Antibiotics /cosmetic dentistry courses

ANTIBIOTICSANTIBIOTICS
INDIAN DENTAL ACADEMYINDIAN DENTAL ACADEMY
Leader in continuing Dental EducationLeader in continuing Dental Education
www.indiandentalacademy.comwww.indiandentalacademy.com

Antibiotics are chemical substancesAntibiotics are chemical substances
elaborated by various species of microelaborated by various species of micro
organisms, such as fungi, actinomycetes andorganisms, such as fungi, actinomycetes and
bacteria.bacteria.
Sulfanamider were the first antimicrobialSulfanamider were the first antimicrobial
agents effective against pyogenic bacterialagents effective against pyogenic bacterial
injection.injection.
Initiation of the therapeutic use ofInitiation of the therapeutic use of
sulfanamides in the late 1930s and penicillinsulfanamides in the late 1930s and penicillin
shortly there after represents one of theshortly there after represents one of the
highlights in the history of medicine.highlights in the history of medicine.
IntroductionIntroduction

The evolution of chemotherapy can be tracedThe evolution of chemotherapy can be traced
through three distinct periods.through three distinct periods.
 A pre-Ehrlich era before 1891A pre-Ehrlich era before 1891
 Period of Paul Ehrlich andPeriod of Paul Ehrlich and
 Period after 1935 highlighted by the discovery ofPeriod after 1935 highlighted by the discovery of
sulfonamides and antibiotics.sulfonamides and antibiotics.
In the 1891 pre-Ehrlich demonstrated theIn the 1891 pre-Ehrlich demonstrated the
efficacy of methylene blue in the treatment of humanefficacy of methylene blue in the treatment of human
malaria.malaria.
Ehrlich introduced arrephenamine, the firstEhrlich introduced arrephenamine, the first
really effective chemothreapeutic agent in man, inreally effective chemothreapeutic agent in man, in
the treatment of syphilis.the treatment of syphilis.
He is aptly called “the father of modernHe is aptly called “the father of modern
chemotherapy”.chemotherapy”.
HistoryHistory

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The next major contribution to chemotherapyThe next major contribution to chemotherapy
came from Domagk, and his colleagues (1938) who,came from Domagk, and his colleagues (1938) who,
while working on zeo dayes, demonstrated thewhile working on zeo dayes, demonstrated the
efficacy of “prontosil” a dye with a suyonamideefficacy of “prontosil” a dye with a suyonamide
chain, in inhibiting the growth of streptococci.chain, in inhibiting the growth of streptococci.
In 1928, Six Alexander Fleming, while studyingIn 1928, Six Alexander Fleming, while studying
staphylococcal variants, found one of his culturestaphylococcal variants, found one of his culture
plates contaminated by a fungus which preventedplates contaminated by a fungus which prevented
the growth of surrounding bacterial colonies.the growth of surrounding bacterial colonies.
He cultivated the fungus and showed that theHe cultivated the fungus and showed that the
filtrate, which be named penicillin, inhibited thefiltrate, which be named penicillin, inhibited the
growth of a number of gram positive organisms.growth of a number of gram positive organisms.

ChemotherapyChemotherapy →→ may be designed as the use ofmay be designed as the use of
synthetic, semisynthetic, and naturally occurringsynthetic, semisynthetic, and naturally occurring
chemicals that selectively inhibit specific organismschemicals that selectively inhibit specific organisms
coursing. Infections disease or that exhibitcoursing. Infections disease or that exhibit
effectiveness in the treatment of cancer.effectiveness in the treatment of cancer.
AntibioticAntibiotic →→ AntiAnti →→ againstagainst
BiosisBiosis →→ lifelife GreekGreek
DefDef →→ designed as a chemical substance produceddesigned as a chemical substance produced
by micro-organisms having the property of inhibitingby micro-organisms having the property of inhibiting
the growth of or destroying other micro-organism inthe growth of or destroying other micro-organism in
high dilution.high dilution.

