Antibiotics :

 Substance produced by microorganisms that

destroys or inhibits the growth of other
microorganisms
 Most are now manufactured synthetically
Classification of antibiotics :
Antibiotics are classified according to:
Mechanism of action
Spectrum of activity
Mode of action
Mechanism of action:
Cell Wall Synthesis inhibitors:
Penicillins DNA Synthesis Inhibitors
Cephalosporins Fluoroquinolones
Vancomycin (Ciprofloxacin)
Polymycin Metronidazole
Bacitracin
RNA synthesis Inhibitors
Protein Synthesis Inhibitors Rifampin
Inhibit 30s Subunit
Aminoglycosides (Gentamicin)
Mycolic Acid synthesis inhibitors
Tetracyclines
Inhibit 50s Subunit Isoniazid
Macrolides (Erythromycin)
Chloramphenicol Folic Acid synthesis inhibitors
Clindamycin Sulfonamides
Streptogramins Trimethoprim
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Spectrum activity :
 Broad spectrum antibiotics :
Amoxicillin
Tetracycline
Cephalosporins
Chloramphenicol
Erythromycin
 Narrow spectrum antibiotics:
Penicillin –G
Cloxacillin
Vancomycin
Bacitracin
Fluxacillin
Mode of action
Bacteriostatic Drugs : agents that temporarily inhibits
the growth of microorganism. When the drug is
removed, organism will resume growth and infection
or disease may reoccur.e.g., Tetracycline,
Chlorampenicol, Erythromycin, Lincomycin,
sulfonamides
Bactericidal Drugs
These are drugs that kills the microorganism e.g.,
Penicillin, Cephalosporins, aminoglycosides,
Erythromycin, Cotrimoxazole
.
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Ideal properties of an antibiotic
 Have the appropriate spectrum of activity
 Have no toxicity to the host, be well tolerated
 Low tendency for development of resistance
 Not induce hypersensitivities in the host
 Have rapid and extensive tissue distribution
 Have a relatively long half-life
 Be free of interactions with other drugs
 Be convenient for administration.
 Be relatively inexpensive

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 Antibiotic combinations
Antibiotic synergism
Combination of antibiotics have enhanced activity when
tested together compared with each antibiotic
alone (e.g. 2 + 2 = 6)
e.g. ampicillin+gentamicin in enterococcal endocarditis
Additive effect
Combination of antibiotics has an additive effect
(e.g. 2 + 2 = 4)
e.g. combination of two ß-lactam antibiotics

Antibiotic antagonism
Combination in which the activity of one antibiotic
interferes with the activity of the other (e.g. 2 + 2 < 4)
bactericidal + bacteriostatic

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Misuse of antibiotics :
 Antibiotic misuse, sometimes called antibiotic abuse or
antibiotic overuse.
 The misuse or overuse of antibiotics, may produce
serious effects on health.
 It is a contributing factor to the creation of multidrug-
resistant bacteria, relatively harmless bacteria can
develop resistance to multiple antibiotics and cause life-
threatening infections.

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 Prevention of Drug resistance
1. Avoid Indiscriminate use
2. Avoid inadequate use
3. Avoid prolonged use: Short term therapy
4. Use fast acting, selective antibiotics [Narrow
spectrum]
5. Use broad spectrum only when needed
6. Combination therapy for long term therapy
7. Treat resistance-prone infections intensively
 Eg Staph aureus, E coli, M tuberculosis
 ‫عالج العدوى المعرضة للمقاومة بشكل مكثف‬

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 PRINCIPLES OF ANTIBIOTIC
THERAPY IN DENTAL INFECTIONS

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Important Host Determinants
a) Hepatic function: Erythromycin, clindamycin,
rifampin, Chloramphenicol, etc. Patients with
impaired liver function may accumulate such drugs to a
toxic level if the dosage adjustment is not made.
b) Kidney function: Normal kidney function is essential
for disposal of -lactams, aminoglycosides,
vancomycin, etc. Active form of these drugs may
accumulate in the patient with renal diseases.
c) Host defense mechanism: A chemotherapeutic
regimen that is perfectly adequate for immuno-
competent patient may be totally ineffective for
immuno-incompetent patient.

