This document provides an overview of antibiotics used to treat maxillofacial infections. It discusses the history and classification of antibiotics, principles for choosing the appropriate antibiotic, administration of antibiotics, combination antibiotic therapy, antibiotic prophylaxis and its principles. It also discusses some of the most commonly used antibiotics for maxillofacial infections such as penicillin, cephalosporins, and tetracyclines. Specific antibiotics discussed in more detail include amoxicillin, penicillin VK, and minocycline.

1. ANTIBIOTICS IN
MAXILLOFACIAL INFECTION
Resource faculty:
Dr.Jyotsna Rimal
Head of department
Department of Oral Medicine and Radiology
Dr.Iccha Kumar Maharjan
Associate Professor
Department of Oral Medicine and Radiology
Presented by:
Alka Singh
BDS 2011

2. CONTENTS
• INTRODUCTION
• HISTORY AND CLASSIFICATION
• PRINCIPLES FOR CHOOSING THE APPROPRIATE
ANTIBIOTICS
• PRINCIPLES OF ANTIBIOTIC ADMINISTRATION
• COMBINATION ANTIBIOTIC THERAPY
• ANTIBIOTIC PROPHYLAXIS AND ITS PRINCIPLES
• MOST COMMONLY USED ANTIBIOTICS IN MAXILLOFACIAL
INFECTION

3. INTRODUCTION
• An antibiotic is a word derived from the
Ancient Greek meaning:
(anti, i.e., "against", and bios, i.e., "life")
• DEFINITION:
SUBSTANCES PRODUCED BY MICROORGANISMS, WHICH
SUPPRESS THE GROWTH OF OR KILL OTHER
MICROORGANISMS AT VERY LOW CONCENTRATIONS

4. HISTORY
Louis Pasteur was one of the first
physician who observed that bacteria
kill other bacteria.
Penicillin, the first natural antibiotic
discovered by Alexander Fleming in
1928.
Chain and Florey followed up this
observation in 1939 which culminated
the use of Penicillin in clinical use in
1941.

5. CLASSIFICATION
• ON THE BASIS OF PREPARATION:
- NATURALLY OCCURRING : PENICILLIN , CEPHALOSPORIN, ERYTHROMYCIN.
- SYNTHETIC: SULFONAMIDES
• ON THE BASIS OF FAMILY:
- PENICILLIN
- CEPHALOSPORIN
- SULFONAMIDES
- TETRACYCLINE
- AMINOGLYCOSIDES : GENTAMICIN , NEOMYCIN, STREPTOMYCIN
- MACROLIDES: CLARITHROMYCIN, ERYTHROMYCIN, AZITHROMYCIN
- QUINOLONES: CIPROFLOXACIN , NORFLOXACIN

6. On the basis of spectrum of activity:
- Narrow: Penicillin, Streptomycin
- Broad: Ampicillin,Tetracycline,Chloramphenicol
On the basis of effect:
- Bacteriostatic: Erythromycin , Tetracycline, Sulfonamides
- Bactericidal: Penicillin, Cephalosporin
On the basis of antibiotics obtained from:
- Fungi: Penicillin , Cephalosporin
- Bacteria : Bacitracin, Polymixin B
- Actinomycetes : Aminoglycoside, Chloramphenicol, tetracycline

8. INDICATIONS
• Treatment of established infections;
• infections that persists inspite of local measures
• where there is signs of systemic involvement eg.submandibular
lymphadenopathy and fever
• when surgical access is difficult e.g severe trismus
• when there is a diffuse , spreading infection eg.facial cellulitis
• Prophylaxis against infections:
• Immunocompromised patient
• Surgical procedures with a high likelihood of infections
» Maxillofacial trauma
» Major or difficult surgery
» When the consequences of infections are serious
» Infective endocarditis
» Orthopaedic joint prosthesis

9. Before antibiotic prescription one should know,
1. Bacterial flora causing most odontogenic
infections
2 .The basic mechanism of host defenses
3. The variety of contemporary antibiotics and
principles to choose
Once the decision has been made to use antibiotics
as an adjunct to treating infection the antibiotics
should be properly selected following a set of

