  21. 21. •• Extended spectrum penicillins :Extended spectrum penicillins : •• Carboxypenicillins : Carbenicillin, ticarcillinCarboxypenicillins : Carbenicillin, ticarcillin •• Aminopenicillins : Ampicillin, amoxicillinAminopenicillins : Ampicillin, amoxicillin •• UreidopenicillinsUreidopenicillins •• BENZYL PENICILLIN (PENCILLIN G)BENZYL PENICILLIN (PENCILLIN G) •• Antibacterial activityAntibacterial activity •• Inhibits the growth of susceptible organism.Inhibits the growth of susceptible organism. •• Mainly gram +ve, gram –ve cocci and some gram +ve bacilli with exceptionMainly gram +ve, gram –ve cocci and some gram +ve bacilli with exception of enterococci.of enterococci. •• Cocci – Highly sensitive – Streptococci, Pneumococci, Staph. aureus, N.Cocci – Highly sensitive – Streptococci, Pneumococci, Staph. aureus, N. gonorrhoeae, N. meningitisgonorrhoeae, N. meningitis •• Bacilli – B. anthracis, Corynebacterium diphtheriae, clostridium tetany andBacilli – B. anthracis, Corynebacterium diphtheriae, clostridium tetany and spirochetesspirochetes •• Actinomyces israelii is moderately sensitiveActinomyces israelii is moderately sensitive •• Preparation and dose :Preparation and dose : •• PnG inj 0.5-5 MU i.m or i.v 6-12 hoursPnG inj 0.5-5 MU i.m or i.v 6-12 hours •• Procaine pencillin inj 0.5, 1 MU dry powder in vialProcaine pencillin inj 0.5, 1 MU dry powder in vial •• ADVERSE REACTIONS :ADVERSE REACTIONS : •• Miscellaneous reactions :Miscellaneous reactions : •• Nausea and vomiting on oral PnGNausea and vomiting on oral PnG •• Sterile inflammatory reaction at the site of IM inj.Sterile inflammatory reaction at the site of IM inj.
  22. 22. •• Prolonged IV administration may cause thrombophlebitisProlonged IV administration may cause thrombophlebitis •• Accidental IV administration of procaine PP cause anxiety, mentalAccidental IV administration of procaine PP cause anxiety, mental disturbances paraesthesia and convulsionsdisturbances paraesthesia and convulsions •• Intolerance :Intolerance : •• Major problem with PnG includes idiosyncratic, anaphylactic and allergicMajor problem with PnG includes idiosyncratic, anaphylactic and allergic reactionsreactions •• Other allergic reactions areOther allergic reactions are •• Skin rashesSkin rashes •• Serum sicknessSerum sickness •• Renal disturbanceRenal disturbance •• Hemolytic disturbanceHemolytic disturbance •• AnaphylaxisAnaphylaxis •• Jarisch herxheimer reactionJarisch herxheimer reaction •• Super infectionSuper infection •• HyperkalemiaHyperkalemia •• Uses :Uses : •• PnG is the drug of choice for infectionsPnG is the drug of choice for infections •• Streptococcal infectionsStreptococcal infections •• Pneumococcal infectionsPneumococcal infections •• Meningococcal infectionsMeningococcal infections
  23. 23. •• GonorrhoeaGonorrhoea •• SyphilisSyphilis •• DiphtheriaDiphtheria •• Tetanus and gas gangreneTetanus and gas gangrene •• Prophylactic usesProphylactic uses •• The major drawbacks of benzyl penicillin areThe major drawbacks of benzyl penicillin are •• Inactivation by the gastric hydrochloric acidInactivation by the gastric hydrochloric acid •• Short duration of actionShort duration of action •• Poor penetration into CSFPoor penetration into CSF •• Activity mainly against gram +ve organismActivity mainly against gram +ve organism •• Possibility of anaphylaxisPossibility of anaphylaxis •• Acid resistant pencillins :Acid resistant pencillins : •• 1. Potassium phenoxymethyl penicillin (penicillin V)1. Potassium phenoxymethyl penicillin (penicillin V) •• Dose : infants 60 mg, children 125-250 mg given 6 hourlyDose : infants 60 mg, children 125-250 mg given 6 hourly •• CRYSTAPEN-V, KAYPEN, PENIVORAL 65, 130, 125, 250 mg tabletsCRYSTAPEN-V, KAYPEN, PENIVORAL 65, 130, 125, 250 mg tablets 125 mg/5 ml dry ser125 mg/5 ml dry ser •• II) Pencillinase resistant pencillins :II) Pencillinase resistant pencillins : •• MethicillinMethicillin
