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4. INTRODUCTION
Antimicrobial
agents: Substances that will
suppress the growth/ multiplication of
bacteria and prevent their action.
Antibiotic
agents: Chemical substances
produced by microorganisms that have the
capacity, in dilute solutions, to produce
antimicrobial action.
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5. HISTORYOF ANTIBIOTICS
1877 Louis Pasteur Inhibition of some
microbes by others; anthrax (Bacillus
anthracis)
1908 Gelmo Synthesized sulfanilamide
(1st sulfonamide
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6. 1928 Fleming…
Penicillin notatum inhibits growth
‘PENICILLINS’
1941 Chain n Florey
Discovered properties of penicillin
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19. Problems with use of AMA
Toxicity
-Local irritancy:
-Systemic toxicity:
-Therapeutic index- high, low, very low
Hypersensitivity reactions :
Drug resistance
- Natural- lack of metabolic process or target site
- Acquired – due to use over a period of time, mutations
or gene transfer
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20. Preventing
Resistance to Drugs
Limit
the use of antimicrobial agents to the treatment
of specific pathogens sensitive to the drug being used
Notorious-Make
sure doses are high enough, and the
duration of drug therapy long enough , combination
therapy
Be
cautious about the indiscriminate, inadequate or
unduly prolonged use of anti-infectives
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22. Choice of AMA agent- patient factors
1.Age : affect kinetics of drug.
Conjugation and excretion of chloremphenicol- gray baby
syndrome
Sulfonamides displace bilirubin from PBS- kernicterus
Tetracycline accumulates in bone and teeth
2. Renal and hepatic failure: cautious use and dose
reduction
3. Local factors:
presence of pus and secretions- AMAs, surgical
drainage reduces causative bacteria and suppresses
anaerobic bacteria
Presence of necrotic material and infection
Hematomas – foster growth
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24.
Organism related considerations
Drug factors
1.
2.
3.
4.
5.
6.
7.
8.
Spectrum of activity
Type of activity
Sensitivity of the organism
Relative toxicity
Pharmacokinetic profile
Route of administation
Evidence of clinical efficacy
Cost
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28. PRINCIPLES OF ANTIBIOTIC THERAPY
PRINCIPLE 1: TO DETERMINE THE SEVERITY OF
INFECTION
PRINCIPLE 2: TO EVALUATE STATE OF PATIENT’S
HOST DEFENSE MECHANISMS
PRINCIPLE 3: TO TREAT INFECTION SURGICALLY
PRINCIPLE 4: TO SUPPORT THE PATIENT
MEDICALLY
PRINCIPLE 5: CHOOSE AND PRESCRIBE
APPROPRIATE ANTIBIOTIC
PRINCIPLE 6: PROPER ANTIBIOTIC
ADMINISTRATION
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29. PRINCIPLES OF ANTIBIOTIC ADMINISTRATION
1.
Proper dose :
DRUG DOSAGE
‘Dose’ is the appropriate amount of a drug needed to produce a
certain degree of response in a patient.
Body size :
Individual dose = BW(kg)/70 x average adult dose
Individual dose = BSA(m2
) /1.7x average adult dose
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30. Age :
The dose of drug for children is often calculated from the adults dose
Young’s formula
Child dose =
Age
x adult dose
Age +12
Dilling’s formula
Child dose =
Age
20 x adult dose
Clarke’s rule
Child dose =
wt in lb x adult dose
150
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31. NEONATES AND INFANTS
Greater
percentage of body weight
compared with body water
Greater volume of distribution
Increased serum half lives
Reduced gastric emptying
Reduced plasma protein binding
Reduced GFR
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33. 2) Proper time interval :
3) Proper route of administration :
Parenteral administration will produce the necessary serum level
of antibiotics.
Oral route results in the most variable absorption.
For maximum absorption is taken in fasting stage.
4) Consistency in regard to route of administration :
When treating a serious, established infections, parenteral
antibiotic therapy is frequently the method of choice.
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34.