10. PRINCIPLES FOR CHOOSING ANTIBIOTIC
1) IDENTIFICATION OF THE CAUSATIVE ORGANISM
2) DETERMINATION OF ANTIBIOTIC SENSITIVITY
3) USE OF A SPECIFIC, NARROW-SPECTRUM ANTIBIOTIC
4) USE OF THE LEAST TOXIC ANTIBIOTIC
5) PATIENT DRUG HISTORY
6) USE OF A BACTERICIDAL RATHER THAN A BACTERIOSTATIC DRUG
7) USE OF THE ANTIBIOTIC WITH A PROVEN HISTORY OF SUCCESS
8) COST OF THE ANTIBIOTIC
9) ENCOURAGE PATIENT COMPLIANCE

11. Principles of antibiotic administration
•Proper dose (3-4×MIC)
•Proper time interval(4×t1/2)
•Proper route of administration
•Consistency in route of administration
•Combination in antibiotic therapy

12. Duration of action of antibiotics
Depends on t1/2
Uaual dose interval =4×t1/2
As at 5t1/2 95%of drugs has been excreted
Eg. t1/2 for cephazolin 2 hours ,dose interval =8 hrs
Half life of some antibiotics
Penicillin=30 min
Metronidzole=8 hrs
Tetracycline=6-10 hrs(given qid)
Doxycycline=18- 24 hrs(given od)

13. RATIONALE
• To have an additive synergistic effect.
• In mixed infections when bacteria are sensitive to different drugs.
• To achieve delay in development of resistance.
• To decrease the incidence of adverse reactions to an individual drug ,
another drug is added so that the doses of individual drug can be
reduced and possible toxic effects can be avoided
• To reduce the cost of therapy
COMBINATION ANTIBIOTIC THERAPY

14. Indications:
 when its necessary to increase the spectrum ,e.g. life
threatening sepsis of unknown cause
 when increased bactericidal effect against a specific
organism is desired e.g.. infection caused by group d
streptococcus –penicillin and aminoglycosides is given
 prevention of rapid emergence of resistance
 rapidly progressive odontogenic infection e.g.. Severe
cellulitis rapidly progressing posteriorly around retro
pharyngeal space, bactericidal activity against
Streptococcus and oral anaerobes is important ;
rational approach to treatment would be penicillin G
AND metronidazole

15. Disadvantage of combination therapy
- Increased incidence and variety of adverse effects.
- Increased chances of super infections.
- Emergence of resistance.
- Increased cost of therapy

16. ANTIBIOTIC AS PROPHYLAXIS
• Use of AMA(Antimirobial) for preventing the setting in
of an infection or suppressing contacted infection
before it becomes clinically manifest.

17. 1. Prophylaxis against specific microorganisms
• Rheumatic fever- group. A Streptococci-long acting
Penicillin G
• HIV infection- zidovudine+lamivudine+indinavir
(needle stick injury)
2. Prevention of infection in high risk situations
3. Prevention of infection in general

18. Prophylactic Antibiotic Regimen*
Situation Agent Regimen—Single Dose
30-60 minutes before procedure
Adult Children
Oral Amoxicillin 2 g 50 mg/kg
Unable to
take oral
medication
Ampicillin or 2 g IM or IV* 50 mg/kg IM
or IVCefazolin or
Ceftriaxone
1 g IM or IV
50 mg/kg IM
or IV
Allergic to
Penicillin or
Ampicillin—
Oral regimen
Cephalexin or 2g 50mg/kg
Clindamycin or 600mg 20mg/kg
Azithromycin or
Clarithromycin
500mg 15mg/kg
Allergic to
Penicillin or
Ampicillin and
unable to take
oral medication
Cefazolin or
Ceftriaxone
1 g IM or IV 50 mg/kg IM
or IV
OR
Clindamycin
600 mg IM
or IV
20 mg/kg IM
or IV
*Adapted from Prevention of Infective Endocarditis: Guidelines From the American Heart Association, by
the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease. Circulation, 2007

19. Case Report
A 22 year old boy reported to dental OPD with massive swelling of the cheek to the level of
the eyelid.
before the onset of swelling ,he had a toothache in molar region .his temperature was 101F
,and the skin of
his cheek was warm tender and erythematous.
Diagnisis:buccal space infection
Treatment:
percutaneous incision and drainage
penicillin(500mg×qid× 10 days) followed by endodontic filling
of offending tooth
ideal antibiotic for treating dental infections-bactericidal against gram positive
cocci and the major pathogens of mixed anaerobic infections.
with minimal adverse effects and allergic reactions and relatively low in cost.

