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Antimicrobials
DHYG 139 PharmacologyHeidi Emmerling, RDH, PhD
Fall 2010
2
Antimicrobial AgentsP 139
DHYG 139 Pharmacology Heidi
Emmerling, RDH, PhD Fall 2010
3
Antimicrobial Agents
An antimicrobial agent suppresses the growth or destroys microorganisms.
DHYG 139 Pharmacology Heidi
Emmerling, RDH, PhD Fall 2010
4
Antimicrobial Agents
An antimicrobial agent suppresses the growth or destroys microorganisms.
The categories of antimicrobial agents:
DHYG 139 Pharmacology Heidi
Emmerling, RDH, PhD Fall 2010
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Antimicrobial Agents
An antimicrobial agent suppresses the growth or destroys microorganisms.
The categories of antimicrobial agents:• Antibacterial agents
AntibioticsSulfonamides
DHYG 139 Pharmacology Heidi
Emmerling, RDH, PhD Fall 2010
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Antimicrobial Agents
An antimicrobial agent suppress the growth or destroys microorganisms.
The categories of antimicrobial agents:• Antibacterial agents
Antibiotics Sulfonamides
• Antifungal agents• Antiviral agents
DHYG 139 Pharmacology Heidi
Emmerling, RDH, PhD Fall 2010
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Antibiotics
DHYG 139 Pharmacology Heidi
Emmerling, RDH, PhD Fall 2010
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Antibiotics
Chemical substances which were originally produced by micro-organisms and either retard the growth of other microorganisms or result in their death.
DHYG 139 Pharmacology Heidi
Emmerling, RDH, PhD Fall 2010
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Antibiotics
Antibiotics can exert their effects in 4 different ways:
DHYG 139 Pharmacology Heidi
Emmerling, RDH, PhD Fall 2010
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Antibiotics
1. Inhibition of bacterial cell wall synthesis
DHYG 139 Pharmacology Heidi
Emmerling, RDH, PhD Fall 2010
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Antibiotics
1. Inhibition of bacterial cell wall synthesis2. Alteration of bacterial cell membrane
permeability
DHYG 139 Pharmacology Heidi
Emmerling, RDH, PhD Fall 2010
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Antibiotics
1. Inhibition of bacterial cell wall synthesis2. Alteration of bacterial cell membrane
permeability3. Alteration of bacterial synthesis of
cellular components
DHYG 139 Pharmacology Heidi
Emmerling, RDH, PhD Fall 2010
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Antibiotics
1. Inhibition of bacterial cell wall synthesis2. Alteration of bacterial cell membrane
permeability3. Alteration of bacterial synthesis of
cellular components4. Inhibition of bacterial cell metabolism
DHYG 139 Pharmacology Heidi
Emmerling, RDH, PhD Fall 2010
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Resistance of bacteria to antibiotics
• Natural resistance – occurs before exposure to an antibiotic
DHYG 139 Pharmacology Heidi
Emmerling, RDH, PhD Fall 2010
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Resistance of bacteria to antibiotics
• Natural resistance – occurs before exposure to an antibiotic
• Acquired resistance – occurs after exposure to the antibiotic
DHYG 139 Pharmacology Heidi
Emmerling, RDH, PhD Fall 2010
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Resistance of bacteria to antibiotics
• Natural resistance – occurs before exposure to an antibiotic
• Acquired resistance – Occurs after exposure to the antibiotic– A low dose or short treatment may develop
resistant strains
DHYG 139 Pharmacology Heidi
Emmerling, RDH, PhD Fall 2010
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Resistance of bacteria to antibiotics
• Natural resistance – occurs before exposure to an antibiotic
• Acquired resistance – occurs after exposure to the antibiotic– A low dose or short treatment may develop
resistant strains– If not all the bacteria are destroyed, the next
infection will be by offspring from the most-resistant organisms
DHYG 139 Pharmacology Heidi
Emmerling, RDH, PhD Fall 2010
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Spectrum of Activity
• Different antibiotics will be effective against different bacteria
DHYG 139 Pharmacology Heidi
Emmerling, RDH, PhD Fall 2010
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Spectrum of Activity
• Different antibiotics will be effective against different bacteria
• Some antibiotics are very specific and are only effective against a limited type of bacteria. (i.e. Only Gram + bacteria)
DHYG 139 Pharmacology Heidi
Emmerling, RDH, PhD Fall 2010
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Spectrum of Activity
• Different antibiotics will be effective against different bacteria
• Some antibiotics are very specific and are only effective against a limited type of bacteria. (i.e. Only Gram + bacteria)– These are called limited spectrum antibiotics
DHYG 139 Pharmacology Heidi
Emmerling, RDH, PhD Fall 2010
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Spectrum of Activity
• Different antibiotics will be effective against different bacteria
• Some antibiotics are very specific and are only effective against a limited type of bacteria. (i.e. Only Gram + bacteria)– These are called limited spectrum antibiotics
• Some antibiotics have a broad spectrum of activity and are effective against a broader range of bacteria.