Combination antibiotic therapy :
The rationale for the use of 2 or more drugs together is to minimize
the emergence of antibiotic resistant microorganisms
to increase the certainty of a successful clinical outcome
to treat mixed bacterial infections
to prevent superinfection
to treat severe infections of unknown etiology
to decrease toxicity without decreasing efficacy
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35. Examples :
Isoniazid + ethambutol + streptomycin in treatment of
tuberculosis.
Rules :
2 bactericidal drugs produce, supraadditive effects, not
antagonism. (1+1>2)
The combination of a bacteriostatic and a bactericidal
drug generally results in diminished effects. (1+1<2)
2 bacteriostatic drugs are never inhibitory. (1+1=2)
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36. Results :
Indifference when the effect is equal to the
single most active drug or equal to the
arithmetic sum of the two, use is not justified.
Antagonism : when the combined drug effect is
less than the algebraic sum of the effects on
the individual drugs in the mixture.
Synergism : ability of two antibiotics acting
together to markedly increases the rate of
bactericidal action compared to either drug
alone.
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37. Disadvantages :
Adds nothing to therapeutic efficacy and may even reduce it
(antagonism).
Increase antibiotic toxicity and allergy.
Increase the likelihood of superinfection
Discourages specific etiologic diagnosis and promote false
security.
Encourage inadequate doses, particularly with fixed dose
combination therapy.
Increased cost
Emergence of resistant bacterial strains
Increase the environmental spread of antibiotic resistant
bacteria.
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39. MINIMAL INHIBITORY CONCENTRATION
Is
the lowest antibiotic concentration that
prevents growth of microorganism after an
incubation period of 18 – 24 hours with a
standard inoculum of 104 to 105 cu/ml
MINIMAL
BACTERICIDAL CONCENTRATION
Is the lowest concentration of drug that causes
the complete destruction of the organisms or
permits survival of less than 0.1% of the
inoculum
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40. RULE OF THUMB
The
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 the infected site
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41. CONCENTRATION DEPENDENT
Vs
TIME DEPENDENT ANTIBIOTICS
Aminoglycosides, metronidazole,
fluoroquinolones
Concentration dependent
Bactericidal activity depends on the
drug concentration
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43. POSTANTIBIOTIC EFFECTS
Is
the persistent supression of microbial
growth after short time exposure to an
antimicrobial agent.
MECHANISM
:
Is the time necessary to recover from
sublethal structural and metabolic
alterations that prevents resumption of
bacterial regrowth.
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45. Dental procedure for which antibiotic prophylaxis is
recommended to prevent infective endocardititis
(AHA recommendation)
Dental extractions
Periodontal procedures
Replantation procedure
Implant placement
Initial placement of orthodontic bands
Intra ligamentary local anesthetic injection
Incision and drainage
Not recommended :
1.Restorative dentistry
2.LA injections
3.Intracanal endodontic treatment
4.Post-op suture removal
5.Oral radiographs
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46. American Heart Association guidelines for antibiotic prophylaxis
Standard general
prophylaxis
Amoxicillin
Adults: 2 g
Children: 50 mg per kg
Taken orally one hour before the procedure
Patient is unable to
take oral medications
Ampicillin
Adults: 2 g
Children: 50 mg per kg
Given IM or IV within 30 minutes before the procedure
Patient is allergic to
penicillin
Clindamycin
Adults: 600 mg
Children: 20 mg per kg
Taken orally one hour before the procedure
or
Azithromycin
or clarithromycin
Patient is allergic to
penicillin and is
unable to take oral
medication
Clindamycin
Adults: 500 mg
Children: 15 mg per kg
Taken orally one hour before the procedure
Adults: 600 mg
Children: 20 mg per kg
Given IV or IM within 30 minutes before the procedure
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50.
Preparation and dose :
PnG inj 0.5-5 MU i.m or i.v 6-12 hours
Procaine pencillin inj 0.5, 1 MU dry powder in vial
ADVERSE REACTIONS :
Miscellaneous reactions :
Nausea and vomiting on oral PnG
Sterile inflammatory reaction at the site of IM inj.
Prolonged IV administration may cause
thrombophlebitis
Accidental IV administration of procaine PP cause
anxiety, mental disturbances paraesthesia and
convulsions
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51.