Mechanism of action of antimicrobial drugsMechanism of action of antimicrobial drugs
1. Inhibition of cell wall synthesis1. Inhibition of cell wall synthesis
Bacitracin, cephalosporins, Penicillins,Bacitracin, cephalosporins, Penicillins,
vancomycinvancomycin
2. Inhibitiors of protein synthesis2. Inhibitiors of protein synthesis
Aminoglycosider, chloram phenicol , Clindamycin,Aminoglycosider, chloram phenicol , Clindamycin,
Exythromin, TteracyclinesExythromin, Tteracyclines
3. Agents affecting cell membrane3. Agents affecting cell membrane
Amphotericin B, NystatinAmphotericin B, Nystatin
4. Inhibitiors of nucleic acid synthesis4. Inhibitiors of nucleic acid synthesis
Ciprofloxacin, Metranidoxole, RifampinCiprofloxacin, Metranidoxole, Rifampin
5. Antimetabolites5. Antimetabolites
Aminosalicyclin acidAminosalicyclin acid
Sulfonamides, SulfonesSulfonamides, Sulfones

PenicillinPenicillin
The golden age of antimicrobial therapy began with theThe golden age of antimicrobial therapy began with the
first clinical use of penicillin 1941.first clinical use of penicillin 1941.
ClassificationClassification
I Natural penicillinI Natural penicillin
Penicillin GPenicillin G
Procarne penicillin GProcarne penicillin G
Benzathine penicillin GBenzathine penicillin G
II Acid resistant PenicillinsII Acid resistant Penicillins
Phenoxy methyl penicllin (Penicillin)Phenoxy methyl penicllin (Penicillin)
Phenoxy ethyl penicllinPhenoxy ethyl penicllin
III Penicillinase – resistant penicillinsIII Penicillinase – resistant penicillins
a) Acid labiel = cloxacillin, Dicloxacillina) Acid labiel = cloxacillin, Dicloxacillin
b) Acid resistantb) Acid resistant →→ FluxloxacilinFluxloxacilinwww.indiandentalacademy.comwww.indiandentalacademy.com

IV Penicillns effective agains gram +veIV Penicillns effective agains gram +ve
gram –ve organismsgram –ve organisms
Ampicillin, AmoxycillinAmpicillin, Amoxycillin
Benzathine penicillin GBenzathine penicillin G
V Intended spectrum penicillinsV Intended spectrum penicillins
a) Carboxy penicillinsa) Carboxy penicillins
b) Ureido penicillinsb) Ureido penicillins
c) Amidino penicillinsc) Amidino penicillins
VI Penicllins with betalactomase inhibitorsVI Penicllins with betalactomase inhibitors
Amoxycillin – clavulamic acidAmoxycillin – clavulamic acid

I Benzyl penicillin (Penicillin G)I Benzyl penicillin (Penicillin G)
It is available in the form of its water solubleIt is available in the form of its water soluble
sodium and potassium salts.sodium and potassium salts.
It is effective mainly agains Gram +ve and gram –It is effective mainly agains Gram +ve and gram –
ve cocci and some Gram +ve bacilli.ve cocci and some Gram +ve bacilli.
Mechanism of actionMechanism of action
All of the penicillins except amdinocillin have theAll of the penicillins except amdinocillin have the
same mechanism of action.same mechanism of action.
Inhibition of enzymes responsible for the cross-Inhibition of enzymes responsible for the cross-
lnking of peptidoglycan polymers during the cross –lnking of peptidoglycan polymers during the cross –
linking of peptidoglycan polymers during the last stagelinking of peptidoglycan polymers during the last stage
of bacterial cell wall synthesis.of bacterial cell wall synthesis.www.indiandentalacademy.comwww.indiandentalacademy.com