DHYG 139 Pharmacology Heidi
Emmerling, RDH, PhD Fall 2010
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Spectrum of Activity
• Different antibiotics will be effective against different bacteria
• Some antibiotics are very specific and are only effective against a limited type of bacteria. (i.e. Only Gram + bacteria)– These are called limited-spectrum antibiotics
• Some antibiotics have a broad spectrum of activity and are effective against a broader range of bacteria.– These are called broad-spectrum antibiotics
DHYG 139 Pharmacology Heidi
Emmerling, RDH, PhD Fall 2010
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Spectrum of Activity
• Limited-spectrum antibiotics are more effective against a particular bacteria than are the broad-spectrum antibiotics.
DHYG 139 Pharmacology Heidi
Emmerling, RDH, PhD Fall 2010
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Spectrum of Activity
• Limited-spectrum antibiotics and more effective against a particular bacteria than are the broad-spectrum antibiotics.
What?????
DHYG 139 Pharmacology Heidi
Emmerling, RDH, PhD Fall 2010
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Spectrum of Activity
A limited-spectrum antibiotic is effective against only A Limited-Spectrum
(Bacteria) A B C D
DHYG 139 Pharmacology Heidi
Emmerling, RDH, PhD Fall 2010
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Spectrum of Activity
A limited-spectrum antibiotic A broad-spectrum antibiotic is effective against only A is effective against A B C D Limited-spectrum Broad-spectrum
(Bacteria) A B C D
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Spectrum of Activity
A limited-Spectrum antibiotic A broad-spectrum antibiotic is effective against only A is effective against A B C D Limited-spectrum Broad-spectrum
A B C D
Although the broad-spectrum does kill bacterial A, the limited-spectrum antibiotic will do a much better and faster job and would be the drug-of-choice.
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Penicillin P 140
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Penicillin
• The first antibiotic discovered
DHYG 139 Pharmacology Heidi
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Penicillin
• The first antibiotic discovered• Discovered by Alexander Fleming in
1928
DHYG 139 Pharmacology Heidi
Emmerling, RDH, PhD Fall 2010
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Penicillin
• The first antibiotic discovered• Discovered by Alexander Fleming in
1928• It’s still the most effective antibiotic
we have
DHYG 139 Pharmacology Heidi
Emmerling, RDH, PhD Fall 2010
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Penicillin
• The first antibiotic discovered• Discovered by Alexander Fleming in
1928• It’s still the most effective antibiotic
we have• It’s the most widely used antibiotic in
dentistry
DHYG 139 Pharmacology Heidi
Emmerling, RDH, PhD Fall 2010
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Penicillin
• Spectrum of Activity
DHYG 139 Pharmacology Heidi
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Penicillin
• Spectrum of Activity– Gram (+) organisms (most dental infections)
• Staph• Strep• Pneumococcus
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Penicillin
• Spectrum of Activity– Gram (+) organisms (most dental infections)
• Staph• Strep• Pneumococcus
– Gram (-) organisms• Gonorrhea• Syphilis
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Penicillin
• Preparations
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Penicillin
• Preparations– Category 1 (Penicillin G)– Category 2 (Penicillin V)– Category 3 (Penicillinase-
resistant synthetics)– Category 4 (Broader-spectrum
Penicillin)– Category 5 (New synthetic
broad- spectrum penicillin)
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Penicillin
• Category 1 Penicillin G
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Emmerling, RDH, PhD Fall 2010
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Penicillin
• Category 1 Penicillin G– The 1st form of penicillin discovered
DHYG 139 Pharmacology Heidi
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Penicillin
• Category 1 Penicillin G– The 1st form of penicillin discovered– Still the most effective form
DHYG 139 Pharmacology Heidi
Emmerling, RDH, PhD Fall 2010
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Penicillin
• Category 1 Penicillin G– The 1st form of penicillin discovered– Still the most effective form– Unstable in the stomach, so it must be
injected
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Penicillin
• Category 1 Penicillin G– The 1st form of penicillin discovered– Still the most effective form– Unstable in the stomach, so it must be
injected– Comes in many different forms:
• Potassium Penicillin G– Reaches blood levels fast/ drops fast
• Procaine Penicillin G– Reaches blood levels slow/drops slow
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Penicillin
• Category 2 Penicillin V
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Penicillin
• Category 2 Penicillin V– Stable in the stomach so taken orally
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Penicillin
• Category 2 Penicillin V– Stable in the stomach so taken orally– Can be injected, but G is better