Intolerance :
Major problem with PnG includes idiosyncratic, anaphylactic and
allergic reactions
Other allergic reactions are
Skin rashes
Serum sickness
Renal disturbance
Hemolytic disturbance
Anaphylaxis
Jarisch herxheimer reaction
Super infection
Hyperkalemia
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52. Uses :
PnG is the drug of choice for infections
Streptococcal infections
Pneumococcal infections
Meningococcal infections
Gonorrhoea
Syphilis
Diphtheria
Tetanus and gas gangrene
Prophylactic uses
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53.
The major drawbacks of benzyl penicillin
are
Inactivation by the gastric hydrochloric acid
Short duration of action
Poor penetration into CSF
Activity mainly against gram +ve organism
Possibility of anaphylaxis
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54. Acid resistant pencillins :
1. Potassium phenoxymethyl penicillin (penicillin V)
Dose : infants 60 mg, children 125-250 mg given 6 hourly
CRYSTAPEN-V, KAYPEN, PENIVORAL 65, 130, 125, 250
mg tablets 125 mg/5 ml dry ser
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55. II) Pencillinase resistant pencillins :
Methicillin
Effective in staphylococci
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
special adverse effect of methicillin.
Cloxacillin
Weaker antibacterial activity.
Distrubuted throught out the body, but highest concentration in
kidney and liver. 30% excreted in urine.
Oral dose for adults 2-4 gm divided into 4 portions children 50100mg/kg/day.
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.
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56.
III) Extended spectrum pencillins :
Amino pencillins
Ampicillin –
Antibacterial activity is similar to that of PnG that is more
effective than PnG against a variety of gram-ve bacteria
Drug is effective against H.influenzae strep.viridans,
N.gonorrhea, Salmonella, shigellae, Klebsilla and enterococci.
Absorption, fate and excretion :
Oral absorption is incomplete but adequate
Food interferes with absorption
Partly excreted in bile and partly by kidney
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57. Dose : 0.5-2 gm oral/IM or IV depending on severity of
infection every 6 hours
Children : 25-50 mg/kg/day
AMPILIN, ROSCILLIAN, BIOCILIN – 250, 500 mg cap 100mg/ml
ped drops, 250 mg/ml dry syr, 1 gm/vial inj.
USES :
Urinary tract infections
Respiratory tract infections
Meningitis
Gonorrhoea
Bacillary dysentry
Septicaemias
SABE
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58. Adverse
effects :
Diarrhoea
is frequent
Skin
rashes is more common
Unabsorbed drug irritates lower intestines
Patient with history of hypersensitivity to PnG
should not be given ampicillin.
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59. AMOXICILLIN
:
This
is a semisynthetic penicillin.
(amino-p-hydroxy-benzylpenicillin)
Antibacterial spectrum is similar to ampicillin.
Oral absorption is better; food does not interfere;
higher and more sustained blood levels are produced.
It is less protein bond and urinary excretion is higher
than that of ampicillin.
Incidence of diarrhoea is less
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61. BETA LACTAMASE INHIBITORS
CLAVULANIC ACID
Obtained from STREPTOMYCES CLAVULIGERUS
Betalactam ring – no antibacterial activity
Suicide inhibitor –inactivated after binding to enzyme
Permeates the outer layers of cell wall of gram-ve bacteria
Pharmacokinetics :
Oral absorption- rapid
Bioavailability-60%
Distribution similar that of amoxicillin
Excretion-tubular secretion
Used as :
Amoxicillin+clavulanic acid (AUGMENTIN,ENHANCIN)
Ticarcillin+clavulanic acid (TIMENTIN)
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63. CEPHALOSPORINS
Cephalosporium acremonium was the first source.
They contain 7 amino cephalosporonic acid nucleus.
Structurally they contain betalactam and dihydro thiazine
rings.
Mechanism of action :
Act by inhibiting bacterial cell was synthesis and are
bactericidal.
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64. Classification
Classified according to its antibacterial activity.
First generation cephalosporin
Good activity against gram +ve bacteria. (except
enterococci).
Most oral cavity anaerobes are sensitive.
Parental
Oral
CEPHALOTHIN
CEPHALEXIN
CEFAZOLIN
CEPHRADINE
CEFADROXIL
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65. Cephalaxin and Cephadroxil :
Useful in treating community acquired, respiratory and
urinary tract infections and in surgical prophylaxis.