  24. 24. •• Effective in staphylococciEffective in staphylococci •• It is given IM or IV (slow) in the dose of 1 gm every 4-6 hours.It is given IM or IV (slow) in the dose of 1 gm every 4-6 hours. •• Haematuria, albuminuria and reversible interstitial nephritis are the specialHaematuria, albuminuria and reversible interstitial nephritis are the special adverse effect of methicillin.adverse effect of methicillin. •• CloxacillinCloxacillin •• Weaker antibacterial activity.Weaker antibacterial activity. •• Distrubuted throught out the body, but highest concentration in kidney andDistrubuted throught out the body, but highest concentration in kidney and liver. 30% excreted in urine.liver. 30% excreted in urine. •• Oral dose for adults 2-4 gm divided into 4 portions children 50-Oral dose for adults 2-4 gm divided into 4 portions children 50- 100mg/kg/day.100mg/kg/day. •• IM adults 2-12 gm/day, children 100-300 mg/kg/day every 4-6 hours.IM adults 2-12 gm/day, children 100-300 mg/kg/day every 4-6 hours. •• BIOCLOX, KLOX, CLOCILIN 0.25, 0.5 gm cap, 0.5 gm/vial.BIOCLOX, KLOX, CLOCILIN 0.25, 0.5 gm cap, 0.5 gm/vial. •• III) Extended spectrum pencillins :III) Extended spectrum pencillins : •• Amino pencillinsAmino pencillins -- Ampicillin –Ampicillin – •• Antibacterial activity is similar to that of PnG that is more effective thanAntibacterial activity is similar to that of PnG that is more effective than PnG against a variety of gram-ve bacteriaPnG against a variety of gram-ve bacteria •• Drug is effective against H.influenzae strep.viridans, N.gonorrhea,Drug is effective against H.influenzae strep.viridans, N.gonorrhea, Salmonella, shigellae, Klebsilla and enterococci.Salmonella, shigellae, Klebsilla and enterococci. -- Absorption, fate and excretion :Absorption, fate and excretion : •• Oral absorption is incomplete but adequateOral absorption is incomplete but adequate •• Food interferes with absorptionFood interferes with absorption •• Partly excreted in bile and partly by kidneyPartly excreted in bile and partly by kidney
  25. 25. •• Dose : 0.5-2 gm oral/IM or IV depending on severity of infection every 6Dose : 0.5-2 gm oral/IM or IV depending on severity of infection every 6 hourshours -- Children : 25-50 mg/kg/dayChildren : 25-50 mg/kg/day -- AMPILIN, ROSCILLIAN, BIOCILIN – 250, 500 mg cap 100mg/mlAMPILIN, ROSCILLIAN, BIOCILIN – 250, 500 mg cap 100mg/ml ped drops, 250 mg/ml dry syr, 1 gm/vial inj.ped drops, 250 mg/ml dry syr, 1 gm/vial inj. •• USES :USES : •• Urinary tract infectionsUrinary tract infections •• Respiratory tract infectionsRespiratory tract infections •• MeningitisMeningitis •• GonorrhoeaGonorrhoea •• Bacillary dysentryBacillary dysentry •• SepticaemiasSepticaemias •• SABESABE •• Adverse effects :Adverse effects : •• Diarrhoea is frequentDiarrhoea is frequent •• Skin rashes is more commonSkin rashes is more common •• Unabsorbed drug irritates lower intestinesUnabsorbed drug irritates lower intestines •• Patient with history of hypersensitivity to PnG should not be givenPatient with history of hypersensitivity to PnG should not be given ampicillin.ampicillin.
  26. 26. •• AMOXICILLIN :AMOXICILLIN : •• This is a semisynthetic penicillin.This is a semisynthetic penicillin. •• (amino-p-hydroxy-benzylpenicillin)(amino-p-hydroxy-benzylpenicillin) •• Antibacterial spectrum is similar to ampicillin.Antibacterial spectrum is similar to ampicillin. •• Oral absorption is better; food does not interfere; higher and more sustainedOral absorption is better; food does not interfere; higher and more sustained blood levels are produced.blood levels are produced. •• It is less protein bond and urinary excretion is higher than that of ampicillin.It is less protein bond and urinary excretion is higher than that of ampicillin. •• Incidence of diarrhoea is lessIncidence of diarrhoea is less •• Dose : 0.25-1 g TDS oral;Dose : 0.25-1 g TDS oral; •• AMOXYLIN, NOVAMOX, SYNAMOX, MOX, AMOXIL 250, 500 mgAMOXYLIN, NOVAMOX, SYNAMOX, MOX, AMOXIL 250, 500 mg cap, 125 mg/5ml dry syr, 500 mg/vial inj.cap, 125 mg/5ml dry syr, 500 mg/vial inj. •• USES :USES : •• Oro-dental infectionsOro-dental infections •• Upper RTIUpper RTI •• BronchitisBronchitis •• Urinary infectionUrinary infection •• SBESBE •• GonorrhoeaGonorrhoea •• BETA LACTAMASE INHIBITORSBETA LACTAMASE INHIBITORS
  27. 27. •• CLAVULANIC ACIDCLAVULANIC ACID •• Obtained from STREPTOMYCES CLAVULIGERUSObtained from STREPTOMYCES CLAVULIGERUS •• Betalactam ring – no antibacterial activityBetalactam ring – no antibacterial activity •• Suicide inhibitor –inactivated after binding to enzymeSuicide inhibitor –inactivated after binding to enzyme •• Permeates the outer layers of cell wall of gram-ve bacteriaPermeates the outer layers of cell wall of gram-ve bacteria •• Adverse effects :Adverse effects : •• Pain-thrombophebitisPain-thrombophebitis •• Rashes and diarrhoeaRashes and diarrhoea •• Uses :Uses : •• Mixed aerobic-anaerobic infectionsMixed aerobic-anaerobic infections •• Dental infections caused by beta lactamase producing bacteriaDental infections caused by beta lactamase producing bacteria •• GonorrhoeaGonorrhoea •• Skin/soft tissue infectionsSkin/soft tissue infections •• SULBACTAMSULBACTAM •• CEPHALOSPORINSCEPHALOSPORINS •• Cephalosporium acremonium was the first source.Cephalosporium acremonium was the first source. •• They contain 7 amino cephalosporonic acid nucleus.They contain 7 amino cephalosporonic acid nucleus. •• Structurally they contain betalactam and dihydro thiazine rings.Structurally they contain betalactam and dihydro thiazine rings. •• Mechanism of action :Mechanism of action :
