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Pharmacological Drugs Used
After Tooth Extraction
Dr. Wael M. Talaat
Antibiotic/Antimicrobial
• Antimicrobial agent: Chemical
that kills or inhibits the growth of
microorganisms
Antibiotic Spectrum of Activity

• No antibiotic is effective against all
microbes
Common routes of administration
Parentral intravenous (i.v) & intramuscular
(i.m)
Rectal
Enema, Ointments & Suppositories
Oral
Capsule, Tablet & Solution
Topical Cream, Ointment & Transdermal
patch
Parentral

Rectal

rapid
rapid
precise
precise

•toxicity
•invasive
•skill

avoid
avoid first-pass
Oral
Oral not
recommended

Oral

Convenient
Convenient
economical
economical
non-invasive
non-invasive
safer
safer route

Topical

 minimize side
effects

•Incomplete ab.
(pH)
TREATMENT of INFECTION
• Remove the cause of infection is the most
important of all, by either spontaneously or
surgically drain the pus.
• Antibiotics are merely an adjunctive therapy.
Drainage

Host defense

Antibiotics
INDICATIONS for ANTIBIOTICS
1. Severity of the infection
• Acute onset
• Diffuse swelling involves fascial spaces
2. Adequacy of removing the source of infection
• When drainage can’t be established immediately
3. The state of patients’ host defense
• When the patient is febrile
• Compromised host defenses
• For prophylaxis
MICROBIOLOGY
• Most oral infections are mixed in origin
consisting of aerobic and anaerobic gram
positive and gram negative organisms
• Anaerobes predominant (75%)
SELECTION of A/B
• Use the narrowest spectrum antibiotics
• Use the antibiotics with the lowest toxicity
and side effects
• Use bactericidal antibiotics if possible
• Be aware of the cost of antibiotics
Mechanisms of
Antimicrobial Action
• Bacteria have their own enzymes
for
– Cell wall formation
– Protein synthesis
– DNA replication
– RNA synthesis
– Synthesis of essential
metabolites
Mechanisms of
Antimicrobial Action
• Viruses use host enzymes inside
host cells
• Fungi and protozoa have own
eukaryotic enzymes
• The more similar the pathogen and
host enzymes, the more side
effects the antimicrobials will have
Modes of Antimicrobial Action
Antibacterial Antibiotics
Inhibitors of Cell Wall Synthesis
• Penicillin (over 50 compounds)
– Share 4-sided ring (β lactam ring)
• Natural penicillins
• Narrow range of action
• Susceptible to penicillinase (β
lactamase)
Prokaryotic Cell Walls
Penicillins
Fig 20.6

Figure 20.6
Penicillinase (β Lactamase)

Figure 20.8
Semisynthetic Penicillins
• Penicilinase-resistant penicillins
• Carbapenems: very broad
spectrum
• Monobactam: Gram negative
• Extended-spectrum penicillins
• Penicillins + β-lactamase inhibitors
Other Inhibitors of Cell Wall
Synthesis
• Cephalosporins
– 2nd, 3rd, and 4th
generations
more effective
against gramnegatives
Figure 20.9
Other Inhibitors of Cell Wall
Synthesis
• Polypeptide antibiotics
– Bacitracin
• Topical application
• Against gram-positives
– Vancomycin
• Glycopeptide
• Important "last line" against
antibiotic resistant S. aureus
Other Inhibitors of Cell Wall
Synthesis

• Antibiotics
effective against
Mycobacteria:
interfere with
mycolic acid
synthesis or
incorporation
– Isoniazid (INH)
– Ethambutol
Inhibitors of Protein Synthesis
• Broad spectrum, toxicity problems
• Examples
– Chloramphenicol (bone marrow)
– Aminoglycosides: Streptomycin,
neomycin, gentamycin (hearing, kidneys)
– Tetracyclines (Rickettsias & Chlamydia;
GI tract)
– Macrolides: Erythromycin (gram +, used
in children)
Injury to the Plasma Membrane
• Polymyxin B (Gram negatives)
– Topical
– Combined with bacitracin and
neomycin (broad spectrum) in overthe-counter preparation
Inhibitors of Nucleic Acid
Synthesis
• Rifamycin
– Inhibits RNA synthesis
– Antituberculosis
• Quinolones and fluoroquinolones
– Ciprofloxacin
– Inhibits DNA gyrase
– Urinary tract infections
Competitive Inhibitors
– Sulfonamides (Sulfa drugs)
• Inhibit folic acid synthesis
• Broad spectrum

Figure 5.7
Antifungal Drugs
• Fungi are
eukaryotes
• Have unique
sterols in their cell
walls
• Pathogenic fungi
are often outside
the body
Antiviral Drugs
• Viruses are composed of nucleic
acid, protein capsid, and host
membrane containing virus proteins
• Viruses live inside host cells and
use many host enzymes
• Some viruses have unique
enzymes for DNA/RNA synthesis or
protein cutting in virus assembly
Figure 20.16a
Antiviral Drugs
Nucleoside and Nucleotide Analogs

Figure 20.16a
Analogs Block DNA Synthesis

Figure 20.16b, c
Antiviral Drugs
Enzyme Inhibitors
• Inhibit assembly
– Indinavir (HIV)
• Inhibit attachment
– Zanamivir (Influenza)
• Inhibit uncoating
– Amantadine (Influenza)
Antiviral Drugs
Enzyme Inhibitors
• Interferons prevent spread of viruses
to new cells (Viral hepatitis)
• Natural products of the immune
system in viral infections
Antiprotozoan Drugs
• Protozoa are
eukaryotic cells
• Many drugs are
experimental and
their mode of
action is unknown
Measuring Antimicrobial
Sensitivity
• E Test
• MIC: Minimal
inhibitory
concentration
Measuring Antimicrobial
Sensitivity: Disk Diffusion
Antibiotic Resistance

Figure 20.20
Antimicrobial Resistance
• Relative or complete lack of
effect of antimicrobial against a
previously susceptible microbe
Mechanisms of Antibiotic
Resistance
• Enzymatic destruction of drug
• Prevention of penetration of drug
• Alteration of drug's target site
• Rapid ejection of the drug
Antibiotic Selection for
Resistant Bacteria
What Factors Promote
Antimicrobial Resistance?
• Exposure to sub-optimal levels
of antimicrobial
• Exposure to microbes carrying
resistance genes
Inappropriate Antimicrobial
Use
• Prescription not taken correctly
• Antibiotics for viral infections
• Antibiotics sold without medical
supervision
• Spread of resistant microbes in
hospitals due to lack of hygiene
Inappropriate Antimicrobial
Use
• Lack of quality control in
manufacture or outdated
antimicrobial
• Inadequate surveillance or
defective susceptibility assays
• Poverty or war
• Use of antibiotics in foods
Consequences of
Antimicrobial Resistance
• Infections
resistant to
available
antibiotics
• Increased
cost of
treatment
Proposals to Combat
Antimicrobial Resistance
• Speed development of new
antibiotics
• Track resistance data nationwide
• Restrict antimicrobial use
• Direct observed dosing (TB)
Proposals to Combat
Antimicrobial Resistance
• Use more narrow spectrum
antibiotics
• Use antimicrobial cocktails
The Future of
Chemotherapeutic Agents
• Antimicrobial peptides
– Broad spectrum antibiotics from
plants and animals
• Squalamine (sharks)
• Protegrin (pigs)
• Magainin (frogs)
The Future of
Chemotherapeutic Agents
• Antisense agents
– Complementary DNA or peptide
nucleic acids that binds to a
pathogen's virulence gene(s) and
prevents transcription

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