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Microsoft powerpoint - chapter 7 - pharm.ppt [compatibility mode]

 General adverse reactions and disadvantages Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Dental infections often follow similar pathways  Infection, after pain management, is the  The organisms initially responsible for a dental infection are primarily gram-positive cocci  Dental infections can be divided into several  After a short time, the gram-positive infection begins to include a variety of both gram-positive and gram- negative anaerobic organisms; this is termed a mixed  Over time, the proportion of organisms that are anaerobic increases until it consists of predominately Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 In the mixed stage, agents effective against  The choice of antibiotics for an infection either gram-positive or anaerobic organisms  If the infection is just beginning, the  For gram-positive organisms, the drug of choice is organisms are most likely gram-positive cocci penicillin/amoxicillin or, with penicillin allergy, a macrolide antibiotic  Pen VK is the drug of choice unless the patient is  For anaerobic organisms, metronidazole is effective  In an allergic patient, alternatives might include  Clindamycin affects both gram-positive cocci and • Oral surgeons have been comfortable using it, but other dentists have avoided it because of an association with pseudomembranous colitis Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 In 1928, Fleming observed that a mold, Penicillium notatum, produced a substance  Substances that act against or destroy infections that inhibited the growth of certain bacteria  Chain and coworkers reported the low toxicity and  Substances that destroy or suppress the growth or systemic antibacterial effectiveness of penicillin  Concern has surfaced about indiscriminate microorganisms that have the capacity, in dilute  Totally resistant strains of bacteria have made this solutions, to destroy or suppress the growth or multiplication of organisms or prevent their action Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Substances that destroy or suppress the growth or  Irreversible; if the bacteria are removed from the  Substances that destroy or suppress the growth or  Ability to inhibit or retard the multiplication or  Substances that destroy or suppress the growth or  Reversible; if the bacteria are removed from the agent, they are able to grow and multiply Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Minimal inhibitory concentration (MIC)  Concentration of antiinfective agent in blood or  Lowest concentration needed to inhibit visible growth of an organism on media after 18 to 24 hours of  Certain levels of an antibiotic are required to incubation
produce an effect on various types of organisms  The natural or acquired ability of an organism to be  Invasion by pathogenic microorganisms and immune to or resist the effects of an antiinfective  Presence of a pathogen does not constitute Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Combination produces more than an additive  May be narrow, intermediate, or broad  Bactericidal combinations are generally synergistic; bacteriostatic combinations are merely  Infection caused by proliferation of microorganisms different from those causing the  Occurs when a combination produces less effect  The practitioner can cause and eliminate  A combination of a bactericidal and bacteriostatic agent is often poorer than either alone (1 + 1 < 2) Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 The factors that determine the likelihood of a  Ideally, all infections requiring antimicrobial therapy would be cultured and sensitivity  Disease-producing power of the microorganism  Culturing involves growing the bacteria  Number of organisms present (inoculum)  Sensitivity involves exposing the organism to test  Resistance of the host (immunologic response) antibiotics and determining whether the organism is sensitive or resistant Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Culture and sensitivity is the only way to be sure a drug will kill or inhibit the growth of the  Proper collection materials and methods must  In dentistry, the need for anaerobic culturing  The laboratory should perform a Gram stain and makes obtaining a sample and culturing it more report all bacteria present in high numbers  Both obligate and facultative anaerobes should be  Dental infections are often of a mixed nature Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Depending on the site, the collection method  After the organism is identified, it is grown on  Examples include aspiration with a needle for an abscess, a swab from an anaerobic pack for a  Observing whether the organisms are sensitive or draining lesion, and properly handled absorbent resistant to test antibiotics helps determine which antibiotic to use in difficult infections  Care must be taken to avoid contaminating the Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 When an organism has always been resistant to an antimicrobial agent because of the bacteria’s  When an organism that was previously sensitive to an antimicrobial agent develops resistance Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Considerable controversy exists regarding the need for antimicrobial agents in various  No simple rule has been developed to determine whether antimicrobial therapy is  The two categories of indications are prophylactic needed in dentistry; many infections do not  Most patients, without immune function deficiencies, in whom drainage can be obtained, do not need antibiotics to manage their dental infections Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