20. SOME MAXILLOFACIAL INDICATION OF
ANTIBIOTICS
1. Acute periapical cellulitis and abscess/ Acute dentoalveolar abscess
Microbiology: Treponema spp.
T.forsythia,
P. endodontalis
P. gingivalis
F. nucleatum
Drug of choice: Penicillin
2. Acute pericoronitis
Microbiology: Anaerobic bacteria including gram positive cocci(
Peptostreptococcus) and gram negative rods( Prevotella)
Drug of choice: Penicillin

21. 4. Fractures
• for compound maxillofacial fractures
• Antibiotics to be given in therapeutic doses as soon as possible and
continued until active fracture treatment is completed( open/closed
reduction, rigid fixation)
• Drug of choice: Penicillin
5. Soft tissue wounds
Extensive, deep or old( >6 hours) orofacial lacerations
Microbiology: Animal bites- Staphylococcus, Streptococcus, Bacteroides
Fusobacterium , and Pasteurella multocida
Drug of choice: Amoxicillin and clavulanic acid .

22. .
6). Sinusitis
Microorganisms: S. pneumoniae, H. influenza, Bacteroides spp., Fusobacterium
spp., Streptococcus
Drugs used:
Amoxicillin- 1st line antibiotic given for a minimum of 10 days
Second generation cephalosporins, azithromycin and amoxicillin- clavulanate:
resistant cases
7)Osteomyelitis
Microbiology: Staphylococcus aureus, S. epidermidis
hemolytic Streptococci
Actinomyces,Ekinella corrodens
Drug of choice: Penicillin+Metronidazole
Clindamycin

23. 8) Space infections
Microbiology:
• Mixed aerobic and anaerobic flora( 65-70%)
• Exclusively anaerobic(25-30%)
• Exclusively aerobic (5%)
Microorganisms organisms:
• Aerobic- Streptococci(Alpha, beta and gamma)
Corynebacterium
• Anaerobic- Streptococci( Peptostreptococcus)
Bacteroides( Porphyromonas, Prevotella)
Fusobacterium
Eikenella
Propionibacterium

24. Drugs:
• Empirical antibiotic of choice: Penicillin
• Penicillin+Metronidazole( enhances killing of anaerobes)
• Penicillin resistant: Clindamycin
• Azithromycin
• First and second generation cephalosporins
• Minocycline and doxycycline(low grade dentoalveolar infections)

25. ANTIBIOTICS FOR IMMUNOCOPROMISED
PATIENT
suppressed immunity ↑ risk for dentoalveolar infection
Immunosuppression determined by ANC(Absolute
neutrophil count)
ANC<500ml indicates severe neutropenia
gingival disease in immunosuppressed:chlorhexidine
Use of broad spectrum antibiotic is appropriate
penicillin vk,amoxicillin,clindamycin,azithromycin
commonly used
Prior consultation form oncologist is recommended

26. SOME ANTIBIOTICS COMMONLY USED IN
MAXILLOFACIAL INFECTION

27. Penicillin
Semisynthetic
derivative of Penicillin
Cephalosporins
βlactam antibiotics

28. MECHANISM OF ACTION
B-lactam antibiotics
Mechanism of action :
Acts by inhibiting the synthesis of bacterial cell walls.
It inhibits cross-linkage between the linear
peptidoglycan polymer chains that make up a major
component of the cell walls of both Gram-positive and
Gram-negative bacteria

29. PENICILLIN
• NATURAL: PENICILLIN G
PENICILLIN V
• SEMISYNTHETIC: AMPICILLIN,
AMOXICILLIN,
METHICILLIN,
COAMOXYCLAV,
PROCAINE PENICILLIN,
BENZATHENE PENICILLIN

30. • ADMINISTRATION:
The route of administration is determined by the
stability of drug to gastric acid and the severity of the
infection.
• ROUTES OF ADMINISTRATION:
-ORAL:
Penicillin VK, amoxicillin, amoxicillin in combination
with clavulanic acid.
-Iv/im:
Methicillin,ticarcillin,carbenicillin,mezlocillin ,
piperacillin.