Absorption and excretionAbsorption and excretion
→→ It is mainly absorbed fromduodenumIt is mainly absorbed fromduodenum
→→ Aqueous solution is rapidly absorbedAqueous solution is rapidly absorbed
after subcutaneoys or intra-muscularafter subcutaneoys or intra-muscular
administration.administration.
→→ It is rapidly eliminated by kidneyIt is rapidly eliminated by kidney
Therapeutic usesTherapeutic uses
→→ Pneumococcal injectionPneumococcal injection
→→ Streptococcal injectionStreptococcal injection
→→ Meningococcal meningitisMeningococcal meningitis

Allergic reactionAllergic reaction
→→ Skin rashesSkin rashes
→→ Serum sickness like syndromeSerum sickness like syndrome
→→ Renal disturbancesRenal disturbances
→→ Haemopoietic disturbancesHaemopoietic disturbances
→→ AngioedemaAngioedema
→→ AnaphylaxisAnaphylaxis
Penicillin prophylarusPenicillin prophylarus
→→ Rheumatic feverRheumatic fever
→→ Streptococcal infectionsStreptococcal infections
→→ Bacterial endocarlitisBacterial endocarlitis
→→ Gonorrhoea syphillisGonorrhoea syphillis
→→ Recurrent lymphangitisRecurrent lymphangitis

II Potassium phenoxy methyl penicllin (Penicillin V)II Potassium phenoxy methyl penicllin (Penicillin V)
It has similar antibacterial spectrum like penicillinIt has similar antibacterial spectrum like penicillin
G though the degree of activity differs.G though the degree of activity differs.
It is freely soluble in water DoseIt is freely soluble in water Dose →→ 65 and 125mg65 and 125mg
tablets.tablets.
It may be employed in less serious injections dueIt may be employed in less serious injections due
to pneumococci and streptococci.to pneumococci and streptococci.
In injections which requires a prolonged treatment.In injections which requires a prolonged treatment.

III Penicillinase reisstant penicillinIII Penicillinase reisstant penicillin
MethicillinMethicillin
It is effective in treatment of injections due toIt is effective in treatment of injections due to
penicillinase producing staphylococci.penicillinase producing staphylococci.
DoseDose →→ 1M and IV infusion in the dose of 1g every1M and IV infusion in the dose of 1g every
4-6 hours.4-6 hours.
CloxacillinCloxacillin
It has a weakes antibacterial activity than penicillin GIt has a weakes antibacterial activity than penicillin G
but is 5 to 10 times more active than methicillin.but is 5 to 10 times more active than methicillin.
DoseDose →→ 0.5 to 1g 6 hourly (250 mg).0.5 to 1g 6 hourly (250 mg).

IV Penicillins effective agains Gram +ve and Gram –veIV Penicillins effective agains Gram +ve and Gram –ve
organismsorganisms
It is more effective against a variety of gramIt is more effective against a variety of gram
negative bacteria.negative bacteria.
→→ Gram +ve are less sensitiveGram +ve are less sensitive
→→ It is water soluble and acid resistantIt is water soluble and acid resistant
DoseDose
AdultAdult →→ 250 to 500mg (6 hourly)250 to 500mg (6 hourly)
ChildrenChildren →→ 50 to 200mg per kg50 to 200mg per kg
TherapeuticTherapeutic
→→ Urinary tract injectionsUrinary tract injections
→→ respiratory tract infectionsrespiratory tract infections
→→ Meningitis and subacute bacterial enclocarditisMeningitis and subacute bacterial enclocarditis
→→ Childhood meningitis, soChildhood meningitis, so
Adverse effectsAdverse effects →→ skin rash, Diarrhoeaskin rash, Diarrhoeawww.indiandentalacademy.comwww.indiandentalacademy.com

AmoxycillinAmoxycillin
It is a semisynthetic penicillin with a broad spectrumIt is a semisynthetic penicillin with a broad spectrum
of antibacterial activity similar to that of ampicillin.of antibacterial activity similar to that of ampicillin.
AbsorptionAbsorption
→→ It is a best absorbed on an empty stomachIt is a best absorbed on an empty stomach
→→ Hence the duration of action of amoxicillin isHence the duration of action of amoxicillin is
twice as long as ampicillintwice as long as ampicillin
DoseDose
250 – 500mg every 8hr (oral)250 – 500mg every 8hr (oral)
→→ Urinary tract injectionUrinary tract injection
→→ respiratory injectionrespiratory injection
→→ Gonococcal infectionsGonococcal infections