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Penicillin
• Category 2 Penicillin V– Stable in the stomach so taken orally– Can be injected, but G is better– Popular in dentistry
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Penicillin
• Category 2 Penicillin V– Stable in the stomach so taken orally– Can be injected, but G is better– Popular in dentistry– Infections that require immediate
attention:• 1st give Pencillin G• Then follow-up for the long-term with
Pencillin V orally (7-10 days)
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Penicillin
• Category 3 Penicillinase-resistant Synthetics
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Penicillin
• Category 3 Penicillinase-resistant Synthetics– Penicillinase is a chemical produced by some
bacteria that destroys penicillin
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Penicillin
• Category 3 Penicillinase-resistant Synthetics– Penicillinase is a chemical produced by some
bacteria that destroys penicillin– Therefore normal penicillin is ineffective
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Penicillin
• Category 3 Penicillinase-resistant Synthetics– Penicillinase is a chemical produced by some
bacteria that destroys penicillin– Therefore normal penicillin is ineffective– These synthetics are effective against those
bacteria that produce penicillinase
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Emmerling, RDH, PhD Fall 2010
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Penicillin
• Category 3 Penicillinase-resistant Synthetics– Penicillinase is a chemical produced by some
bacteria that destroys penicillin– Therefore normal penicillin is ineffective– These synthetics are effective against those
bacteria that produce penicillinase– They can be used for all bacterial infections but
are not as effective as G or V for non-penicillinase producing bacteria.
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Penicillin
• Category 3 Penicillinase-resistant Synthetics– Penicillinase is a chemical produced by some
bacteria that destroys penicillin– Therefore normal penicillin is ineffective– These synthetics are effective against those
bacteria that produce penicillinase– They can be used for all bacterial infections but
are not as effective as G or V for non-penicillinase producing bacteria.
– Examples:• Methicillin Oxacillin Nafcillin
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Penicillin P 141
• Category 4 Broader-spectrum Penicillins
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Penicillin
• Category 4 Broader-spectrum Penicillins
– These have a wider spectrum than other penicillins
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Penicillin
• Category 4 Broader-spectrum Penicillins
– These have a wider spectrum than other penicillins
– Are effective against organisms affected by the category 1 & 2 penicillins plus more Gram (-) organisms
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Penicillin
• Category 4 Broader-spectrum Penicillins
– These have a wider spectrum that other penicillins
– Are effective against organisms effected by the category 1&2 penicillins plus more gram (-) organisms
– Examples:
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Penicillin
• Category 4 Broader-spectrum Penicillins– Amoxicillin
• Becoming very popular because:– Reaches high blood levels– Better absorption from the stomach even with
presence of food.– Need less frequent dosing (TID not QID)
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Penicillin
• Category 4 Broader-spectrum Penicillins– Amoxicillin
• Becoming very popular because:– Reaches high blood levels– Better absorption from the stomach even with
presence of food.– Need less frequent dosing (TID not QID)
– Ampicillin• Used on small children• Will deactivate the birth control pill
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Penicillin
• Category 5 (New Synthetic Broad- spectrum Penicillin)
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Penicillin
• Category 5 – These are less effective than the other
penicillins– They are very expensive
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Penicillin
• Category 5 – These are less effective than the other
penicillins– They are very expensive– They are used when other penicillins (or
other antibiotics) are ineffective
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Penicillin
• Category 5 – These are less effective than the other
penicillins– They are very expensive– They are used when other penicillins (or
other antibiotics) are ineffective– Examples:
• Ticarcillin• Piperacillin
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Penicillin
• Limited-spectrum vs Broad-spectrum
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Penicillin
• Limited-spectrum vs Broad-spectrumEach category of penicillin has a rather limited-spectrum, with some categories (i.e.Category 4) having a somewhat wider spectrum.
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Penicillin
• Limited-spectrum vs Broad-spectrumEach category of penicillin has a rather limited-spectrum, with some categories (i.e.Category 4) having a somewhat wider spectrum.