31. RECOMMENDED DOSES

32. Generic name- Penicillin VK
Brand name- CRYSTAPEN-V, KAYPEN
Indications- Bacterial infection
Administration- Tablets
Dosage- 500mg qid x 7-10d
Contraindications- Documented hypersensitivity
Common side effects-Rash(hypersensitivity), nausea,
abdominal pain, diarrhoea
Drug interactions-Chloroquine phosphate, methotrexate

33. AMOXICILLIN
GENERIC NAME- AMOXICILLIN
BRAND NAME- AMOXYLIN, NOVAMOX
INDICATIONS- BACTERIAL INFECTION
ADMINISTRATION-CAPSULE
DOSAGE- 250-500MG T.D.S. X 7D(HALF LIFE 30 MIN
COMMON SIDE EFFECTS-RASH, NAUSEA, ABDOMINAL PAIN, DIARRHEA
DRUG INTERACTIONS- CHLORAMPHENICOL, MACROLIDES,
SULFONAMIDES, TETRACYCLINES

34. 1. First
generation(1960s):
Cephalothin,
Cephalexin, Cefazolin,
Cefadroxil
-high activity against
gram +ve but weaker
against gram –ve
bacteria
-Effective against Gram
+ve cocci except
enterococci
2. Second
generation(197
0s):
Cefuroxime,
Cefaclor
-Greater activity
against Gram -
ve than 1st
generation
-some members
active against
anaerobes
3.Third
generation(1980s):
Ceftriaxone, cefotaxime,
Ceftazidime, Cefixime
-highly augmented
activity against gram-ve
CEPHALOSPORINS

35. 4. Fourth generation(1997): Cefpirome, Cefipime
-Highly resistant to β-Lactamases
-covers pseudomonal infections
5. Fifth generation: Ceftobiprole
-used to treat MRSA

36. MOA
lInhibition of
bacterial cell
wall
peptidoglycan
synthesis by
inhibition of
penicillin-
sensitive
enzymes which
form the rigid
bacterial cell
wall.
USE
Infections caused
by staphylococci
and streptococci.
Surgical and
endocarditis
prophylaxis
Osteomyelitis
ADR
Hypersensitivity
reaction
Nephrotoxicity
Neutropenia
Thrombocytope
nia

37. TETRACYCLINES
• MECHANISM OF ACTION:
Inhibits protein synthesis by binding to 30s ribosomes
• Bacteriostatic
• They are effective in treating periodontal diseases because their concentration
in the gingival crevice is 2-10 times that in serum
• Besides they exert an anticollagenase effect that can inhibit tissue destruction
and may aid bone regeneration

38. USES
- Localized aggressive
periodontitis
(inhibits the growth of Actinobacillus
actinomycetemcomitans)
- Refractory periodontitis
- Actinomycosis
- Juvenile periodontitis
- Chronic periodontal disease
- Desquamative gingivitis
- vomiting, diarrhoea
-Renal toxicity
-Phototoxicity
-Hypersensitivity
-Superinfection
-Tooth discoloration
-Temporary suppression of bone
growth
-Furry darkening or blackish
discoloration of tongue
ADR

39. Minocycline
•Used in adult
periodontitis
•Dose: 200 mg
initially,then,100-
200 mgOD
•Half life =16 to 24
hrs
• Doxycycline:
• - Subantimicrobial dose i.e.,20
mg is used in host modulation
therapy for 3-9 months.
• - Indicated when topical and
intralesional therapy is not
successful in controlling
desquamative gingivitis.
•

40. • Doxycycline hyclate(20 mg capsule) is used as a subantimicrobial dose
for:
- suppression of collagenase activity,esp. that produced by the PMN
leucocytes, matrix metalloproteinase and osteoclastic resorption,
CAUSING
- decreased tissue destruction
HENCE HELPING IN
- bone regeneration
• No antimicrobial effects because 20 mg BD is too low dose to affect the
bacteria.

