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