Pharmacology Chap 7

When are systemic antibiotic indicate for endo therapy

are indicate with an endo lesion with soft tissue swelling that not draining, systemic involvement, or spread of the infection. the drug of choice is penicillin VK

the absorption of penicillin depends on

acid stability in the stomach, but penicillins are primarily absorbed from the duodenum

Piperacillin and ticarcillin are absorbed

are not acid stable and thus have to be injected to bypass the stomach

Penicillin

first antibiotic Administered either orally or parenterally but never topically because of severe allergic reactions

what patient taking clindamycyn should observe

for changes in bowel frequency and discontinue the antibiotic if there is watery diarrhea

How many generation of cephalosporin

4 and only a few are given orally

Penicillin adverse effect

Allergic reactions occur in <10% of the population. Pseudomembranous colitis Gastrointestinal upset: nausea vomiting, and diarrhea are most common AE. Superinfection( especially with the broad-spectrum Seizure Activity associate with high level of penicillin

Substantivity

Ability of the drug to adsorb or bind to intraoral surfaces with subsequent release of the drug in its active form

Clindamycin indication

Acute bacterial exacerbation of chronic bronchitis, acute bacterial sinusitis and community-acquired pneumonia, dental infections, and refractory periodontitis (FDA off-label use). Penetrates well into GCF

Tetracycline and periodontal disease tx

Adjunctive therapy Aggressive perio Tetracycyline concentrates higher in the GCF in the pocket than in the blood

What type of perio disease are Systemic antibiotics used

Agressive perio

Augmentim

Amoxicillin + clavulanic acid Prevents the penicillin beta-lactam ring from being destroyed by beta-lactamase enzyme

what can be use to tx peri implant mucosisti

An antimicrobial mouth rinse such as chlorhexidine gluconate.

endodontic therapy

Antibiotics are not indicated in an uncomplicated endodontic infection or if there is well-localized soft tissue swelling without systemic signs of infection such as fever, lymphadenopathy, or cellulitis

what are antibiotics Bactericidal Bacteriostatic

Are defined as substances produced by living organisms (microorganisms) that are harmful to other organisms

Azalides

Are second-generation erythromycins that have a broader spectrum of action with fewer adverse side effects than the erythromycins

Sulfonamides

Are synthetic analogue of para-aminobenzoic acid (PABA) that inhibits the synthesis of folic acid from PABA in bacteria

Second generation of erythromycin

Azalides has fewer AE than erythromycin

Azalides classification

Azithromycin (Zithromax) Clarithromycin (Biaxin)

Clidamycin pregnancy category

B

Penicillin pregnancy category

B

Adversed effect of antibiotic

Bacterial resistance to the antibiotic Superinfections Gastrointestinal (nausea, vomiting, diarrhea) Allergic reactions Photosensitivity Drug interactions

Taking a bactericidal + bacteriostatic antibiotic together

Bactericidal antibiotic such as penicillin with a bacteriostatic antibiotic may interfere with the action of the bacteria antibiotic. Space the two antibiotics

Classification of antibiotic

Batctericidal or bacteriostatic

How antibiotic affect the GI tract

By direct irritation or caused indirectly by upsetting the normal GI flora, resulting in GI distress, including nausea, vomiting, and/or diarrhea.

Cephalosporin

Cephalosporins were isolated at the same time as penicillins were discovered. they have similar β-lactam ring as penicillins, which is responsible for their antibacterial activity. It is a bactericidal and kill bacteria by inhibiting cell wall synthesis by the same mechanism as penicillins

quinolones indication

Chronic periodontitis (FDA unapproved indication), acute bacterial sinusitis, acute bacterial chronic bronchitis, pneumonia, skin infections, bacterial conjunctivitis ( eye drops), urinary tract infections

Type of licomycin

Clindamycin

where is macrolide metabolize

Concentrate in the liver and are partly metabolized in the liver and primarily excreted unchanged via the bile

Tetracycline pregnancy category

D

Penicillin and probenicid ( tx of gout)

Decrease renal (kidney) elimination of penicillin, raising the blood levels.