41. AMINOGLYCOSIDES
• Systemic-Streptomycin,Gentamicin,Kanamycin,Amikacin
• Topical-Neomycin,Framycein
Mechanism of action : Binds at several sites at 30s and
50s as well as their juncture and inhibits protein
synthesis
Use: gentamycin 2mg/kg i.m/i.v single dose to supplement
amoxicillin or vancomicin in endocarditis prophylaxis
SHARED TOXICITY:
Ototoxicity
Nephrotoxicity
Neuromuscular blocked

42. MACROLIDES
•MECHANISM OF ACTION:
-inhibits protein synthesis by binding to
50s ribosomes and interfering with
translocation.

43. Azithromycin
•Generic name- Azithromycin
•Brand name- AZITHRAL,
AZIWOK
•Indications- Bacterial
infection
•Administration-Capsule
•Dosage- 500mg 1 day, then
250 mg for 2-5 day
•Common side effects-Rash,

44. erythromycin •active against gram +ve and a
few gram –ve bacteria.
•It is widely distributed in the
body, enters cells and into
abscesses, crosses serous
membranes and placenta but
not the blood brain barrier.
•It is used in patients with
refractory periodontitis and as
a prophylaxis against
endocarditis.
clarithromycin
•Mechanism is similar to
that of erythromycin.
•It is more active
against gram positive
cocci and anaerobes
(Actinomyces,
Lactobacillus).
•First line of drugs in
combination regimens
for Mycobacterium
Avium Complex
infection.

45. Mechanism of action :
• Clindamycin has a bacteriostatic effect. It is a bacterial protein
synthesis inhibitor by inhibiting ribosomal translocation.
• It does so by binding to the 50S rRNA of the large bacterial ribosome
subunit.
NOTE:
It readily enters hard and soft tissues because of its relatively small molecular size(
greater bone permeability)
LINCOSAMIDE
CLINDAMYCIN

46. Generic name- Clindamycin
Brand name- DALCAP, CLINCIN
Indications- Bacterial infection
Administration-Capsule
Prescription/OTC-Prescription
Dosage- 300mg q.i.d. x 7days
Common side effects-Rash, nausea, abdominal pain,
diarrhoea

47. FLUOROQUINOLONES
• 1st Generation: Norfloxacin, Ofloxacin, Ciprofloxacin
• 2nd Generation: Lomefloxacin, Sparfloxacin, Moxifloxacin,
Gatifloxacin
• 3RD Generation:Gemifloxacin,prulifloxacin
• Mechanism of action:
• Inhibits the enzyme bacterial DNA gyrase which nicks the double
stranded DNA

48. Uses
–Osteomyelitis
–ANUG
–Recurrent periodontitis
Adverse effects
–GI symptoms: Nausea, vomiting, anorexia
–Hypersensitivity reaction
–Arthritis

49. • Metronidazole
• Prototype drug of nitroimidazole
• MOA-bactericidal to anaerobes
• Enters cell by diffusion
• nitro group
• Highly active nitro radical(electron sink)
• Disturbs metabolism of anaerobes
Ccertain redox protein of anerobic microbes

50. Routes of administration
Metronidazole can be
given via following
routes:
- Oral tablets
- Topical gels
Oral: Tab.500mg tds .
Uses
Acute necrotizing
ulcerative
gingivitis(ANUG)
-Aggressive
periodontitis
-Abscesses
Adverse effect
nausea,vomiting,abdominal
cramp
-Dry mouth, unpleasant
metallic taste
-Dark or reddish-brown
urine
-Furry tongue: mouth or
tongue irritation
“disulfiram interaction” with
alcohol