• Acute necrotizing ulcerative gingivitis (ANUG): penicillin VK,  Mixed infections insensitive to penicillin • Anaerobes and chronic infections: metronidazole, • Localized juvenile periodontitis (LJP): doxycycline, • Adult periodontitis: not usually treated with drugs  Prophylaxis for infective endocarditis • Rapidly advancing periodontitis (RAP): doxycycline, • Prosthetic heart valve, no penicillin allergy: amoxicillin • Patient with LJP: doxycycline for 3 weeks followed by the • Soft-tissue infections: penicillin VK, amoxicillin• Osteomyelitis: penicillin VK, amoxicillin Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 The best defense against a pathogen is host microorganism are important in deciding the  When this defense is lacking, the need for acuteness, severity, and spreading tendency  An acute, severe, rapidly spreading infection should generally be treated with antimicrobial agents  A mild, localized infection in which drainage can Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 If the periodontal pocket remains active despite repeated root planing, the use of  Few situations arise for which a definite antibiotics that alter the flora should be indication for prophylactic antibiotic coverage  One clear-cut use of antibiotics for prophylaxis before a dental procedure, such as Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 All antiinfective agents can produce an overgrowth of an organism that is different from the original infecting organism and is  The wider the spectrum of the antiinfective agent and the longer the agent is administered, the  This side effect can be minimized by use of the most specific antiinfective agent, the shortest effective course of therapy, and adequate doses Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 All antiinfective agents have the potential to produce a variety of allergic reactions from  Most antiinfective agents have been implicated in a drug interaction with oral contraceptives • When antibiotics are given, the number of bacteria in the  Some agents, such as penicillins and cephalosporins are more allergenic than others • Hydrolysis of the estrogen conjugate does not occur  Many agents, such as erythromycin and • Because the estrogen remains conjugated, it will not be • The absorption of estrogen decreases and its blood level  In certain patients, additional birth control measures should be used during antibiotic administration Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Antiinfective agents potentiate the effect of oral  Antibiotics that act at the same receptor may compete for that receptor and should not be given • Oral anticoagulants are vitamin K inhibitors; thus interfering with production of vitamin K could increase the  An antibiotic with bacteriostatic properties stops  Bacterial flora in the intestine produce most of the bacteria from growing, thereby inhibiting the action • Antiinfective agents reduce the bacterial flora that • With vitamin K reduced, the oral anticoagulant’s effect is Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 All antiinfective drugs can produce a variety  Antimicrobial agents that can be used pregnancy to treat infections are limited  Complaints include stomach pain, increased  Penicillin and erythromycin have not been associated with teratogenicity and are often used  The incidence varies, depending on the agent  Before any antibiotics are used in the pregnant used, the dose, and whether the patient takes the dental patient, the patient’s obstetrician should  Erythromycin has the highest incidence of GI  Metronidazole is not usually used during pregnancy;  Tetracyclines are contraindicated during pregnancy Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 An important factor in choosing an antibiotic for  Adult dose forms of antibiotics are commonly  The best inexpensive antibiotic that can be taken will  Children’s dose forms, including liquid and be more effective than an expensive one that cannot chewable antibiotic dose forms, contain sugar  Common; involves nausea, anorexia, diarrhea, and  Central nervous system (CNS) effects: headache, dizziness, vertigo, ataxia (inability to coordinate muscle activity)  Confusion, depression, weakness, insomnia, and serious convulsive seizures are rarely associated Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Rational use of antiinfective agents in dentistry  Antimicrobial agents for nondental use  Antibiotic prophylaxis used in dentistry Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 The mold Penicillium notatum and related  Semisynthetic penicillins are produced by chemically altering the natural penicillins  The penicillins structure has a β-lactam ring  When the β-lactam ring is broken, such as in the presence of penicillinase, the antimicrobial activity Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Penicillin is administered orally or parenterally;  Bactericidal agent that attaches to penicillin- binding proteins (PBPs) on the bacterial cell  After oral administration, the amount absorbed can  PBPs are enzymes involved in synthesis of the  Penicillin V is absorbed orally better than penicillin G, thus penicillin V is used for oral administration cell wall and maintenance of the cell’s structural integrity  Distributed throughout the body, except  Penicillin destroys cell wall integrity and lead  Metabolized by hydrolysis in the liver and undergoes tubular secretion in the kidney Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Penicillin G and V have a narrow spectrum of  Can occur by several different mechanisms  Penicillinase-producing staphylococci produce  Includes gram-positive cocci, and certain gram- enzymes that inactivate penicillin by cleaving the  Effective against spirochetes and anaerobes  In hospitals, more than 95% of staphylococci responsible for many periodontal conditions  Clavulanic acid serves as a substrate, which allows the use of amoxicil in to treat