  28. 28. •• Act by inhibiting bacterial cell was synthesis and are bactericidal.Act by inhibiting bacterial cell was synthesis and are bactericidal. •• ClassificationClassification •• Classified according to its antibacterial activity.Classified according to its antibacterial activity. •• First generation cephalosporinFirst generation cephalosporin •• Good activity against gram +ve bacteria. (except enterococci).Good activity against gram +ve bacteria. (except enterococci). •• Most oral cavity anaerobes are sensitive.Most oral cavity anaerobes are sensitive. •• ParentalParental OralOral •• CEPHALOTHINCEPHALOTHIN CEPHALEXINCEPHALEXIN •• CEFAZOLINCEFAZOLIN CEPHRADINECEPHRADINE  CEFADROXILCEFADROXIL •• Cephalaxin and Cephadroxil :Cephalaxin and Cephadroxil : •• Useful in treating community acquired, respiratory and urinary tractUseful in treating community acquired, respiratory and urinary tract infections and in surgical prophylaxis.infections and in surgical prophylaxis. •• Infections of head and neck region.Infections of head and neck region. •• Dose: Oral 0.25 - 1g 6-8 hrlyDose: Oral 0.25 - 1g 6-8 hrly •• Children : 25-100mg/kg/dayChildren : 25-100mg/kg/day •• IM – 0.25g 8 hrly (mild cases) 1g 6 hrly (severe cases).IM – 0.25g 8 hrly (mild cases) 1g 6 hrly (severe cases). •• Drops – cephaxin 125mg/5ml syrup.Drops – cephaxin 125mg/5ml syrup. •• 100mg /ml ped. drops.100mg /ml ped. drops. •• SPORIDEX, CEPHAXIN, CEPHACILLIN, CEFADROX, DROXYLSPORIDEX, CEPHAXIN, CEPHACILLIN, CEFADROX, DROXYL
  29. 29. •• Second generation cephalosporins :Second generation cephalosporins : •• Increased activity against gram –ve organism.Increased activity against gram –ve organism. •• More active against anaerobes.More active against anaerobes. -- ParenteralParenteral OralOral •• CEFUROXIMECEFUROXIME CEFACLORCEFACLOR •• CEFOXITINCEFOXITIN CEFUROXIME AXETILCEFUROXIME AXETIL •• More active against H. influenzae, E coli.More active against H. influenzae, E coli. •• Dose : 250mg, 125mg, 125mg/5ml syr. andDose : 250mg, 125mg, 125mg/5ml syr. and •• 50 mg /ml ped. drops.50 mg /ml ped. drops. •• KEFLOR, CEFTUM, CEFOGEN, FUROXIL.KEFLOR, CEFTUM, CEFOGEN, FUROXIL. •• Third Generation CephalosporinsThird Generation Cephalosporins •• High activity against gram –ve entrobacteriaceae, some inhibitHigh activity against gram –ve entrobacteriaceae, some inhibit Pseudomonas as well.Pseudomonas as well. •• Parenteral OralParenteral Oral  Cefataxime CefiximeCefataxime Cefixime  Ceftizoxime Cefpodoxime proxetilCeftizoxime Cefpodoxime proxetil  Ceftriaxone CefdinirCeftriaxone Cefdinir  Ceftazidime CeftibutenCeftazidime Ceftibuten  CefoperazoneCefoperazone •• Dose: 250mg, 500mg, 1000mg per vial injDose: 250mg, 500mg, 1000mg per vial inj •• CLAFORAN, CEFIZOX,MONOCEF,CEFAZID.CLAFORAN, CEFIZOX,MONOCEF,CEFAZID.
  30. 30. •• Fourth Generation CephalosporinsFourth Generation Cephalosporins •• Similar to 3Similar to 3rdrd generation ,but is highly resistant to beta- lactamases.generation ,but is highly resistant to beta- lactamases. Due to high potency and extended spectrum, it is effective in many seriousDue to high potency and extended spectrum, it is effective in many serious infections like hospital acquired pneumonia, bacteremia, septicaemia.infections like hospital acquired pneumonia, bacteremia, septicaemia. •• ParentralParentral  CefepimeCefepime  CefpiromeCefpirome •• Dose: 1-2 g i.m/i.v 12hrlyDose: 1-2 g i.m/i.v 12hrly •• CEFROM, CEFROTH, KEFAGECEFROM, CEFROTH, KEFAGE •• Adverse reactions :Adverse reactions : •• Local reactions – cause pain (IM) and cause thrombophlebitis (IV)Local reactions – cause pain (IM) and cause thrombophlebitis (IV) •• Allergy – skin rashesAllergy – skin rashes •• NephrotoxicityNephrotoxicity •• Bleeding disordersBleeding disorders •• Intolerance to alcoholIntolerance to alcohol •• Uses :Uses : •• Alternatives to penicillins.Alternatives to penicillins. •• RTI, UTI and soft tissue infectionRTI, UTI and soft tissue infection •• Penicillinase producing staph infection.Penicillinase producing staph infection. •• Septicaemias.Septicaemias.
