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.