Infections of head and neck region.
Dose: Oral 0.25 - 1g 6-8 hrly
Children : 25-100mg/kg/day
IM – 0.25g 8 hrly (mild cases) 1g 6 hrly (severe cases).
Drops – cephaxin 125mg/5ml syrup.
100mg /ml ped. drops.
SPORIDEX, CEPHAXIN, CEPHACILLIN, CEFADROX,
DROXYL
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66. Second generation cephalosporins :
Increased activity against gram –ve organism.
More active against anaerobes.
Parenteral
Oral
CEFUROXIME
CEFACLOR
CEFOXITIN
CEFUROXIME AXETIL
More active against H. influenzae, E coli.
Dose : 250mg, 125mg, 125mg/5ml syr. and
50 mg /ml ped. drops.
KEFLOR, CEFTUM, CEFOGEN, FUROXIL.
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67. Third Generation Cephalosporins
High activity against gram –ve entrobacteriaceae, some
inhibit Pseudomonas as well.
Parenteral
Oral
Cefataxime
Cefixime
Ceftizoxime
Cefpodoxime proxetil
Ceftriaxone
Cefdinir
Ceftazidime
Ceftibuten
Cefoperazone
Dose: 250mg, 500mg, 1000mg per vial inj
CLAFORAN, CEFIZOX,MONOCEF,CEFAZID.
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68. Fourth Generation Cephalosporins
Similar to 3rd generation ,but is highly resistant to
betalactamases. Due to high potency and extended
spectrum, it is effective in many serious infections like
hospital acquired pneumonia, bacteremia, septicaemia.
Parentral
Cefepime
Cefpirome
Dose: 1-2 g i.m/i.v 12hrly
CEFROM, CEFROTH, KEFAGE
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69. Adverse reactions :
Local reactions – cause pain (IM) and cause
thrombophlebitis (IV)
Allergy – skin rashes
Nephrotoxicity
Bleeding disorders
Intolerance to alcohol
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70. Uses :
Alternatives to penicillins.
RTI, UTI and soft tissue infection
Penicillinase producing staph infection.
Septicaemias.
Surgical prophylaxis
Meningitis, gonorrhoea
Typhoid
Mixed aerobic and anaerobic infections
Infection by odd organism or hospital infections
Prophylactic treatment in neutropenic patients.
Dental infections
Alternative to pencillins- hypersensitivity and resistance
Oral – 1st and 2nd generation
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71. Sulfonamides
Short acting(4-8hr)- Sulfadiazine
Intermediate acting (8-12hr)- Sulfamethoxazole,
Sulfamoxole
Long acting(7 days)- Sulfadoxine, Sulfamethopyrazine
Special purpose Sulfonamides – Sulfacetamide sod,
Sulfasalazine,
Mafenide,
Silver sulfadiazine
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72. Mechanism of action
In
bacteria, antibacterial sulfonamides act as
competitive inhibitors of the enzyme
dihydropteroate synthetase, DHPS. DHPS catalyses
the conversion of PABA (para-aminobenzoate) to
dihydropteroate, a key step in folate synthesis. Folate
is necessary for the cell to synthesize nucleic acids
(nucleic acids are essential building blocks of DNA
and RNA), and in its absence cells will be unable to
divide. Hence the sulfonamide antibacterials exhibit a
bacteriostatic rather than bactericidal effect.
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73. Side
effects
Sulfonamides have the potential to cause a variety of
untoward reactions, including urinary tract disorders,
haemopoietic disorders, porphyria and hypersensitivity
reactions. When used in large dose, it may develop a
strong allergic reaction. One of the most serious is
Stevens Johnson syndrome(or toxic epidermal
necrolysis).
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74. QUINOLONES
Entirely
synthetic antimicrobials are active
primarily against gram –ve bacteria.
Nalidixic acid- low potency, modest blood and
tissue levels, limited spectrum, high resistance
Fluoroquinolones – high potency, expanded
spectrum, better tissue penetrance, slow
resistance.