  31. 31. •• Surgical prophylaxisSurgical prophylaxis •• Meningitis, gonorrhoeaMeningitis, gonorrhoea •• TyphoidTyphoid •• Mixed aerobic and anaerobic infectionsMixed aerobic and anaerobic infections •• Infection by odd organism or hospital infectionsInfection by odd organism or hospital infections •• Prophylactic treatment in neutropenic patients.Prophylactic treatment in neutropenic patients. •• Dental infectionsDental infections •• Alternative to pencillins- hypersensitivity and resistanceAlternative to pencillins- hypersensitivity and resistance •• Oral – 1Oral – 1stst and 2and 2ndnd generationgeneration •• SulfonamidesSulfonamides •• Short acting(4-8hr)- SulfadiazineShort acting(4-8hr)- Sulfadiazine •• Intermediate acting (8-12hr)- Sulfamethoxazole,Intermediate acting (8-12hr)- Sulfamethoxazole, SulfamoxoleSulfamoxole •• Long acting(7 days)- Sulfadoxine, SulfamethopyrazineLong acting(7 days)- Sulfadoxine, Sulfamethopyrazine •• Special purpose Sulfonamides – Sulfacetamide sod,Special purpose Sulfonamides – Sulfacetamide sod,  Sulfasalazine,Sulfasalazine,  Mafenide,Mafenide,  Silver sulfadiazineSilver sulfadiazine •• Mechanism of actionMechanism of action •• InIn bacteriabacteria, antibacterial sulfonamides act as, antibacterial sulfonamides act as competitive inhibitorscompetitive inhibitors of theof the enzymeenzyme dihydropteroate synthetasedihydropteroate synthetase, DHPS. DHPS catalyses the conversion, DHPS. DHPS catalyses the conversion of PABA (of PABA (parapara-aminobenzoate-aminobenzoate) to) to dihydropteroatedihydropteroate, a key step in, a key step in folatefolate synthesis. Folate is necessary for the cell to synthesizesynthesis. Folate is necessary for the cell to synthesize nucleic acidsnucleic acids (nucleic(nucleic acids are essential building blocks ofacids are essential building blocks of DNADNA andand RNARNA), and in its absence), and in its absence
  32. 32. cells will be unable to divide. Hence the sulfonamide antibacterials exhibit acells will be unable to divide. Hence the sulfonamide antibacterials exhibit a bacteriostaticbacteriostatic rather thanrather than bactericidalbactericidal effect.effect. •• Side effectsSide effects •• Sulfonamides have the potential to cause a variety of untoward reactions,Sulfonamides have the potential to cause a variety of untoward reactions, including urinary tract disorders, haemopoietic disorders,including urinary tract disorders, haemopoietic disorders, porphyriaporphyria andand hypersensitivity reactions. When used in large dose, it may develop a stronghypersensitivity reactions. When used in large dose, it may develop a strong allergic reaction. One of the most serious isallergic reaction. One of the most serious is Stevens Johnson syndromeStevens Johnson syndrome(or(or toxic epidermal necrolysis).toxic epidermal necrolysis). •• QUINOLONESQUINOLONES •• Entirely synthetic antimicrobials are active primarily against gram –veEntirely synthetic antimicrobials are active primarily against gram –ve bacteria.bacteria. •• Nalidixic acid- low potency, modest blood and tissue levels, limitedNalidixic acid- low potency, modest blood and tissue levels, limited spectrum, high resistancespectrum, high resistance •• Fluoroquinolones – high potency, expanded spectrum, better tissueFluoroquinolones – high potency, expanded spectrum, better tissue penetrance, slow resistance.penetrance, slow resistance. •• CIPROFLOXACINCIPROFLOXACIN •• First generation FQ active against a broad range of bacteria especiallyFirst generation FQ active against a broad range of bacteria especially
  33. 33. gram –ve aerobic bacilli.gram –ve aerobic bacilli. •• Microbiological features :Microbiological features : •• Rapid bactericidal activity and high potency.Rapid bactericidal activity and high potency. •• Relatively long post antibiotic effectRelatively long post antibiotic effect •• Low frequency of mutational resistance.Low frequency of mutational resistance. •• Protective intestinal streptococci and anaerobes are spared.Protective intestinal streptococci and anaerobes are spared. •• Less active at acidic pH.Less active at acidic pH. •• Adverse effect :Adverse effect : •• GIT – Nausea, vomiting, bad taste, anorexia, diarrhoea is infrequent.GIT – Nausea, vomiting, bad taste, anorexia, diarrhoea is infrequent. •• CNS- Dizziness, headache, restlessness, anxiety, insomnia and seizures areCNS- Dizziness, headache, restlessness, anxiety, insomnia and seizures are rare.rare. •• Skin/hypersensitivity – rashes, pruritis, urticaria.Skin/hypersensitivity – rashes, pruritis, urticaria. •• Tendonitis and tendon ruptureTendonitis and tendon rupture •• Uses :Uses : •• Broad range of infectionsBroad range of infections •• Minor cases, orodental -not indicatedMinor cases, orodental -not indicated •• UTIUTI •• Bacterial gastroenteritisBacterial gastroenteritis •• Prophylaxis -TyphoidProphylaxis -Typhoid