MacrolidesMacrolides
Erythomycin, oleandomycin, triacetyloleandomycinErythomycin, oleandomycin, triacetyloleandomycin
spiramycin are a group of antibotics named asspiramycin are a group of antibotics named as
macrolides.macrolides.
ErythromycinErythromycin
It is mainly effective against the Gram +ve cocciIt is mainly effective against the Gram +ve cocci
including streptococci, staphylococci.including streptococci, staphylococci.
Effective against penicillin resistant staphylococci.Effective against penicillin resistant staphylococci.
Absorption fate and excretionAbsorption fate and excretion
→→Absorbed mainly in small intestineAbsorbed mainly in small intestine
→→ It is concentrated in the liverIt is concentrated in the liver
DoseDose
AdultAdult →→ 1 to 2g 6 hourly1 to 2g 6 hourly
ChildrenChildren →→ below 1 year 5mg / kg 6 hourlybelow 1 year 5mg / kg 6 hourly
upto 8 yearsupto 8 years →→ 10mg/kg 6 hourly10mg/kg 6 hourly
8-15 years8-15 years →→ 15mg / kg 6 hourly15mg / kg 6 hourly

Allergic reactionsAllergic reactions
→→ fever, corinophilia, coticaria, dermatitis andfever, corinophilia, coticaria, dermatitis and
lymphadenipathylymphadenipathy
→→ It is an excellent alternative antibiotic toIt is an excellent alternative antibiotic to
penicillin G.penicillin G.
→→ It is second only to the penicllins for theIt is second only to the penicllins for the
treatment of dental injectiontreatment of dental injection
→→ It exhibits good activity against many oralIt exhibits good activity against many oral
anaerobic bacteriaanaerobic bacteria
→→ Prophylatic coverage against bacterialProphylatic coverage against bacterial
endocarditis for patient allergic to penicillin.endocarditis for patient allergic to penicillin.www.indiandentalacademy.comwww.indiandentalacademy.com

TetracyclineTetracycline
It is a group of broad – spectrum bacteriostaticIt is a group of broad – spectrum bacteriostatic
antibiotics.antibiotics.
It inihibits Gram +ve and Gram –ve organismsIt inihibits Gram +ve and Gram –ve organisms
such as Pneumococci, Gonococci.such as Pneumococci, Gonococci.
AbsorptionAbsorption
It is mainly absorbed from the duodenum andIt is mainly absorbed from the duodenum and
the upper small intestine.the upper small intestine.
It is metabolised in the liver and metabolitiesIt is metabolised in the liver and metabolities
excreted mainly in the urine.excreted mainly in the urine.

Adverse reactionsAdverse reactions
→→ Naurea, vomiting, epigastric distressNaurea, vomiting, epigastric distress
→→ Antianabolic effectAntianabolic effect
→→ Administration of there antibiotics to pregnant womenAdministration of there antibiotics to pregnant women
may lead to yellow staining of the teeth of the infant.may lead to yellow staining of the teeth of the infant.
→→ Defective formation of enamel and hypoplaria of theDefective formation of enamel and hypoplaria of the
teethteeth
→→ If also deposited in nails and fluorescence of theIf also deposited in nails and fluorescence of the
nails may occur after prolonged tetracycline therapy.nails may occur after prolonged tetracycline therapy.
Semisynthetic tetracyclinaSemisynthetic tetracyclina
DemethylchlortetracyclineDemethylchlortetracycline
MethcyclineMethcycline
LymecyclineLymecycline
DoxycyclineDoxycycline
MinocyclineMinocycline www.indiandentalacademy.comwww.indiandentalacademy.com