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75. Mechanism
Quinolones and fluoroquinolones are bactericidal
drugs, actively killing bacteria. Quinolones inhibit
the bacterial DNA gyrase or the topoisomerase IV
enzyme, thereby inhibiting DNA replication and
transcription.
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77. CIPROFLOXACIN
First generation FQ active against a broad range of bacteria
especially gram –ve aerobic bacilli.
Microbiological features :
Rapid bactericidal activity and high potency.
Relatively long post antibiotic effect
Low frequency of mutational resistance.
Protective intestinal streptococci and anaerobes are spared.
Less active at acidic pH.
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78. Adverse effect :
GIT
– Nausea, vomiting, bad taste, anorexia,
diarrhoea is infrequent.
CNS- Dizziness, headache, restlessness,
anxiety, insomnia and seizures are rare.
Skin/hypersensitivity – rashes, pruritis, urticaria.
Tendonitis and tendon rupture
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79. Uses :
Broad range of infections
Minor cases, orodental -not indicated
UTI
Bacterial gastroenteritis
Prophylaxis -Typhoid
Bone, soft tissue, wound infection.
Combinations- gram –ve septicaemias
Tuberculosis
CIFRAN, CIPLOX, CIPROBID, CIPROLET
250, 500,750 mg tab, 200mg/100 ml IV infusion 3mg/ml eye drops.
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80. Norfloxacin
- Less potent than Ciprofloxacin.
- Used for Pseudomonas, Urinary and genital tract
infections.
NORFLOX -200,400mg
Ofloxacin
- Activity against gram –ve bacteria
- Chlamydia and Mycoplasma
- Alternative drug for Tuberculosis
- Used mainly for Gonorrhea
ZANOCIN -200,400mg
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81. Levofloxacin
- Sinusitis, Pylonephritis, soft tissue infections.
LOMEF- 400mg
Gatifloxacin
- Excellent activity against Streptococci
pneumoniae
- Indicated in community acquired pneumonia,
exacerbation of chronic bronchitis, and other respiratory
tract infections.
- Used in urinary tract infectons and gonorrhhoea.
GATIQIN – 200,400 mg tab
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82. Sparfloxacin
-Enhanced activity against gram –ve bacteria,
Bacteroides fragilis, anaerobes and mycobacteria.
- Indicated in Pneumonias, chronic bronchitis,
sinusitis and other ENT infections.
- Good efficacy in Mycobacterium avium infection in
AIDS patients and Leprosy.
- Higher incidence of phototoxic reactions.
SPARTA, SPARDAC -100,200 mg tab
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83. NITROIMIDAZOLES
METRONIDAZOLE :
Introduced in 1959
Broad spectrum- e.histolytica, giardia lamblia
Anaerobic infections- chance discovery
Tinidazole, secnidazole, ornidazole, satranidazole
Cidal activity against protozoa and anaerobic bacteria
such as B fragilis, Fusobacterium, h.pyroli, spirochetes
Metronidazole is selectively toxic to anaerobic
microorganisms.
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84. Pharmacokinetics :
Completely absorbed from the small
intestine.
Widely distributed in the body
It is metabolized in liver
Excreted in urine. 8hr
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85. Adverse effects :
Anorexia, nausea, metallic taste and abdominal cramps
Looseness of stool is occasional,
Headache, glossitis, dryness of mouth, dizziness, rashes and transient
neutropenia.
Prolonged administration may cause peripheral neuropathy and CNS effects
Thrombophlebitis
Contraindications :
In neurological disease, blood dyscrasias, chronic alcoholism
First trimister of pregnancy
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86. Ornidazole
Activity similar to Metronidazole but it is slowly
metabolised .
Used in anaerobic infections, Amoebiasis, Giardiasis,
Trichomonasis, and bacterial vaginosis.
DAZOLIC -500mg tab, 500mg/100ml vial for i.v. infusion.
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88. TINIDAZOLE
It is an equally efficacious congener of metronidazole
Metabolism is slower and duration of action is longer
Incidence of side effects is lower-Metallic taste, nausea,
rashes
TINIBA, TRIDAZOLE, 300, 500, 1000 mg tab, 800
mg/400 ml iv
Dental infections: 0.5g(10mg/kg) BD for 5 days
2g orally followed 0.5g BD for 5days
800mg iv until oral therapy
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89. TETRACYCLINES
Napthacene derivatives made up by fusion of 4 partially
unsaturated cyclohexane radicals
Tetracyclines are bacteriostatic.