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Local measures/antibiotics
 1st try to manage bacterial infections by local measures. e.g
drain pus if present by extraction of the tooth or through the
root canals, and attempt to drain any soft-tissue pus by
incision.
 Antibiotics are appropriate for oral infections where there
is evidence of spreading infection (cellulitis, lymph node
involvement, swelling) or systemic involvement (fever,
malaise).

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Antibiotics for bacterial infections
 Indications for antibiotics are acute ulcerative
gingivitis and sinusitis, and pericoronitis when there
is systemic involvement or persistent swelling
despite local treatment.

 Use antibiotics in conjunction with, and not as an

alternative to local measures.

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Prescribe antibiotics cautiously!
 There is no evidence to support the prescription of
antibiotics for the treatment of pulpitis or for the
prevention of dry socket in non-
immunocompromised patients undergoing non-
surgical dental extractions.
 Some broad-spectrum antibiotics, such as amoxicillin
and doxycycline, might reduce the efficacy of
combined oral contraceptives.??
Pulpitis is mainly caused by bacteria infection which itself is a secondary development of
tooth decay.
Dry socket is a painful dental condition that sometimes happens after you have a
permanent adult tooth extracted, Dry socket is when the blood clot at the site of the
tooth extraction fails to develop.
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Infective Endocarditis
 Previously, in dentistry, antibiotics were
prescribed as prophylactics for the prevention
of infective endocarditis.
 However, recent guidelines recommend that
antibiotic prophylaxis is not used in all
patients undergoing dental procedures.
 In addition, there is no evidence that
prophylaxis is of any benefit in patients with
prosthetic joints ‫مفاصل صناعية‬
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 Prophylaxis before procedures that involve
manipulation of gingival tissue is now recommended
only for patients with
Prosthetic heart valve
History of infective endocarditis
Certain forms of congenital heart disease
Valvulopathy after cardiac transplantation,
 Excluded are routine dental cleaning and anesthetic
injections through non-infected tissue, dental
radiography, placement and adjustment of appliances
and bleeding from trauma to the lips.

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Infective endocarditis prophylaxis before dental
procedures
Antibiotic prophylactic regimens
 Can take oral medication Amoxicillin 2 g
 Cannot take oral medication Ampicillin 2 g IM or IV,
Cefazolin or ceftriaxone 1 g IM
 Allergic to penicillins or ampicillin, can take oral
medication Cephalexin 2 g, 50 mg/kg OR Clindamycin 600
mg OR Azithromycin 500 mg
 Allergic to penicillins or ampicillin, cannot take oral
medication Cefazolin 1 g IM or IV or ceftriaxone 50 mg/kg
IM or IV OR Clindamycin 600 mg IM or IV 20 mg/kg.
 All regimens given as a single dose 30 to 60 minutes before
the procedure.

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 Dental Abscess
 Dental abscesses are usually infected with
Streptococcus spp. or Gram-negative organisms that
are penicillin sensitive.
 Treat dental abscesses in the first instance by using
local measures to achieve drainage, with removal of the
cause where possible.
 Antibiotics are required only in cases of spreading
infection (cellulitis, lymph node involvement, swelling) or
systemic involvement (fever, malaise).

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 Dental abscess-antibiotics
 Amoxicillin is effective at treating such infections
 Erythromycin is alternative
 The duration of treatment depends on the severity of the
infection and the clinical response but drugs are usually given
for 5 days.
 For severe infections the dose of amoxicillin, and erythromycin
can be doubled.
 Amoxicillin, like other penicillins, can result in hypersensitivity
reactions, including rashes and anaphylaxis, and can cause
diarrhea.
 Do not prescribe amoxicillin to patients with a history of allergy
to penicillin.

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 Dental abscess-antibiotics

 Metronidazole can be given in combination with

amoxicillin in patients with spreading infection.
 Advise patient to avoid alcohol (metronidazole has a
disulfiram-like reaction with alcohol).
 The anticoagulant effect of warfarin might be
enhanced by metronidazole.

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