penicillinase-producing organisms Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Reactions to penicillins can be divided into  Penicillin’s toxicity is almost nonexistent toxic reactions and allergic or hypersensitivity  Penicillinase-resistant penicillins are significantly  Penicillins are the most common cause of drug  GI irritation can manifest as nausea with or  Irritation caused by injection of penicillin can produce sterile abscesses if given intramuscularly or thrombophlebitis if given intravenously Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Some studies indicate that 5% to 10% of  An anaphylactic reaction occurs in 0.05% of patients receiving penicillin will have a reaction penicillin-treated patients, with a mortality of  Associated allergic reactions include  Anaphylactic reactions: anaphylactic shock occurs  100 to 300 deaths annually in the United States  Allergic reactions to penicillin of any type may  Rash: in 80% to 90% of allergic reactions be followed by more serious allergic reactions  Delayed serum sickness: fever, skin rash, eosinophilia, up to 2 weeks after treatment  Oral lesions: delayed reactions, severe stomatitis, furred tongue, black tongue, acute glossitis, and  Other reactions: interstitial nephritis, hemolytic Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Use of penicillin in dentistry results from its bactericidal potency, lack of toxicity, and  Often used for treatment of dental infections  Penicillin’s effectiveness in the treatment of effectiveness against many aerobic and anaerobic bacteria Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 The prototype penicillin, available as sodium,  The salts differ in their onset and duration of  penicillin G benzathine (Bicillin L-A) action and the blood plasma levels attained  The duration of action is inversely proportional to the solubility of the penicillin form: the least soluble is the longest acting Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Has a spectrum of action very similar to that  The potassium salt of penicillin V is more soluble than the free acid and better absorbed when taken orally Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Should be reserved for use against only  Less effective than penicillin G against penicillin  Produce more side effects such as GI discomfort, bone marrow depression, and abnormal renal and hepatic function  Cloxacillin and dicloxacillin are the drugs of Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Both ampicillin and amoxicillin can produce a  Ampicillin and amoxicillin are penicillinase-  Ampicillin is much more likely to produce rashes  Amoxicillin is most often used to treat infections because it produces higher blood levels, is better  Most agree that the ampicillin rash is not of an absorbed, required less frequent dosing, and its  Amoxicillin is available with clavulanic acid, a Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Carbenicillin has a wider spectrum of action  amoxicillin + clavulanate (Augmentin)  It is not penicillinase resistant and is available parenterally to treat systemic infections Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Consist of erythromycin, azithromycin and Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Usually administered orally as tablets, capsules, oral suspensions in intravenous or • Interferes with protein synthesis by inhibiting the enzyme peptidyl transferase at the P site of the 50S ribosomal  Spectrum of action closely resembles penicillin  Formulated as an enteric-coated tablet, capsule, or insoluble ester to reduce degradation by Not effective against many infections caused by obligate anaerobes involved in some dental infections  Food reduces absorption, but administering with food may be necessary to minimize adverse GI effects Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 With usually therapeutic doses, side effects concentrations of theophylline, warfarin,  GI effects: include stomatitis, abdominal cramps, triazolam, carbamazepine, and cyclosporine  Cholestatic jaundice: has been reported primarily  The mechanism of the drug interactions may with the estolate form; has also been reported with involve inhibition of hepatic metabolism of Erythromycin base has not been associated with this reaction Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 erythromycin base (E-mycin, Ery-Tab, Eryc, microorganisms as penicillin, it is the drug of  Not effective against the anaerobic Bacteroides species implicated in many dental infections Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 GI adverse reactions include dyspepsia,  Both are newer macrolide antibiotics, such as  Much less frequent than with erythromycin  Inhibit RNA-dependent protein synthesis by  Several drug interactions can occur with both agents because of their reduction in the • Activity against gram-positive cocci and gram-negative metabolism of certain drugs metabolized in • In contrast to erythromycin, azithromycin and  Indicated as alternative antibiotics in the clarithromycin have variable action against some treatment of common orofacial infections caused by aerobic gram-positive cocci and  Bacteriostatic; taken without regard to meals Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Broad-spectrum antibiotics affecting a wide  First isolated from a strain of Streptomyces in  Since then, other tetracyclines have been derived from different species of Streptomyces; the rest have been produced semisynthetically Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Usually administered orally; absorption after  All tetracyclines are bacteriostatic and oral administration varies but is fairly rapid interfere with synthesis of bacterial protein by  Wide tissue distribution; tetracyclines are secreted in the saliva and milk of lactating mothers  Concentrated by the liver