51. ANTI FUNGA

52. ANTIFUNGAL DRUGS
CLASSIFICATION:
1. ANTIBIOTICS
A. POLYENES: AMPHOTERICIN-B(AMB), NYSTATIN, HAMYCIN, NATAMYCIN
B. HETEROCYCLIC BENZOFURAN: GRISEOFULVIN
2. ANTIMETABOLITES: FLUCYTOSINE(5-FC)
3. AZOLES
A. IMIDAZOLES(TOPICAL): CLOTRIMAZOLE, ECONAZOLE, MICONAZOLE,
OXICONAZOLE
B. TRIAZOLES(SYSTEMIC): FLUCONAZOLE, ITRACONAZOLE,VORICONAZOLE
4. ALLYLAMINE: TERBINAFINE
5. OTHER TOPICAL AGENTS: BENZOIC ACID, SOD.THIOSULFATE

53. MECHANISM OF ACTION
Inhibits the fungal cytochrome P450 enzyme 14α-
demethylase.
conversion of lanosterol
ergosterol an essential component of the fungal
cytoplasmic membrane
and subsequent accumulation of 14α-methyl sterols.

54. • Generic name: Amphotericin-B
• Brand name: Fungisome, Fungizone
• Indications: Oral, vaginal and cutaneous
candidiasis, otomycosis; antifungal therapy
• Administration: Topical/oral/iv
• Dosage: 50-100mg QID oral;
10mg,25mg,50mg per vial inj.
• Contraindication: renal deficiency
• Common side effects: Acute reaction ->chills,
fever, aches; nephrotoxicity

55. Topical antifungal
•Generic name: Clotrimazole
•Brand name: SURFAZ,
CLOTRIN
•Indications: Oropharengeal
candidiasis
•Administration: Troche
•Dosage: 10mg troche:
dissolve slowly over 15-
30min
•5 times daily: apply to
affected area b.i.d. for 7d
•cream can be applied to the
•Generic name: Nystatin
•Brand name: NYSTIN,
MYCOSTATIN
•Indications: Oropharyngeal
candidiasis
•Administration: Oral
suspension, powder, cream,
lozenge
•Dosage: Oral suspension
(100,000U/ml): 400,000-
600,000 units 4-5
times/d(swish and
swallow)

56. SYSTEMIC ANTIFUNGAL
Use
Administration
Dosage
Side effects
Monitoring
Ketoconazole
Oral and oesophageal
Candidiasis
Tablets
200mg on 1st day
100mg daily for 7-10
Headache,nausea,vomiting,
rash,diarrhea
Liver function test,potasium
Itraconazole
Oral and oesophageal
Candidiasis
Suspension
100-200mg/10ml od
1- 2 wk
Nausea,pruritus,diarrhea,
Incresed liver enzyme
Liver function test
Fluconazole
Oral and oesophageal
Candidiasis
Tablets
200-400mg/d as single dos
For 7-14 days
Pruritus,vomitimg,abdomina
Liver function test