  34. 34. •• Bone, soft tissue, wound infection.Bone, soft tissue, wound infection. •• Combinations- gram –ve septicaemiasCombinations- gram –ve septicaemias •• TuberculosisTuberculosis •• CIFRAN, CIPLOX, CIPROBID, CIPROLETCIFRAN, CIPLOX, CIPROBID, CIPROLET •• 250, 500,750 mg tab, 200mg/100 ml IV infusion 3mg/ml eye drops.250, 500,750 mg tab, 200mg/100 ml IV infusion 3mg/ml eye drops. •• NorfloxacinNorfloxacin -- Less potent than Ciprofloxacin.Less potent than Ciprofloxacin. -- Used for Pseudomonas, Urinary and genital tract infections.Used for Pseudomonas, Urinary and genital tract infections. •• NORFLOX -200,400mgNORFLOX -200,400mg •• OfloxacinOfloxacin -- Activity against gram –ve bacteriaActivity against gram –ve bacteria -- Chlamydia and MycoplasmaChlamydia and Mycoplasma -- Alternative drug for TuberculosisAlternative drug for Tuberculosis -- Used mainly for GonorrheaUsed mainly for Gonorrhea •• ZANOCIN -200,400mgZANOCIN -200,400mg •• LevofloxacinLevofloxacin -- Sinusitis, Pylonephritis, soft tissue infections.Sinusitis, Pylonephritis, soft tissue infections. •• LOMEF- 400mgLOMEF- 400mg •• GatifloxacinGatifloxacin -- Excellent activity against Streptococci pneumoniaeExcellent activity against Streptococci pneumoniae -- Indicated in community acquired pneumonia, exacerbation of chronicIndicated in community acquired pneumonia, exacerbation of chronic
  35. 35. bronchitis, and other respiratory tract infections.bronchitis, and other respiratory tract infections. -- Used in urinary tract infectons and gonorrhhoea.Used in urinary tract infectons and gonorrhhoea. •• GATIQIN – 200,400 mg tabGATIQIN – 200,400 mg tab •• SparfloxacinSparfloxacin  -Enhanced activity against gram –ve bacteria, Bacteroides-Enhanced activity against gram –ve bacteria, Bacteroides fragilis, anaerobes and mycobacteria.fragilis, anaerobes and mycobacteria. -- Indicated in Pneumonias, chronic bronchitis, sinusitis and other ENTIndicated in Pneumonias, chronic bronchitis, sinusitis and other ENT infections.infections. -- Good efficacy in Mycobacterium avium infection in AIDS patientsGood efficacy in Mycobacterium avium infection in AIDS patients and Leprosy.and Leprosy. -- Higher incidence of phototoxic reactions.Higher incidence of phototoxic reactions. •• SPARTA, SPARDAC -100,200 mg tabSPARTA, SPARDAC -100,200 mg tab •• NITROIMIDAZOLESNITROIMIDAZOLES •• METRONIDAZOLE :METRONIDAZOLE : •• Introduced in 1959Introduced in 1959 •• Broad spectrum- e.histolytica, giardia lambliaBroad spectrum- e.histolytica, giardia lamblia •• Anaerobic infections- chance discoveryAnaerobic infections- chance discovery •• Tinidazole, secnidazole, ornidazole, satranidazoleTinidazole, secnidazole, ornidazole, satranidazole •• Cidal activity against protozoa and anaerobic bacteria such as B fragilis,Cidal activity against protozoa and anaerobic bacteria such as B fragilis, Fusobacterium, h.pyroli, spirochetesFusobacterium, h.pyroli, spirochetes •• Metronidazole is selectively toxic to anaerobic microorganisms.Metronidazole is selectively toxic to anaerobic microorganisms.
  36. 36. •• Pharmacokinetics :Pharmacokinetics : •• Completely absorbed from the small intestine.Completely absorbed from the small intestine. •• Widely distributed in the bodyWidely distributed in the body •• It is metabolized in liverIt is metabolized in liver •• Excreted in urine. 8hrExcreted in urine. 8hr •• Adverse effects :Adverse effects : •• Anorexia, nausea, metallic taste and abdominal crampsAnorexia, nausea, metallic taste and abdominal cramps •• Looseness of stool is occasional,Looseness of stool is occasional, •• Headache, glossitis, dryness of mouth, dizziness, rashes and transientHeadache, glossitis, dryness of mouth, dizziness, rashes and transient neutropenia.neutropenia. •• Prolonged administration may cause peripheral neuropathy and CNS effectsProlonged administration may cause peripheral neuropathy and CNS effects •• ThrombophlebitisThrombophlebitis •• Contraindications :Contraindications : •• In neurological disease, blood dyscrasias, chronic alcoholismIn neurological disease, blood dyscrasias, chronic alcoholism •• First trimister of pregnancyFirst trimister of pregnancy •• OrnidazoleOrnidazole
  37. 37. •• Activity similar to Metronidazole but it is slowly metabolised .Activity similar to Metronidazole but it is slowly metabolised . •• Used in anaerobic infections, Amoebiasis, Giardiasis, Trichomonasis, andUsed in anaerobic infections, Amoebiasis, Giardiasis, Trichomonasis, and bacterial vaginosis.bacterial vaginosis. •• DAZOLIC -500mg tab, 500mg/100ml vial for i.v. infusion.DAZOLIC -500mg tab, 500mg/100ml vial for i.v. infusion. •• Uses- Orodental infectionsUses- Orodental infections •• MZ 200-400mg TDS(15-30mg/kg/day) – anaerobes not inhibited byMZ 200-400mg TDS(15-30mg/kg/day) – anaerobes not inhibited by pencillinpencillin •• ANUG- MZ+Amox - 5daysANUG- MZ+Amox - 5days •• Periodontitis, pericoronitis, acute apical infections, endodontic infections- 5-Periodontitis, pericoronitis, acute apical infections, endodontic infections- 5- 7 days7 days •• Aerobic and facultative bacteria- MZ+pencillin/cephalosporin/macrolidesAerobic and facultative bacteria- MZ+pencillin/cephalosporin/macrolides •• FLAGYL, METROGYL, METRON, ALDEZOLE 200, 400 mg tab, 200FLAGYL, METROGYL, METRON, ALDEZOLE 200, 