• However, penicillin as a whole (category 1-5) has a broad-spectrum of activity
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Toxicity of Penicillin
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Toxicity of Penicillin
• Allergic reactions are the only real toxicity
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Toxicity of Penicillin
• Allergic reactions are the only real toxicity– First exposure
• A mild reaction• Skin rash, itching, etc.
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Toxicity of Penicillin
• Allergic reactions are the only real toxicity– First exposure
• A mild reaction• Skin rash, itching, etc.
– Second exposure• Anaphylactic shock• Asthmatic breathing and drop in BP
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Cephalosporins
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Cephalosporins
• A broader-spectrum than penicillin
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Cephalosporins
• A broader-spectrum than penicillin• These drugs are structurally similar to
penicillin.– In 10% of the cases, an individual with an allergy to
cephalosporins will also be allergic to penicillin
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Cephalosporins
• A broader-spectrum than penicillin• These drugs are structurally similar to
penicillin.– In 10% of the cases, an individual with an allergy to
cephalosporins will also be allergic to penicillin
• Spectrum of activity– Gram (+) & (-)– Penicillin-resistant Staph– E. Coli– Klebsiella
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Cephalosporins
• More side effects than penicillin– Renal damage– Increased RBC hemolysis
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Cephalosporins
• More side effects than penicillin– Renal damage– Increased RBC hemolysis
• Many believe this is a better drug for systemic infections than oral infections
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Cephalosporins
• More side effects than penicillin– Renal damage– Increased RBC hemolysis
• Many believe this is a better drug for systemic infections than oral infections
• Example:– Cephalexin– Keflex
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Erythromycin
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Erythromycin P142
• A limited-spectrum antibiotic(slightly greater than Penicillin V)
• Low toxicity
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Erythromycin
• A limited-spectrum antibiotic(slightly greater than Penicillin V)
• Low toxicity• Gastrointestinal upset occurs rarely• Resistance develops slowly
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Lincomycin & Clindamycin
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Lincomycin & Clindamycin
• Developed in 1962• Reserved for patients who cannot take
penicillin, erythromycin or cephalosporins
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Lincomycin & Clindamycin
• Developed in 1962• Reserved for patients who cannot take
penicillin, erythromycin or cephalosporins• Not the drug of choice for dental infections• Expensive
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Lincomycin & Clindamycin
• Developed in 1962• Reserved for patients who cannot take
penicillin, erythromycin or cephalosporins• Not the drug of choice for dental infections• Expensive• A substitute for penicillin in premedication
conditions• Spectrum of activity:
– Similar to erythromycin
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Lincomycin & Clindamycin
• Has good bone-penetrating ability, therefore used to treat osteomyelitis
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Lincomycin & Clindamycin
• Has good bone-penetrating ability, therefore used to treat osteomyelitis
• Side effects:– Diarrhea occurs frequently– Severe hemorrhagic colitis (can be fatal)– Glossitis
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Lincomycin & Clindamycin
• Has good bone-penetrating ability, therefore used to treat osteomyelitis
• Side effects:– Diarrhea occurs frequently– Severe hemorrhagic colitis (can be fatal)– Glossitis
• Example:– Cleocin (clindamycin)– Lincocin (lincomycin)
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Tetracycline
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Tetracycline
• A true broad-spectrum antibiotic
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Tetracycline
• A true broad-spectrum antibiotic• Used for many non-specific infections• Little indication for oral use (except for the
direct gingival sulcus applications)
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Tetracycline
• A true broad-spectrum antibiotic• Used for many non-specific infections• Little indication for oral use (except for the
direct gingival sulcus applications)• Isolate in fast growing tissues:
– Bone (results in stained bone)
– Teeth (results in stained calcifying teeth)
– Tumors
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Tetracycline
• Resistant strains develop rapidly
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Tetracycline
• Resistant strains develop rapidly• Toxicity:
– GI upset– Photosensitivity– Prolonged bleed time
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Tetracycline
• Resistant strains develop rapidly• Toxicity:
– GI upset– Photosensitivity– Prolonged bleed time
• UsesGonorrhea InfluenzaDysentery Typhoid feverSkin acne Chronic periodontal disease
(intra-sulcular)
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Tetracycline
• Preparations– Chlortetracycline (Aureomycin)– Oxytetracycline (Terramycin)– Tetracycline (Achromycin)
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Flagyl (Metronidazole)
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Flagyl (Metronidazole)
• Has a very limited spectrum of activity– Used for HIV+ individuals; – less chance of fungal infections
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Flagyl (Metronidazole)
• Has a very limited spectrum of activity– Used for HIV+ individuals; – less chance of fungal infections
• Used for anaerobic bacteria