57. RESEARCH ON
EFFICACY OF
COMBINATION
THERAPY

58. Title Comparison of clinical efficacy between 3-day combined clavulanate/
amoxicillin preparation treatment and 10-day amoxicillin treatment in
children with pharyngolaryngitis or tonsillitis. Links Export Central
Citation
Author(s) Kuroki H, Ishiwada N, Inoue N, Ishikawa N, Suzuki H, Himi K,
Kurosaki T
Source Journal of infection and chemotherapy
Date of Publication 2013
Volume 19
Issue 1
Pages 12-9
Publisher Name Springer Japan (1-11-11 Kudan-kita, Chiyoda-ku, No. 2 Funato Bldg.,
Tokyo 102-0073, Japan)
City of Publication Japan
Abstract The efficacy of 3-day treatment with a combined clavulanate/amoxicillin preparation (Clavamox
combination dry syrup for pediatric cases) and 10-day treatment with amoxicillin against pediatric
pharyngolaryngitis and tonsillitis caused by Group A beta-hemolytic Streptococcus was compared.
Among the patients included in the efficacy evaluation (54 from the clavulanate/ amoxicillin group
and 43 from the amoxicillin group), the clinical response rate on completion of treatment was 98.1
% in the clavulanate/amoxicillin group and 92.9 % in the amoxicillin group, thus supporting the
equivalent efficacy of these two therapies. The Group A beta-hemolytic Streptococcus eradication
rate at approximately 1-2 weeks after completion/discontinuation of treatment was 65.4 % in the
clavulanate/amoxicillin group and 85.4 % in the amoxicillin group. Even in cases from which the
pathogen continued to be isolated, relapse/recurrence of clinical symptoms was seldom seen.
Urinalysis, conducted to assess the presence or absence of acute glomerulonephritis, revealed no
abnormality in any patient. These results suggest that 3-day treatment with this
clavulanate/amoxicillin preparation is expected to provide a valid means of treating pediatric
pharyngolaryngitis and tonsillitis caused by Group A beta-hemolytic Streptococcus. 2012 Japanese
Society of Chemotherapy and The Japanese Association for Infectious Diseases.
EMBASE keywords adolescent // antibiotic sensitivity // article // body temperature // child // controlled study //
diarrhea/si [Side Effect] // drug efficacy // drug eruption/si [Side Effect] // drug safety // drug
withdrawal // eradication therapy // female // Haemophilus influenzae // human // *laryngitis/dt
[Drug Therapy] // major clinical study // male // minimum inhibitory concentration // Moraxella
catarrhalis // multicenter study // Neisseria // nonhuman // open study // patient compliance //
*pharyngitis/dt [Drug Therapy] // preschool child // randomized controlled trial // respiratory tract
inflammation/si [Side Effect] // school child // Streptococcus group A // Streptococcus pneumoniae
// *tonsillitis/dt [Drug Therapy] // urinalysis // urticaria/si [Side Effect] // *amoxicillin/ae [Adverse
Drug Reaction] // *amoxicillin/ct [Clinical Trial] // *amoxicillin/cm [Drug Comparison] //
*amoxicillin/dt [Drug Therapy] // *amoxicillin plus clavulanic acid/ae [Adverse Drug Reaction] //
*amoxicillin plus clavulanic acid/ct [Clinical Trial] // *amoxicillin plus clavulanic acid/cm [Drug
Comparison] // *amoxicillin plus clavulanic acid/dt [Drug Therapy] // cefcapene pivoxil
Correspondence Address H. Kuroki, Sotobo Children's Clinic, 1880-4 Izumi Misaki-machi,
Isumi Chiba, Japan. E-mail: kuroki-haruo@krc.biglobe.ne.jp
Accession Number EMBASE 2013118760
DOI 10.1007/s10156-012-0444-1
Language eng
Publication Type Journal: Article
ID CN-00911958

59. Title Comparison of clinical efficacy between 3-day combined clavulanate/
amoxicillin preparation treatment and 10-day amoxicillin treatment in children
with pharyngolaryngitis or tonsillitis. Links Export Central Citation
Author(s) Kuroki H, Ishiwada N, Inoue N, Ishikawa N, Suzuki H, Himi K, Kurosaki T
Source Journal of infection and chemotherapy
Date of
Publication
2013
Volume 19
Issue 1
Pages 12-9
Publisher
Name
Springer Japan (1-11-11 Kudan-kita, Chiyoda-ku, No. 2 Funato Bldg., Tokyo
102-0073, Japan)
City of
Publication
Japan

60. Abstract Theefficacyof3-daytreatmentwithacombinedclavulanate/amoxicillinpreparation(Clavamoxcombinationdrysyrup
forpediatriccases)and10-daytreatmentwithamoxicillinagainstpediatricpharyngolaryngitisandtonsillitiscausedby
GroupAbeta-hemolyticStreptococcuswascompared.Amongthepatientsincludedintheefficacyevaluation(54from
theclavulanate/amoxicillingroupand43fromtheamoxicillingroup),theclinicalresponserateoncompletionof
treatmentwas98.1%intheclavulanate/amoxicillingroupand92.9%intheamoxicillingroup,thussupportingthe
equivalentefficacyofthesetwotherapies.TheGroupAbeta-hemolyticStreptococcuseradicationrateatapproximately1-
2weeksaftercompletion/discontinuationoftreatmentwas65.4%intheclavulanate/amoxicillingroupand85.4%inthe
amoxicillingroup.Evenincasesfromwhichthepathogencontinuedtobeisolated,relapse/recurrenceofclinical
symptomswasseldomseen.Urinalysis,conductedtoassessthepresenceorabsenceofacuteglomerulonephritis,revealed
noabnormalityinanypatient.Theseresultssuggestthat3-daytreatmentwiththisclavulanate/amoxicillinpreparationis
expectedtoprovideavalidmeansoftreatingpediatricpharyngolaryngitisandtonsillitiscausedbyGroupAbeta-
hemolyticStreptococcus.2012JapaneseSocietyofChemotherapyandTheJapaneseAssociationforInfectiousDiseases.