400 mg tab, 200 mg/5ml susp.mg/5ml susp. •• TINIDAZOLETINIDAZOLE •• It is an equally efficacious congener of metronidazoleIt is an equally efficacious congener of metronidazole •• Metabolism is slower and duration of action is longerMetabolism is slower and duration of action is longer •• Incidence of side effects is lower-Metallic taste, nausea, rashesIncidence of side effects is lower-Metallic taste, nausea, rashes •• TINIBA, TRIDAZOLE, 300, 500, 1000 mg tab, 800 mg/400 ml ivTINIBA, TRIDAZOLE, 300, 500, 1000 mg tab, 800 mg/400 ml iv •• Dental infections: 0.5g(10mg/kg) BD for 5 daysDental infections: 0.5g(10mg/kg) BD for 5 days •• 2g orally followed 0.5g BD for 5days2g orally followed 0.5g BD for 5days •• 800mg iv until oral therapy800mg iv until oral therapy
  38. 38. •• TETRACYCLINESTETRACYCLINES •• Napthacene derivatives made up by fusion of 4 partially unsaturatedNapthacene derivatives made up by fusion of 4 partially unsaturated cyclohexane radicalscyclohexane radicals •• Tetracyclines are bacteriostatic.Tetracyclines are bacteriostatic. •• ClassificationClassification •• Antimicrobial activity :Antimicrobial activity : •• Gram+ve and –ve cocci are sensitive-RGram+ve and –ve cocci are sensitive-R •• Gram+ve bacilli are inhibitedGram+ve bacilli are inhibited •• Entero bacteriaceae are highly resistantEntero bacteriaceae are highly resistant •• Spirochetes are quite sensitiveSpirochetes are quite sensitive •• All rickettsiae and chlamydiae are highly sensitiveAll rickettsiae and chlamydiae are highly sensitive •• Mechanism of actionMechanism of action •• Tetracycline antibiotics inhibitTetracycline antibiotics inhibit protein synthesisprotein synthesis by inhibiting the binding ofby inhibiting the binding of aminoacyl-tRNAaminoacyl-tRNA to theto the mRNA-ribosomemRNA-ribosome complex. They do so mainly bycomplex. They do so mainly by binding to thebinding to the 30S ribosomal subunit30S ribosomal subunit in thein the mRNA translationmRNA translation complex.complex.[[ •• Tetracyclines are widely used in treatment of periodontal diseases.Tetracyclines are widely used in treatment of periodontal diseases.
  39. 39. •• Used in the treatment of Localised aggressive periodontitis.Used in the treatment of Localised aggressive periodontitis. •• Adverse effects :Adverse effects : •• GIT-epigastric burning, nausea, vomiting, diarrheaGIT-epigastric burning, nausea, vomiting, diarrhea •• Liver damageLiver damage •• Renal failureRenal failure •• PhototoxicityPhototoxicity •• Effects on teeth & bones- Ca tetracycline chelateEffects on teeth & bones- Ca tetracycline chelate •• Hypersensitivity ReactionsHypersensitivity Reactions •• Superinfection; Antianabolic effectSuperinfection; Antianabolic effect •• DOSEDOSE •• Tetracycline – 1-2g per day in adultsTetracycline – 1-2g per day in adults •• Children over 8yrs -25 to 50mg /kg daily in 2 to4 divided doseChildren over 8yrs -25 to 50mg /kg daily in 2 to4 divided dose •• TERRAMYCIN,RESTECLIN-250,500mgcap,50mg/ml in10ml vial injTERRAMYCIN,RESTECLIN-250,500mgcap,50mg/ml in10ml vial inj •• Ledermycin 150,300mg cap/tabLedermycin 150,300mg cap/tab •• DOXT, NOVADOX, TETRADOX-100mg cap.DOXT, NOVADOX, TETRADOX-100mg cap. •• Cyanomycin 50,100 mg capCyanomycin 50,100 mg cap •• Precaution :Precaution :
  40. 40. •• Not to be used in pregnancy, lactation and in childrenNot to be used in pregnancy, lactation and in children •• Avoided in patients on diureticsAvoided in patients on diuretics •• Used cautiously in renal and hepatic insufficiencyUsed cautiously in renal and hepatic insufficiency •• Beyond expiry date should not be usedBeyond expiry date should not be used •• Do not mix injectable Tc with Pn- inactivation occursDo not mix injectable Tc with Pn- inactivation occurs •• Local Drug Delivery SystemsLocal Drug Delivery Systems •• Subgingival DoxycyclineSubgingival Doxycycline •• -FDA approved 10% of Doxycycline in gel system using a syringe-FDA approved 10% of Doxycycline in gel system using a syringe Atridox.Atridox. •• Reduction in oral microbes. No overgrowth of foreign pathogens.Reduction in oral microbes. No overgrowth of foreign pathogens. •• Subgingival MinocyclineSubgingival Minocycline •• --Sustained release form of Minocycline microspheres(Arestin) forSustained release form of Minocycline microspheres(Arestin) for subgingival placement as an adjuvant to scaling and root planing.subgingival placement as an adjuvant to scaling and root planing. •• -2% Encapsulated into bioresorbable microspheres is used.-2% Encapsulated into bioresorbable microspheres is used. •• ORODENTAL CONDITIONSORODENTAL CONDITIONS •• Limited use- acute dental infectionsLimited use- acute dental infections •• Periodontal diseases – collagenasePeriodontal diseases – collagenase •• Refractory periodontal disease – 2week tetracycline(1g/day) orRefractory periodontal disease – 2week tetracycline(1g/day) or doxycycline(0.1-0.2g/day)doxycycline(0.1-0.2g/day) •• Juvenile periodontitis – 2-4 weekJuvenile periodontitis – 2-4 week