Clindamycin contraindication

Do not give to patients with Crohn's disease, pseudomembranous enterocolitis, or ulcerative colitis

Tetracycline precaution

Do not take with milk, other dairy products, iron, magnesium-containing products, antacids Doxycycline and minocycline are OK with dairy Wait at least two hours before or after taking with lipid-lowering drugs such as colestipol (Colestid) and cholestyramine (Questran) Take with a full glass of water.

Two semisynthetic analogues of tetracycline

Doxycycline hyclate and minocycline HCl

Metronidazole (Flagyl)

Effective against obligate or strict anaerobic Found in GCF it is a bactericidal, and its mechanism of action is bind to a break down DNA Adjunctive treatment of periodontal diseases

Type of macrolides

Erythromycin (E-mycin)

Oral penicillin VK is the drug of choice

For mild to moderate endodontic, periodontic, and odontogenic infections

Metronidazole AE

GI upset; OK with food Metallic taste; dry mouth

erythromycin and clarithromycin drug interaction

Have the potential to inhibit drug metabolism in the liver through inactivation of the cytochrome P450 liver enzyme.Erythromycin and clarithromycin (not azithromycin) are inhibitors of CYP3A4 enzymes in the liver. Theophylline, carbamazepine, cyclosporine, phenytoin, lovastatin, and simvastatin are metabolized by the CYP3A4 enzymes These drugs will not be metabolized, resulting in increased blood levels.

Metronidazole and alcohol interaction

Headache Nauseas Vomiting Cramps

Macrolides AE

Hepatic dysfunction (mild elevated liver function tests evident as hepatitis—usually with erythromycin estolate) Gastrointestinal disturbances ( abdominal pain, diarrhea, nausea, vomiting) but the second-generation macrolides have fewer

antibiotic allergy reaction

Hives wheezing systemic anaphylaxis

Drug interaction Penicillin+ a bacteriostatic antibiotic( tetracycline, erythromycin)

If a bacteriostatic if given concurrently, penicillin will no work.

how penicillin should be given if a bacteriostatic antibiotic is necessary

If concurrent use of penicillin plus a bacteriostatic antibiotic is necessary, then the penicillin should be given a few hours before the bacteriostatic antibiotic is given

Topical antimacrobial agents ( Atridox, Arestin) are used

In pt with localize chronic peril

Penicillin and food interaction

Increases breakdown of penicillin in the stomach

Superinfection

Infection imposed upon another infection due to overgrowth of normal flora (bacteria/fungi that are normally found in the body), usually with prolonged use and more likely with the broad-spectrum penicillins

Type of antibiotic resistance

Inherent resistance Acquired antibiotic resistance Genetic exchange Active efflux Adaptation

Lincomycin

Inhibit protein synthesis by binding to the 50S ribosomal subunit on the bacteria. Primarily bacteriostatic but can be bactericidal in high doses. Effective against most Gram-positive organisms. Gram-negative bacteria aerobes are resistant to it

Macrolides

Inhibit the multiplication of bacteria by reversibly binding to the 50S ribosomal subunit of susceptible bacteria and consequently inhibiting protein synthesis within the bacterial cell

Oral penicillin may be taken with

Lactobacilus acidophilus to help replace normal flora and reduce GI disease

Antibacterial agent topical

Local delivery of antimicrobial agents is either by topical application or by controlled-release devices. The most common route for the supragingival topical delivery of antimicrobial agents is by a mouth rinse, a dentifrice, or an oral irrigator. Subgingival topical delivery of antimicrobial agents is by oral irrigation or the use of controlled-release devices

Drug interaction penicillin and oral contraceptive

MAy decrease effectiveness of oral contraceptive

Bateriostatic antibiotic

Macrolides Lincomycin Tetracycline

Erythromycin (E-mycin) Macrolides

May be bactericidal at high doses. Can be used when pt is allergy to penicillin. Erythromycins are most effective against Gram-positive bacteria and some Gram-negative strains. Resistance to erythromycin is generally not a problem in short-term therapy.