→→ Rickettsial infectionsRickettsial infections
→→ Primary atypucal pneumoniaPrimary atypucal pneumonia
→→ CholeraCholera
→→ Bacillary infectionsBacillary infections
LincomycinLincomycin
It is mainly bacteriostaticIt is mainly bacteriostatic
It inhibits the growth of many Gram +ve organisms, such asIt inhibits the growth of many Gram +ve organisms, such as
staphylococci, Pneumococci.staphylococci, Pneumococci.
It acts by interferring with protein synthesis.It acts by interferring with protein synthesis.
DoseDose →→ 500mg 3 to 4 times daily500mg 3 to 4 times daily
Adverse reactionAdverse reaction
NaureaNaurea
VomitingVomiting
Gladominal painGladominal pain
DiarrhoeaDiarrhoea

→→ Staphylococcal, Pneumococcal and StreptococcalStaphylococcal, Pneumococcal and Streptococcal
infectioninfection
→→ More effective in treatment of acute and chronicMore effective in treatment of acute and chronic
osteomyelitisosteomyelitis
ClindamycinClindamycin
It is bactericidal at slightly higher ones andIt is bactericidal at slightly higher ones and
bacteriostatic at low concentrations.bacteriostatic at low concentrations.
→→ Useful in prophylaxis and treatment ofUseful in prophylaxis and treatment of
anaerobic infectionsanaerobic infections
→→ It is useful along with on aminoglycoside, inIt is useful along with on aminoglycoside, in
the treatment of peritonitis due to fecal contamination.the treatment of peritonitis due to fecal contamination.
DoseDose →→ 150 to 450mg150 to 450mg

MetronidazoleMetronidazole
It is a drug of choice for variety of protozoal infection.It is a drug of choice for variety of protozoal infection.
It is almost always bactericidalIt is almost always bactericidal
It is well absorbed after oral administration.It is well absorbed after oral administration.
It is a major antiprotozoal drugIt is a major antiprotozoal drug
It is effective in treatment of ANUG.It is effective in treatment of ANUG.
Therapeutic uses of Antibiotics in DentistryTherapeutic uses of Antibiotics in Dentistry
→→ Treatment of an acute dental infectionTreatment of an acute dental infection
→→ Prophylaxis in patients at risk of developingProphylaxis in patients at risk of developing
bacterial endocarditis or other problems as the resultbacterial endocarditis or other problems as the result
of bacteria caused by dental procedures or traumaticof bacteria caused by dental procedures or traumatic
injury.injury.
→→ Prophylaxis in patient with compromised hostProphylaxis in patient with compromised host
defense mechanism.defense mechanism.

Antibiotics used in orodental infectionsAntibiotics used in orodental infections
Penicillin GPenicillin G Periapical abscessPeriapical abscess
Penicillin VPenicillin V Periodontal abscessPeriodontal abscess
Acute suppurative pulpitisAcute suppurative pulpitis
Toxic cellulitisToxic cellulitis
Post Surgical or post traumaticPost Surgical or post traumatic infectionsinfections
Oral-antral or oral-nasal fistulasOral-antral or oral-nasal fistulas
with sinusitiswith sinusitis
Periocoronitis with cellulitisPeriocoronitis with cellulitis
OsteomyelitisOsteomyelitis
TetracyclinesTetracyclines →→ localized Juvenile periodontitislocalized Juvenile periodontitis
Penicillin G (1M)Penicillin G (1M)
Penicillin V (Po)Penicillin V (Po) Vincent’s infectionVincent’s infection
NystatinNystatin →→ oral candidiasisoral candidiasis
Prophylactiv use of antibiotics in dentistryProphylactiv use of antibiotics in dentistrywww.indiandentalacademy.comwww.indiandentalacademy.com