  41. 41. •• MACROLIDESMACROLIDES •• Macrocyclic lactone ring with attached sugarsMacrocyclic lactone ring with attached sugars •• ERYTHROMYCIN-Streptomyces erythreusERYTHROMYCIN-Streptomyces erythreus •• Alternative to pencillinAlternative to pencillin •• Water solubility is limited-stable in coldWater solubility is limited-stable in cold •• Antibacterial activity : static- cidalAntibacterial activity : static- cidal •• Narrow spectrum antibioticNarrow spectrum antibiotic •• against penicillin resistant staphylococciagainst penicillin resistant staphylococci •• Active against more gram+veActive against more gram+ve •• Mechanism of action :Mechanism of action : •• Dose :Dose : •• Adults 250 - 500mg 6hrlyAdults 250 - 500mg 6hrly •• Children 30 – 60mg/kg/dayChildren 30 – 60mg/kg/day •• Erythromycin (base) - ERYSAFE 250 mg tabErythromycin (base) - ERYSAFE 250 mg tab •• Erythromycin stearate -ERYTHROCIN – 250,500mg tabErythromycin stearate -ERYTHROCIN – 250,500mg tab •• 100mg/5ml susp;100mg/ml ped drops100mg/5ml susp;100mg/ml ped drops •• E estolate- ALTHROCIN 125mg kid tabE estolate- ALTHROCIN 125mg kid tab •• E ethylsuccinate- ERYNATEE ethylsuccinate- ERYNATE
  42. 42. •• Adverse effects :Adverse effects : •• GIT – epigastric painGIT – epigastric pain •• On high doses – hearing impairmentOn high doses – hearing impairment •• Hypersensitivity reactions – rareHypersensitivity reactions – rare •• Uses :Uses : •• Substitute for penicillin, pencillin resistant infectionsSubstitute for penicillin, pencillin resistant infections •• Oral adm, safe and effectiveOral adm, safe and effective •• Perio/periapical/NUG/extractionPerio/periapical/NUG/extraction •• Prophylactic useProphylactic use •• ROXITHROMYCINROXITHROMYCIN •• Semisynthetic - long acting, stable macrolideSemisynthetic - long acting, stable macrolide •• Antibacterial spectrum similar to erythromycinAntibacterial spectrum similar to erythromycin •• DoseDose - 150-300mg BD 30min before food- 150-300mg BD 30min before food •• Children - 2.5-5mg/kg BDChildren - 2.5-5mg/kg BD •• ROXID, ROXIBID 150,300mg tabROXID, ROXIBID 150,300mg tab •• 50mg kid tab,150 mg tab50mg kid tab,150 mg tab •• Clarithromycin – CLARIMAC 250,500mg tabClarithromycin – CLARIMAC 250,500mg tab •• CLINDAMYCINCLINDAMYCIN •• It is lincosamide antibiotic having similar action (macrolide 50s)It is lincosamide antibiotic having similar action (macrolide 50s) •• Bacteriostatic – low conc;Bacteriocidal – high concBacteriostatic – low conc;Bacteriocidal – high conc
  43. 43. •• Most active against gram+ve cocci, C.diphtheriae, ActinomycesMost active against gram+ve cocci, C.diphtheriae, Actinomyces •• Highly active against – anaerobes (B fragilis)Highly active against – anaerobes (B fragilis) •• Pharmacokinetics :Pharmacokinetics : •• Oral absorption – goodOral absorption – good •• Distribution – skeletal and soft tissuesDistribution – skeletal and soft tissues •• Excreted in urineExcreted in urine •• Adverse effects :Adverse effects : •• Rashes ,UrticariaRashes ,Urticaria •• Abdominal painAbdominal pain •• Superinfection -Enterocolitis &DiarrhoeaSuperinfection -Enterocolitis &Diarrhoea •• Uses :Uses : •• Anaerobic and mixed infections- alternative to Pn & macroAnaerobic and mixed infections- alternative to Pn & macro •• Abscess and bone infections-staphy and bacteroidsAbscess and bone infections-staphy and bacteroids •• Infective endocarditisInfective endocarditis •• Doses : 150-300 mg QID oral ; 200-600mg I.v. 8 hourlyDoses : 150-300 mg QID oral ; 200-600mg I.v. 8 hourly •• DALCAP, CLINCIN, DALCIN, 150, 300 mg cap, 300mg/2ml and 600DALCAP, CLINCIN, DALCIN, 150, 300 mg cap, 300mg/2ml and 600 mg/4ml inj.mg/4ml inj. •• Anti fungal drugsAnti fungal drugs •• FungusFungus •• Composed of a rigid cell wall made up of chitin and variousComposed of a rigid cell wall made up of chitin and various polysaccharides, and a cell membrane containing ergosterolpolysaccharides, and a cell membrane containing ergosterol
  44. 44. •• Protective layers of the fungal cell make the organism resistant to antibioticsProtective layers of the fungal cell make the organism resistant to antibiotics •• Related groups of anti fungal agentsRelated groups of anti fungal agents •• 1.Antibiotics1.Antibiotics •• A. PolyenesA. Polyenes •• B. Heterocyclic benzofuramB. Heterocyclic benzofuram •• 2.Antimetabolites2.Antimetabolites •• 3. Azoles3. Azoles •• A.ImidazolesA.Imidazoles •• B.TriazolesB.Triazoles •• 4.Allylamine4.Allylamine •• 5.Topical agents5.Topical agents •• NystatinNystatin •• A polyene derived fromA polyene derived from Streptomyces nourseiStreptomyces noursei •• Binds to sterols of fungal cell membraneBinds to sterols of fungal cell membrane •• Topical antifungal agentTopical antifungal agent- fungicidal- fungicidal •• 22ndnd choice to clotrimazolechoice to clotrimazole •• 1 lac units-4 times a day, 10-14 days1 lac units-4 times a day, 10-14 days •• Suspended with glycerineSuspended with glycerine •• CLOTRIMAZOLECLOTRIMAZOLE •• Effective in the topical treatment. Esp, athletes foot, otomycosis and oral,Effective in the topical treatment. Esp, athletes foot, otomycosis and oral, cutaneous candidiasis.cutaneous candidiasis.