Macrolides indication

Mild upper and lower respiration tract infection Pharyngitis Tonsillitis Community-acuquierd pneumonia Gonorrhea, skin infection Otitis media Acute pelvic inflammatory disease Legionnaires' disease Chlamydia infections

Quinolones AE

Muscle weakness Muscle pain Photoxicity Dizziness Convolution Headache Hallucination posible join and cartilage damage

Spectrum of activity of antibiotic

Narrow spectrum Broad spectrum Extended spectrum

Penicillin resistance

Natural penicillins (penicillin Vand G) are more potent than semisynthetic penicillin, but natural penicillin are more susceptible to destroy by B-lactamase( penicillinase). 95% staphylococcus aureus produce this enzyme, making penicillins ineffective.

are cephalosporins a drug of choice for dental infections

No

Quinolones (fluoroquinolones)

Not actually an antibiotic because they are totally synthetically produced. they frequently referred to as broad-spectrum antimicrobials with good activity against facultative Gram-negative anaerobes. Good alternative if patient is allergic to penicillin

Aminoglycosides

Not used in dentistry Used for serious systemic infections, burns

Bactericidal antibiotic

Penicillin Cephalosporin Quinolones

Drugs of choice for NUG

Penicillin VK

penicillin indication

Penicillin VK and amoxicillin are the only two penicillins that are used in dentistry for mild to moderate odontogenic infections. Amoxicillin is effective against Peptostreptococcus, which is found in periodontitis sites

Tetracycline contraindication

Pregnant woman Contraindicated in children under eight years

Vancomycin

Primarily active against Gram-positive bacteria (e.g, Clostridium difficile) Not used for dental infections

Penicillin spectrum activity

Primarily effective against Gram-positive cocci and bacilli bacteria (Streptococcus pneumoniae) but also some gram-negative bacteria Bacteriocidal

Clindamycin AE

Pseudomembranous colitis (characterized by severe watery diarrhea or blood in the stools), visual disturbances, liver dysfunction pseudomembranous enterocolitis, or ulcerative colitis Pregnancy category: B

Metronidazole is contraindicate lithium interaction

Pt taking lithium( drug use for manic depression) and cimetidine ( anti ulcer drug)

Treatment resistance

Refers to "doctor-induced resistance" where there is a delay in treatment because Diagnosis was not made early enough Inadequate doses were initially given Patient did not take the prescribed antibiotic for the prescribed amount of time and discontinued the drug early

Methotrexate used

Rheumatoid arthritis Psoriasis Cancer Immunomodulary

Tetracycline AE

Risk of superinfections due to candida Take with acidophilus in the form of yogurt or gelcaps Causes photosensitivity, which may occur within a few minutes to hours after sun exposure

when amoxicillin should be used

Should be use for more serious infections, since it is a broad-spectrum penicillin

how are antibiotic uses in periodontal therapy

Systemic antibiotics used in conjunction with periodontal debridement and surgery

how should clindimacyn be taken

The drug may be taken with food to minimize stomach upset and a full glass of water to prevent esophagitis

who is taking quinolones

The majority of dental patients taking a quinolone will most likely be taking it for chronic bronchitis

Cephalosporin AE

There is a 10% cross-hypersensitivity reaction with penicillins (10% of people allergic to penicillin will be allergic to cephalosporins) Allergy reaction Morbilliform (skin) rashes superinfection Gastrointestinal

where is macrolide absorb

They are orally administrate are absorbed primarily in the duodenum and widely distributed to most body tissues except the brain.

