DrugsI. hemostatics/

antihemorragicII. AntibioticIII. AntihistmineIV. Analgesic,

Antipyretic AntiinflammatoryV. AnestheticsVI . Minor tranquilizer,

sedative-hypnotic sedative

antihistamine

Bleeding infection Allergy Pain, Fever

Inflammation

Pain Anxiety/fear

Drugs that suppress the growth of kill bacteria and other microorganism

Categories

□ Antibiotic □ Sulfonamide

Characteristics of an ideal antibiotic □ Be selective and effective without injury to the host□ Destroy microorganism (bacteriocidal)□ Do not become ineffective because of bacterial resistance

Types of Bacterial Resistance

* Natural

e.g. Penicillinase resistant Staphylococcus Aureus

* Acquired

* Cross

e.g. Penicillin and Cephalosporin

□ not be inactivated by plasma protein, enzymes or body fluid

□ have minimal adverse effects

Indications

(√) 1. an infection is genuinely present(√) 2. the infection is likely to respond to

the antibiotic(√) 3. the infection is sever enough to

warrant treatment(√) 4. antibiotic is the best form of

treatment

Points to Remember

(√) antibiotic should not be used unless the

need for them is certain

(√) an adequate history must be taken prior

to treatment

(√) less than therapeutic dose must never be prescribed

(√) administration of 1 ½ hours before and 3 hours after

meals is advisable

(√) there should be prompt response that is beneficial

usually 24-48 hrs (√) therapy should continue 2-3 days pass the asymptomatic point(√) if antibiotic fails do not hesitate to utilized

other antibiotic therapy or dosage(√) attention must be paid at all times to possible development of adverse effect

Classification of AntibioticI. Type of Action

bactriocidal bacteriostaticII. Mechanism of action

* inhibition of cell wall* affect cell membrane

permeability* interferes with protein

synthesis* competitive antagonism

III. Spectrum ( Range of activity)narrow broad

IV. Similarity in chemical structure penicillin – cephalosporin erythromycin- lincomycin

General Adverse Effects

□ superinfection (fungal infection)□ allergies□ drug interactions□ GIT irritations

Antimicrobials in Dentistry

Penicillin Type of Type of

Action Action Mechanism of Mechanism of

ActionAction

SpectrumSpectrum CategoryCategory

bacteriocidbacteriocidalal

Cell wallCell wall

Narrow-Narrow-

Gm(+)Gm(+)

aerobic andaerobic and

facultativefacultative

Gm (-) Gm (-)

N. GonorrheaN. Gonorrhea

N. MeningitidesN. Meningitides

I.I. PrototypePrototype

II.II. OralOral

III.III. PenecillinaPenecillinasese

resistantresistant

IV extended IV extended spectrumspectrum

Categories

I. Prototype penicillin Pen G Best for treating sensitive

microorganismII. Oral penicillin Pen V (Phenoxymethyl penicillin) Often used for dental infection Available as potassium (K) and free

acid Dosage: 250mg- 500mg every 6 hours

Categories

I. Prototype penicillin Pen G Best for treating sensitive

microorganism 1 mg sodium Pen G= 1665

units 1 mg of potassium Pen G =

1595 units

Categories

II. Oral penicillin Pen V (Phenoxymethyl penicillin) Often used for dental infection (Pen

vk) Available as potassium (k) and free

acid Dosage: 250mg- 500mg every 6

hours

III. Penicillin Resistant Penicillin * cloxacillin, methicillin,

oxacillin

IV Extended Spectrum Penicillina. Ampicillin-like

ampicillin (Ampicin) 250mg-500mg every 6 hours

amoxicillin ( Amoxil) 250mg-500mg every 8 hours

b. Carbenicillin-likec. Amdinopenicillin

* Clavulanic acid

Oral and parenteral Degraded by gastric juice Crosses placental barrier Excretion: kidney Uses: dental infection

: prevent bacterial endocarditis

Erythromycin(Macrolide)Type of Type of ActionAction

MechanisMechanism of m of ActionAction

SpectrumSpectrum Kinds Kinds

bacteriostatic/bacteriostatic/

BacteriocidalBacteriocidalProtein Protein synthesissynthesis

narrownarrow BaseBase

StearateStearate

EthylsuccinEthylsuccinateate

estolateestolate

Best substitute for patient allergic to penicillin

Adverse effect : cholestatic jaundice precaution: liver disease Dosage: 250 mg - 500mg every 4-6

hours

Tetracycline

Type or Type or ActionAction

MechanisMechanism of m of ActionAction

SpectrumSpectrum KindsKinds

bacteriostbacteriostaticatic

Protein Protein synthesissynthesis

Broad Broad TetracyclineTetracycline

OxytetracycinOxytetracycinee

DoxycylineDoxycyline

MinocyclineMinocycline

MethacyclineMethacycline

demeclocylinedemeclocyline

Usually given by mouth Stored in the dentin and enamel of

unerupted teeth Concentrated in the gingival

crevicular fluid Do not give with food with high

calcium content, aluminum oral iron supplements of antacids

Adverse effects:GIT effectsHepatotoxicityRenal toxicityEffect in teeth and bonePhotosensitivitysuperinfection

Dosage

Tetracycline/ Oxytetracycline

250mg-500mg every 4-6 hours

Doxycyline

50 mg every 12 hrs or 100mg every 24 hours

Minocycline

100mg every 12 hours

Methacycline/ Demeclocycline

150mg every 6 hours 300mh every 12 hours

Cephalosporin

Type of action, mechanism of action spectrum- similar to penicillin

Contraindication: kidney disease Agents recommended for dentistry:

Cephalexin, cephradine Dosage: 250mg -500mg every 4-6

hours

Clindamycin / Lincomycin

Bacteriostatic/ bacteriocidal Narrow spectrum Protein synthesis Recommended for Osteomyelitis Adverse effect: Pseudomembranous colitis Dosage: Clindamycin (Dalacin C) 150-300mg

every 4-6 hour

Lincomycin (Lincosin) 250-500mg every 4-6 hours

Other antimicrobials

Metronidazole (Flagyl) Aminoglycoside: for Gm – infection Chloramphenicol ( Chloromycetin) Drug of choice

for typhoid fever Sulfonamides:

□ mechanism of action : competitive antagonism

□ recommended for lower urinary tract infection

□ adverse effect: Urinary tract crystals

* Flouroquinolones: Ciprofloxacin (Ciprobay)

Antifungal agents

Types Fungal infectiona. Involve the skinb. Involve the oral mucosa

(Candida species)c. Produce systemic disease

Oral Candidiasis ( Thrush Mouth)Drug of choice: Nystatin (Mycostatin) □ Mechanism of action: binds to

fungal cell membrane □ Fungistatic/fungicidal □ Dosage: 400,000-600, 000 units

(4-6ml) 4 x a day

Other agetns: clotrimazole: Canesten ketoconazole: Nizoral Ampotheracin ( Fungizone)

Antiviral

Acyclovir(Zovirax) Inteferon ( Intron A) Idoxuridine( Herplex)