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Anti-tuberculosis Antibiotics
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Anti-tuberculosis Antibiotics
• TB is difficult to treat because:– The patient’s immune system is usually
compromised– Resistant strains develop rapidly
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Anti-tuberculosis Antibiotics
• TB is difficult to treat because:– The patient’s immune system is usually
compromised– Resistant strains develop rapidly– Antibiotics are only bacteriostatic
• To be effective, antibiotics are used in small doses over a long period of time
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Anti-tuberculosis Antibiotics
• TB is difficult to treat because:– The patient’s immune system is usually
compromised– Resistant strains develop rapidly– Antibiotics are only bacteriostatic
• To be effective antibiotics are used in small doses over a long period of time
– Non-compliance is an issue
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Anti-tuberculosis Antibiotics
• Antibiotics are usually given as a cocktail (multiple drugs)
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Anti-tuberculosis Antibiotics
• Antibiotics are usually given as a cocktail (multiple drugs)
• Antibiotics used today:– Isoniazid (used for 9-12 months)– Rifampin (used for 9-12 months)– Pyrazinamide (used for 1st 2 months)
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Topical Antibiotics
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Topical Antibiotics
• There is little evidence that these have any positive effect
• Examples:– Neomycin– Bacitracin
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Sulfonamides
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Sulfonamides
• Developed in 1908• No use for intraoral infections• These are bacteriostatic only
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Sulfonamides
• Developed in 1908• No use for intraoral infections• These are bacteriostatic only• Used for:
– Urinary-tract infections– Meningococcal meningitis
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Antifungal Drugs
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Antifungal Drugs
1. Nystatin (Mycostatin)
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Antifungal Drugs
1. Nystatin (Mycostatin)• Very effective• Little toxicity
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Antifungal Drugs
1. Nystatin (Mycostatin)• Very effective• Little toxicity• Applied topically or given systemically• Very effective against Candida albicans
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Antifungal Drugs
1. Nystatin (Mycostatin)• Very effective• Little toxicity• Applied topically or given systemically• Very effective against Candida albicans• Vaginal lozenges work better than intraoral
preparations (no sugar)• Dissolve lozenge for 15 minutes 5 times per
day
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Antifungal Drugs
2. Mycelex (Chlotrimazole)• Similar in most aspects with Nystatin
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Antifungal Drugs
2. Mycelex (Chotrimazole)• Similar in most aspects with Nystatin
3. Nizoral• A topical antifungal cream • Used for systemic candidiasis• Used for skin fungal problems
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Antiviral Drugs
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Antiviral Drugs
• Limited success with antiviral drugs because:– A virus is an intracellular parasite– By the time a viral infection becomes noticed,
the virus is well established
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Antiviral Drugs
• Limited success with antiviral drugs because:– A virus is an intracellular parasite– By the time a viral infection becomes noticed,
the virus is well established• The body has begun fighting the virus well
before the antiviral drug is applied.
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Antiviral Drugs
• Limited success with antiviral drugs because:– A virus is an intracellular parasite– by the time a viral infection becomes noticed,
the virus is well established• The body has begun fighting the virus well
before the antiviral drug is applied• In many cases, the body takes care of the
virus: – the antiviral is given too late to be effective
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Antiviral Drugs
1. Acyclovir (most effective antiviral to date)
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Antiviral Drugs
1. Acyclovir• Used with some success on herpes simplex
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Antiviral Drugs
1. Acyclovir• Used with some success on herpes simplex• Comes in three forms:
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Antiviral Drugs
1. Acyclovir• Used with some success on herpes simplex• Comes in three forms:
1. Topical ointment (Denavir)• Does tend to shorten the length of a cold sore• It must be started early to be effective
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Antiviral Drugs
1. Acyclovir• Used with some success on herpes simplex• Comes in three forms:
1. Topical ointment (Denavir)• Does tend to shorten the length of a cold sore• It must be started early to be effective
2. Oral Tablets• Restricted to serious cases• May decrease incidents and severity
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Antiviral Drugs
1. Acyclovir• Used with some success on herpes simplex• Comes in three forms:
1. Topical ointment (Denavir)• Does tend to shorten the length of a “cold sore”• It must be started early to be effective
2. Oral Tablets• Restricted to serious cases• May decrease incidents and severity
3. IV Only on severe viral herpetic invasions
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Antibiotic Premedication P 144
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Antibiotic Premedication
• General (broad) indications
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Antibiotic Premedication