Selection of antibiotic in dental practice

Treatment of acute odontogenic/orofacial infections Prophylaxis against infective endocarditis Prophylaxis for patients at risk for infection because of compromised host defense mechanisms resulting from disease

when are systemic antibiotic indicate in implant

Tx of peri-implant, which are associate with the bone loss and suppuration, and increased pocket depth

used of sulfonamides

Used in HIV/AIDS patients for Pneumocystis carinii pneumonia (PCP) not for dental infection

Azithromycin

Used in treatment of periodontal disease. It concentrates in phagocytes such as PMNs and macrophages, which contributes to their distribution into inflamed periodontal tissues in greater amounts than in plasma

Narrow-spectrum or natural penicillins

are relative ineffective against Gram-negative bacteria because Gram-negative bacteria have a thick lipopolysaccharide coat that penicillins cannot penetrate. Penicilli Vand G

Dependin of their concentration penicillin can be

bactricidal or bacteriostatic

Antacid and macrolide interaction

decrease level of macrolide

quinines interaction with dairy products (calcium), sodium bicarbonate, iron, and antacids (magnesium, aluminum)

delay absorption so these products should be given four hours before or two hours after giving the drug

what to do if an allergy reaction occurs

discontinue drug immediately

acidophilus

good bacteria found normally in the intestine. By taking the antibiotic with acidophilus may avoid the GI irritation

Alcohol-containing mouth rinses, including Peridex, PerioGard, and Listerine, should not be used

in a patient taking metronidazole

Broad-spectrum penicillins

include the aminopenicillins (amoxicillin and ampicillin) and antipseudomonal penicillins (piperacillin, ticcarcillin) and they are more active against Gram-negative bacteria.

Metronidazole and anticoagulant interaction

increase the bleeding effect

Bacteriostatic

inhibit bacterial multiplication

Quinolones and warfarin, theophylline (anti asthma) or caffeine drug iteration

inhibits their metabolism, resulting in increased blood levels.

Tetracycline and oral contraceptive interaction dru

interfere with oral contraceptive

What is peri implant mucositis

involves soft tissue inflammation around the dental implant.

penicillin V is an acid stable an can be absorbed

is absorbed orally

Erythromycin used

is not used in the management of perio/endo infections because it is primarily effective against Gram-positive bacteria and cannot penetrate Gram-negative cell walls

Bacterericidal

kill bacteria

Cocktail Metronidazole in combination with amoxicillin

may be effective against refractory and aggressive form of peril associate with Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis infection

Are antibiotic indicate to tx peri implant mucositis

no

Can Ciprofloxacin (quinolones ) be given to children

no to children younger than 18 years of age

Methotrexate and penicillin interaction

posible fatal Penicillins compete in the kidneys for excretion. Leads to toxic levels of methotrexate

Filmtab

prevent the disintegration or breaking down the tablet in the stomach.

can air polishing system should be used s in pt taking quinolones

sodium bicarbonate delays absorption of the drug*

Oral superinfections

sour mouth (stomatitis) or tongue ( glossitis)

Microbial activity of penecillin

the beta-lactam ring on the penicillin molecule is responsible for the antibacterial activity. Penicillins act by inhibiting one or more of the penicillin-binding proteins (PBPs) located on bacterial cell walls of susceptible organisms, thus making the internal part of the bacteria cell vulnerable to the outside environment This results in cell rupture and death. they are more affective against rapidly multiplying bacteria. Do not affect human cells because the cell menbrame

Cephalosporin indication

they are generally used for skin, bone, genitourinary, and respiratory tract infections, otitis media, and acute prostatitis. Not used for dental infections very expensive

how is penicillin eliminate

through the kidney. pt with renal failure, drug dose mut be reduce.

Metronidazole use

tx of necrotizing gingivitis peri-implant infection

Azithromycin indication

used in the management of aggressive periodontal disease

when superinfection mostly occur

when a broad-spectrum antibiotic causes the eradication of microorganisms that are part of the normal flora of the gastrointestinal tract, oral cavity, respiratory tract, or vaginal. This reduction /elimination of normal bact. flora allows for the growth of other organisms such as fungus or bacteria.

when is adsorption of penicillin greater

when penicillins are taken on an empty stomach. to increase adsorption it should be taken with a full glass of water. Amoxicillin is an exception and ca be taken with food.

what is photosensitivity

when taking some antibiotic, some individuals develops and exaggerated sunburn when expose to the sun. Ciprofloxacin and doxycycline cause such photosensitivity.

when does Antibiotic-associated pseudomembranous colitis occurs

when there is an overgrowth of bacterium clostridium difficile, and have been report with all antibiotic.