Classification
Antimicrobial activity :
Gram+ve and –ve cocci are sensitive-R
Gram+ve bacilli are inhibited
Entero bacteriaceae are highly resistant
Spirochetes are quite sensitive
All rickettsiae and chlamydiae are highly sensitive
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91. Mechanism
of action
Tetracycline antibiotics inhibit protein synthesis by
inhibiting the binding of aminoacyl-tRNA to the mRNAribosome complex. They do so mainly by binding to the
30S ribosomal subunit in the mRNA translation complex.[
Tetracyclines are widely used in treatment of
periodontal diseases.
Used in the treatment of Localised aggressive
periodontitis.
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93. DOSE
Tetracycline – 1-2g per day in adults
Children over 8yrs -25 to 50mg /kg daily in 2
to4 divided dose
TERRAMYCIN,RESTECLIN250,500mgcap,50mg/ml in10ml vial inj
Ledermycin 150,300mg cap/tab
DOXT, NOVADOX, TETRADOX-100mg cap.
Cyanomycin 50,100 mg cap
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94. Precaution :
Not to be used in pregnancy, lactation and in children
Avoided in patients on diuretics
Used cautiously in renal and hepatic insufficiency
Beyond expiry date should not be used
Do not mix injectable Tc with Pn- inactivation occurs
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95. Local Drug Delivery Systems
One of the alternative delivery system used to control
release of drugs.
Tetracycline fibres
-An ethylene/ Vinyl acetate copolymers of fibres of 0.5mm
diameter containing Tetracycline drug. (12.7mg per 9inch)
-Packed in periodontal pocket for 10 days.
-Required to inhibit the growth of pathogens isolated from
periodontal pockets.
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96. Subgingival
Doxycycline
-FDA approved 10% of Doxycycline in gel system
using a syringe Atridox.
Reduction in oral microbes. No overgrowth of foreign
pathogens.
Subgingival
Minocycline
-Sustained release form of Minocycline
microspheres(Arestin) for subgingival placement as an
adjuvant to scaling and root planing.
-2% Encapsulated into bioresorbable microspheres is
used.
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98. AMINOGLYCOSIDES
These include amikacin, arbekacin,
gentamicin, kanamycin, neomycin, netilmicin,
paromomycin, streptomycin, tobramycin, and
apramycin.
Mechanism of action
Aminoglycosides work by binding to the bacterial
30S ribosomal subunit (some work by binding to
the 50S subunit), inhibiting the translocation of
the peptidyl-tRNA from the A-site to the P-site
and also causing misreading of mRNA, leaving
the bacterium unable to synthesize proteins vital
to its growth. They kill bacteria by inhibiting
protein synthesis.
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99. Streptomycin
Uses
•Tuberculosis in combination with other anti-TB
drugs. It is not the first line treatment.
•Plague has historically been treated with it as the
first line treatment.
•Infective endocarditis caused by enterococcus
when the organism is not sensitive to Gentamicin
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100. MACROLIDES
Macrocyclic lactone ring with attached sugars
ERYTHROMYCIN-Streptomyces erythreus
Alternative to pencillin
Water solubility is limited-stable in cold
Antibacterial activity : static- cidal
Narrow spectrum antibiotic
against penicillin resistant staphylococci
Active against more gram+ve
Mechanism of action :
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102. Adverse effects :
GIT – epigastric pain
On high doses – hearing impairment
Hypersensitivity reactions – rare
Uses :
Substitute for penicillin, pencillin resistant infections
Oral adm, safe and effective
Perio/periapical/NUG/extraction
Prophylactic use
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103. ROXITHROMYCIN
Semisynthetic
- long acting, stable macrolide
Antibacterial spectrum similar to erythromycin
Dose - 150-300mg BD 30min before food
Children - 2.5-5mg/kg BD
ROXID, ROXIBID 150,300mg tab
50mg kid tab,150 mg tab
Clarithromycin – CLARIMAC 250,500mg tab
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104. CLINDAMYCIN
It
is lincosamide antibiotic having similar action
(macrolide 50s)
Bacteriostatic – low conc;Bacteriocidal – high
conc
Most active against gram+ve cocci,
C.diphtheriae, Actinomyces
Highly active against – anaerobes (B fragilis)
Pharmacokinetics :
Oral absorption – good
Distribution – skeletal and soft tissues
Excreted in urine
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105. Adverse effects :
Rashes ,Urticaria
Abdominal pain
Superinfection -Enterocolitis &Diarrhoea
Uses :
Anaerobic and mixed infections- alternative to Pn &
macro
Abscess and bone infections-staphy and bacteroids
Infective endocarditis
Doses : 150-300 mg QID oral ; 200-600mg I.v. 8 hourly
DALCAP, CLINCIN, DALCIN, 150, 300 mg cap,
300mg/2ml and 600 mg/4ml inj.