  45. 45. •• 10mg -3-4times a day. Gel or lotion-denture stomatitis10mg -3-4times a day. Gel or lotion-denture stomatitis •• Angular chelitisAngular chelitis •• well tolerated although Local irritation and burningwell tolerated although Local irritation and burning •• No systemic toxicity is seen after topical use.No systemic toxicity is seen after topical use. •• SURFAZ, CLOTRIN, CLODERM, 1% lotion, cream, powder 100mg tab.SURFAZ, CLOTRIN, CLODERM, 1% lotion, cream, powder 100mg tab. •• ANTIVIRAL DRUGSANTIVIRAL DRUGS •• Anti-herpes virusAnti-herpes virus •• Idoxuridine,acylovir,famiclovirIdoxuridine,acylovir,famiclovir •• Anti-retrovirusAnti-retrovirus •• NRTINRTI •• ZidovudineZidovudine •• LamivudineLamivudine •• NNRTINNRTI •• nevirapinenevirapine •• PIPI •• RitonavirRitonavir •• IndinavirIndinavir •• Antiinnfluenza virusAntiinnfluenza virus •• AmantadineAmantadine •• Nonselective antiviral drugs-ribavirinNonselective antiviral drugs-ribavirin •• AcyclovirAcyclovir
  46. 46. •• Indications:Indications: Herpes simplex virus (HSV) 1 and 2 infections; HSVHerpes simplex virus (HSV) 1 and 2 infections; HSV encephalitis; shingles and chickenpox; ointment for herpes infections; creamencephalitis; shingles and chickenpox; ointment for herpes infections; cream for cold soresfor cold sores •• Actions:Actions: Inhibits viral DNA replicationInhibits viral DNA replication •• SymptomsSymptoms •• Rapid progressing- facial cellulitis-HI/SPRapid progressing- facial cellulitis-HI/SP •• Chronic/ slowly progressing-odontogenic- staphylococcal/mixedChronic/ slowly progressing-odontogenic- staphylococcal/mixed •• >101 F –nonodontogenic- hospitalization>101 F –nonodontogenic- hospitalization •• Colour:red/ violeciousColour:red/ violecious •• Swelling: indurated, non fluctuant or erythematous – cellulitisSwelling: indurated, non fluctuant or erythematous – cellulitis •• Pointed, fluctuant or productive- abscessPointed, fluctuant or productive- abscess •• ManagementManagement •• Upper faceUpper face •• Outpatient: amoxicillin clavulanate or cefaclor orallyOutpatient: amoxicillin clavulanate or cefaclor orally •• Ceftriaxone- 1 day ivCeftriaxone- 1 day iv •• Inpatient : cefuroxime/ ampicillin+ sulbactam 7-10 daysInpatient : cefuroxime/ ampicillin+ sulbactam 7-10 days •• Odontogenic –pencillin/ clindamycin, surgical interventionOdontogenic –pencillin/ clindamycin, surgical intervention •• Lower faceLower face •• Outpatient: cephalexin, amoxicillin clavuanate, erythromycinOutpatient: cephalexin, amoxicillin clavuanate, erythromycin •• Inpatient : iv cefazolin, clindamycinInpatient : iv cefazolin, clindamycin •• Some of the commonly used drugsSome of the commonly used drugs •• Amox-250,500mg-tidAmox-250,500mg-tid •• 250mg-Rs 67.50250mg-Rs 67.50 •• 500mg-Rs120.80500mg-Rs120.80
  47. 47.  Children20-40mg/kg body weight-tidChildren20-40mg/kg body weight-tid  -125,250mg-125,250mg •• Cephalexin(sporidex)Cephalexin(sporidex) •• 250,500mg250,500mg •• 250mg-10tab-Rs66.50250mg-10tab-Rs66.50 •• 500mg-10tab-Rs120.50500mg-10tab-Rs120.50 •• 125mg,250mg/5ml125mg,250mg/5ml •• 125mg;30ml-Rs34.50125mg;30ml-Rs34.50 •• 250mg;30ml-Rs52.60250mg;30ml-Rs52.60 •• Sporidex dispersible tabsSporidex dispersible tabs •• 125mg-10tabs-Rs32.25125mg-10tabs-Rs32.25 •• 250mg-10tabs-Rs69.95250mg-10tabs-Rs69.95 •• Paed drops-100mg/mlPaed drops-100mg/ml •• 10ml-Rs3310ml-Rs33 •• MetrogylMetrogyl •• 200mg;tab 10-Rs3.64200mg;tab 10-Rs3.64 •• 400mg;tab 10-6.31- given tid for 5-10 days400mg;tab 10-6.31- given tid for 5-10 days •• Suspension; 200mg /5ml-30ml-Rs8.09Suspension; 200mg /5ml-30ml-Rs8.09 •• 60ml-Rs-12.2760ml-Rs-12.27
  48. 48. •• List of referencesList of references •• Essentials of medical pharmacology :Essentials of medical pharmacology : •• KD TRIPATHI; 5th edi.KD TRIPATHI; 5th edi. •• Clinical pharmacology – Bennet & Brown 9Clinical pharmacology – Bennet & Brown 9thth eded •• Oral & maxillofacial infections – Topazian 4Oral & maxillofacial infections – Topazian 4thth eded •• .Text book of pediatric dentistry – Damle 3.Text book of pediatric dentistry – Damle 3rdrd eded •• Caranza Text book of periodontology 10Caranza Text book of periodontology 10thth

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