Prevention of bacterial endocarditis in patient with:Prevention of bacterial endocarditis in patient with:
- Prosthetic heart valves- Prosthetic heart valves
- Congenital and acquired heart defects- Congenital and acquired heart defects
- History of rheumatic fever- History of rheumatic fever
- History of endocarditis- History of endocarditis
- Treatment of patients with artificial or transplanted- Treatment of patients with artificial or transplanted
organs.organs.
Treatment of patients with decreased host defenseTreatment of patients with decreased host defense
mechanisms because ofmechanisms because of
DiseaseDisease
- Aplastic anemia- Aplastic anemia
- Lupur erythematorus- Lupur erythematorus
- Uncontrolled Addison’s disease- Uncontrolled Addison’s disease
- Uncontrolled diabetes metllitus- Uncontrolled diabetes metllitus
- Agranulocytosis- Agranulocytosis

Drug and other therapyDrug and other therapy
- Antineoplastic drugs- Antineoplastic drugs
- Immunosuppressant drugs- Immunosuppressant drugs
- Adrenal corticosteroids- Adrenal corticosteroids
- Uncontrolled diabetes metllitus- Uncontrolled diabetes metllitus
- Agranulocytosis- Agranulocytosis
Drugs reserved for specific infectionsDrugs reserved for specific infections
Some antimicrobial drugs are reserved for the treatment ofSome antimicrobial drugs are reserved for the treatment of
infections caused by specific microorganism.infections caused by specific microorganism.
TuberculosisTuberculosis
- Isoniazid- Isoniazid
- Rifampin- Rifampin
- Pyrazinamide- Pyrazinamide
LeprosyLeprosy
- Sulfones- Sulfones
- Dapsone- Dapsone

GonorrheaGonorrhea
- Penicillin G- Penicillin G
- Ampicillin – like derivatives- Ampicillin – like derivatives
- Tetracyclines- Tetracyclines
How to avoid development of antimicrobial resistanceHow to avoid development of antimicrobial resistance
→→ Use antibiotics only when necessaryUse antibiotics only when necessary
→→ Select the appropriate antibiotic and use it for an adequateSelect the appropriate antibiotic and use it for an adequate
period of time.period of time.
→→ Use and drug combiantion when it is known to delay theUse and drug combiantion when it is known to delay the
development of drug resistance.development of drug resistance.
Dangers of antibiotic therapyDangers of antibiotic therapy
- Development of allergic and anaphylactic reactions- Development of allergic and anaphylactic reactions
- Development of multiple – drug resistant- Development of multiple – drug resistant
- Deficiency of certain vitamins- Deficiency of certain vitamins
- Fetal damage- Fetal damage
- Selective toxicity- Selective toxicity www.indiandentalacademy.comwww.indiandentalacademy.com

ConclusionConclusion
The present total consumption of antibiotics inThe present total consumption of antibiotics in
relation to the known incidence of infections is veryrelation to the known incidence of infections is very
much in excess, indicating that antibiotics are manymuch in excess, indicating that antibiotics are many
times misused.times misused.
Once started the drug must not be changedOnce started the drug must not be changed
without valid reasons and should be continued untilwithout valid reasons and should be continued until
both clinical and bacteriological cure are achieved.both clinical and bacteriological cure are achieved.
This may vary from a few days to many months.This may vary from a few days to many months.
Too large or too low a dosage should be avoidedToo large or too low a dosage should be avoided
as it may either produce toxicity or cause bacterialas it may either produce toxicity or cause bacterial
resistance.resistance. www.indiandentalacademy.comwww.indiandentalacademy.com

If any adverse effect is observed during theIf any adverse effect is observed during the
therapy, the drug should preferably be withdrawntherapy, the drug should preferably be withdrawn
instead of using another compound to suppress it.instead of using another compound to suppress it.
Lastly antibiotics should not be used routinely inLastly antibiotics should not be used routinely in
all fines cares without understanding their natureall fines cares without understanding their nature
simply with the hope of giving “quick benefits” ofsimply with the hope of giving “quick benefits” of
chemotherapy.chemotherapy.

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