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106. Anti fungal drugs
Fungus
Composed
of a rigid cell wall made up of chitin and
various polysaccharides, and a cell membrane
containing ergosterol
Protective layers of the fungal cell make the organism
resistant to antibiotics
Related groups of anti fungal agents
1.Antibiotics
A. Polyenes
B. Heterocyclic benzofuram
2.Antimetabolites
3. Azoles
A.Imidazoles
B.Triazoles
4.Allylamine
5.Topical agents
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107. Nystatin
A polyene derived from Streptomyces noursei
Binds to sterols of fungal cell membrane
Topical antifungal agent- fungicidal
2nd choice to clotrimazole
1 lac units-4 times a day, 10-14 days
Suspended with glycerine
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108. CLOTRIMAZOLE
Effective
in the topical treatment. Esp, athletes
foot, otomycosis and oral, cutaneous
candidiasis.
10mg -3-4times a day. Gel or lotion-denture
stomatitis
Angular chelitis
well tolerated although Local irritation and
burning
No systemic toxicity is seen after topical use.
SURFAZ, CLOTRIN, CLODERM, 1% lotion,
cream, powder 100mg tab.
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110. Acyclovir
Indications:
Herpes simplex virus (HSV) 1
and 2 infections; HSV encephalitis; shingles
and chickenpox; ointment for herpes
infections; cream for cold sores
Actions: Inhibits viral DNA replication
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111. Symptoms
Rapid
progressing- facial cellulitis-HI/SP
Chronic/ slowly progressing-odontogenicstaphylococcal/mixed
>101 F –nonodontogenic- hospitalization
Colour:red/ violecious
Swelling: indurated, non fluctuant or
erythematous – cellulitis
Pointed, fluctuant or productive- abscess
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112. Management
Upper face
Outpatient: amoxicillin clavulanate or cefaclor orally
Ceftriaxone- 1 day iv
Inpatient : cefuroxime/ ampicillin+ sulbactam 7-10 days
Odontogenic –pencillin/ clindamycin, surgical
intervention
Lower face
Outpatient: cephalexin, amoxicillin clavuanate,
erythromycin
Inpatient : iv cefazolin, clindamycin
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113. Some of the commonly used drugs
Amox-250,500mg-tid
250mg-Rs
67.50
500mg-Rs120.80
Children20-40mg/kg body weight-tid
-125,250mg
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115. Metrogyl
200mg;tab
10-Rs3.64
400mg;tab 10-6.31- given tid for 5-10 days
Suspension; 200mg /5ml-30ml-Rs8.09
60ml-Rs-12.27
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116. KNOW THE BUGS, KNOW THE DRUGS
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117. List of references
Essentials of medical pharmacology :
KD TRIPATHI; 5th edi.
Clinical pharmacology – Bennet & Brown 9th ed
Oral & maxillofacial infections – Topazian 4th ed
.Text book of pediatric dentistry – Damle 3rd ed
Caranza Text book of periodontology 10th
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118. Questions to ask
before starting antibiotics
•Does this patient actually need
antibiotics?
•What is best treatment?
•What are the likely organisms?
•Where is the infection?
•How much, how often, what
route, for how long?
•How much does it cost?
•Are there any problems in
using antibiotics in this
patient?
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