61. ANTIVIRAL

62. CLASSIFICATION
1. Anti-herpes virus agents:
Acyclovir, Valacyclovir, Famcyclovir,Gancyclovir, Idoxuridine,
2. Anti-retrovirus agents:
 Nucleoside Reverse transcriptase inhibitors- Zidovudine(AZT),
Didanosine, Stavudine, Lamivudine, Abacavir
Non-nucleoside Reverse transcriptase inhibitors-Nevirapin, Efavirenz
 Protease inhibitors- Ritonavir, Indinavir, Nelfinavir
3. Anti-influenza virus agents:
 Amantadine, Rimantadine
4. Nonselective antiviral drugs:
 Ribavirin, interferon-alpha

63. SOME INDICATIONS
Primary herpetic gingivostomatitis
HERPES LABIALIS
INFECTIOUS MONONUCLEOSIS
ERYTHEMA MULTIFORME

64. Acyclovir
Acyclovir monophosphate
Acyclovir triphosphate
Herpes virus specific thymidine kinase
Inhibits herpes virus DNA polymerase competitively
Gets incorporated in viral DNA and stops
lengthening of DNA strand. The terminated
DNA inhibits DNA-polymerase irreversibly
Mechanism of action

65. Brand name
Incication
Administrtion
Dosage
A.D.R
ACYCLOVIR
Zovirax
herpes labialis
Cream
5%cream qid for 4 days
Pain ,burning,stinging
VALACYCLOVIR
Valtrex
Herpes labialis
Erythema
multiforme
Tablet
RHL: 2g bid for 1d
(separate doses by
12h)
EM 500mg bd
Headache

66. FAMCICLOVIR
Brand name-Famvir
Indication-Herpes zoster, recurrent HSVin
immunocompromised
Tablets
Dosage-500mg t.i.d. for 7d
Recurrent HSV in immunocompromised patients: 125mg
b.i.d. for 5 days
ADR-arthralgia,rigor,upper respiratory tract infection

67. CONCLUSION
• WHEN?
• WHY?
• HOW?
• And What?

69. ANY
QUESTIO
NS?

70. MCQS

71. 1)Which of the following drugs acts by inhibiting the synthesis
of bacterial cell walls?
A) Tetracyclines
B) Penicillins
C) Macrolides
D) Metronidazole
B)Penicillins

72. 2)Which of these drug have chelating
property?
A) Tetracyclines
B) Penicillins
C) Macrolides
D) Metronidazole
A)Tetracyclines

73. 3)Dose of amoxicillin in antibiotic prophylaxis
according to AHA?
A)3g
B)1g
C)2g
D)none
C)2g

74. Which drug causes disulfuram like action?
• A)Metronidazole
• B)Amoxcillin
• C)Azitromycin
• D)Gentamycin
A)METRONIDAZOLE

75. REFERENCES
• ESSENTIALS OF MEDICAL PHARMACOLOGY-K.D TRIPATHI -6 EDITION
• ESSSENTIALS F PHARMACOLOGY FOR DENTISTRY-K.D TRIPATHI -2ND EDITION
• BURKET’S ORAL MEDICINE-11TH EDITION
• TEXT BOOK OF ORAL AND MAXILLOFACIAL SURGREY-NEELIMA ANIL MALLIK-3RD
EDITION
• ORAL AND MAXILLOFACIAL INFECTION- TOPAZION 4TH EDITION