• General (broad) indications– A patient who is susceptible to endocarditis or
an infection in a prosthetic joint and we are about to manipulate the tissue and cause a bacteremia
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Antibiotic Premedication
• General (broad) indications– A patient who is susceptible to endocarditis or
an infection in a prosthetic joint and we are about to manipulate the tissue and will cause a bacteremia
– A patient with reduced resistance to infections
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Antibiotic Premedication
• General (broad) indications– A patient who is susceptible to endocarditis or
an infection in a prosthetic joint and we are about to manipulate the tissue and will cause a bacteremia
– A patient with reduced resistance to infections
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Antibiotic Premedication
• Specific indications
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Antibiotic Premedication
• Specific indications – Patients with an artificial heart valve
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Antibiotic Premedication
• Specific indications – Patients with an artificial heart valve– Patients with a history of infective endocarditis
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Antibiotic Premedication
• Specific indications – Patients with an artificial heart valve– Patients with a history of infective endocarditis– Patients with specific congenital heart defects
• Shunts, conduits, repaired with prosthesis,
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Antibiotic Premedication
• Specific indications – Patients with an artificial heart valve– Patients with a history of infective endocarditis– Patients with specific congenital heart defects– Patients with a cardiac transplant that develops
a problem with a valve
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Antibiotic Premedication
• Specific indications – Patients with an artificial heart valve– Patients with a history of infective endocarditis– Patients with specific congenital heart defects– Patients with a cardiac transplant that develops
a problem with a valve– A patient who has had total joint replacement
within two years
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Antibiotic Premedication
• Indications where antibiotic premedication is not needed:
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Antibiotic Premedication
• Indications where antibiotic premedication is not needed:– Coronary bypass surgery
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Antibiotic Premedication
• Indications where antibiotic premedication is not needed:– Coronary bypass surgery– Mitral valve prolapse
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Antibiotic Premedication
• Indications where antibiotic premedication is not needed:– Coronary bypass surgery– Mitral valve prolapse– History of rheumatic fever w/o valve damage
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Antibiotic Premedication
• Indications where antibiotic premedication is not needed:– Coronary bypass surgery– Mitral valve prolapse– History of rheumatic fever w/o valve damage– Pacemakers
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Antibiotic Premedication
• Indications where antibiotic premedication is not needed:– Coronary bypass surgery– Mitral valve prolapse– History of rheumatic fever w/o valve damage– Pacemakers– Heart murmurs– Bicuspid valve disease, clacified aortic stenosis,
certain congenital conditions like ventricular septal defect, hypertrophic cardiomyopathy
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Antibiotic Premedication
• Indications where antibiotic premedication is not needed:– Artificial joints (knees, hips, etc) after 2
years
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Antibiotic Premedication
• Indications where antibiotic premedication is not needed:– Artificial joints (knees, hips, etc) after 2
years– People with uncontrolled diabetes
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Drugs Used for Premedication
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Drugs Used for Premedication
• Drug of choice: Amoxicillin
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Drugs Used for Premedication
• Drug of choice: Amoxicillin– Orally– 2000 mg for adult– 50 mg/kg for children
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Drugs Used for Premedication
• For penicillin-allergic patients:
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Drugs Used for Premedication
• For penicillin-allergic patients:– Cephalexin
• Unless they have a history of anaphylactic shock with penicillin
• 2000 mg for adults• 50 mg/kg for kids
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Drugs Used for Premedication
• For penicillin-allergic patients:– Cephalexin
• Unless they have a history of anaphylactic shock with penicillin
• 2000 mg for adults• 50 mg/kg for kids
– Clindamycin• 600 mg for adults• 20 mg/kg for kids
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Drugs Used for Premedication
• For penicillin-allergic patients:– Azithromycin
• 500 mg for adults• 15 mg/kg for kids
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Other Information about Premeds
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Other Information about Premeds
• For high-risk patients, always use amoxicillin if possible– i.e. Artificial heart valve
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Other Information about Premeds
• For high-risk patients, always use amoxicillin if possible– i.e. Artificial heart valve
• A bacteremia is only present for about 15 minutes.
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Other information about premeds
• For high-risk patients, always use amoxicillin if possible– i.e. Artificial heart valve
• A bactermia is only present for about 15 minutes. – Don’t give the premedication more than
1 hour before the appointment– Can be effective if given less than 2
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