and excreted into the  Broad spectrum; effective against a wide variety of  Stored in dentin and enamel of unerupted teeth  Bacterial resistance develops slowly in a stepwise and concentrated in gingival crevicular fluid (GCF)  All tetracyclines cross the placenta and enter Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Anorexia, nausea, vomiting, diarrhea,  Tetracycline can produce permanent discoloration gastroenteritis glossitis, stomatitis, xerostomia, • Minocycline can cause black pigmentation of mandibular  Largely related to local irritation from alteration of and maxillary alveolar bone and the hard palate Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Photosensitivity: patients taking tetracyclines  Hepatotoxicity: incidence of liver damage who are exposed to sunlight sometimes react  Nephrotoxicity: reported after use of old  Hematologic effects: uncommon; hemolytic anemia, leukocytosis, and thrombocytopenic dermatologic reactions have occasionally  Superinfection: an overgrowth of Candida albicans is especially prevalent in the Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Cations: reduce intestinal absorption of tetracyclines by forming nonabsorbable chelates of tetracycline with calcium, for example  Medical: rarely the drug of choice for a  Enhanced effect of other drugs: tetracycline enhances the effect of the oral sulfonylureas  Used to treat acne, pulmonary infections in patients with chronic obstructive pulmonary  Reduced doxycycline effect: barbiturates and phenytoin can reduce the action of doxycycline  Dental: often used for certain periodontal  General antibiotic interactions: as with all antibiotics, tetracycline may reduce effectiveness of oral contraceptives or increase effectiveness or Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Effective primarily against gram-positive organisms and anaerobic Bacteroides species  Derived from lincomycin; elaborated by Streptomyces lincolnensis; found in a soil sample Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Absorption: oral is well absorbed; food does  Antibacterial spectrum includes many gram- positive and some gram-negative organisms  Distribution: throughout most body tissues,  Antibacterial action results from interference with  Bacteriostatic, occasionally can be bactericidal at  Excretion: in urine and feces (via bile)  Resistance develops in a slow, stepwise  Cross-resistance between clindamycin and Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Superinfection: C. albicans is sometimes  The most common side effects are GI, including diarrhea, nausea, vomiting, enterocolitis, and  Other effects: adverse reactions involving  Can lead to pseudomembranous colitis (PMC), also known as antibiotic associated colitis (AAC)  Allergy: morbilliform (resembling measles) • Characterized by severe, persistent diarrhea and the  More severe reactions include urticaria, angioneurotic edema, erythema multiforme, serum Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Indications are limited to infections caused by  An antiinfective with trichomonacidal, anaerobic organisms, especially Bacteroides species, and some staphylococcal infections  Exceptional against most obligate anaerobes such when the patient is allergic to penicillin  The patients should be warned of the potential for  Inhibits nucleic acid synthesis leading to death of pseudomembranous colitis and informed of its  Affects neutrophil motility, lymphocyte action, and Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Absorption: taken orally, it is well absorbed  Distribution: will travel into the CSF, saliva,  Effective against the protozoa Trichomonas vaginalis and Entamoeba histolytica and obligate anaerobic bacteria Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Cystitis, polyuria (excessive excretion of urine), dysuria (difficulty or pain in urination), and  Most common; involves nausea, anorexia,  Dry mouth; often, an unpleasant or metallic taste has  Headache, dizziness, vertigo, ataxia (inability to • Confusion, depression, weakness, insomnia, and serious convulsive seizures are rarely associated • Carcinogenicity, mutagenicity, and tumorigenicity in lower life • Administration for dental infections during pregnancy is Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 When alcohol is ingested with metronidazole,  Special usefulness because of its anaerobic it can produce a mild form of the reaction that occurs when a recovering alcoholic drinks alcohol while taking disulfiram (Antabuse) • Treatment of trichomoniasis, giardiasis, amebiasis, and susceptible anaerobic bacterial infections  Symptoms include nausea, abdominal cramps, • Useful in the treatment of periodontal infections  Metronidazole can potentiate the effect of Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Absorption: oral cephalosporins are well  Active against a wide variety of gram-positive and  Distribution: widely distributed throughout  Isolated in 1948 from a fungus of genus Cephalosporium acremonium in a sewer outlet near Sardinia, Italy  Excretion: by glomerular filtration and tubular  Those available for oral use are destroyed by cephalosporinase, an enzyme elaborated by some microorganisms Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Bactericidal, effective against most gram-  Inhibit cell wall synthesis producing a deficiency in  The generation designates the width of  Third-generation cephalosporins have the broadest Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 The most common adverse reaction, including  Can produce localized pain, induration, and diarrhea, nausea, vomiting, abdominal pain, anorexia (aversion to food), dyspepsia (gastric indigestion), and stomatitis  Hemostasis and disulfiram-like reaction  May produce nephrotoxic effects under certain  Reported in approximately 5% of patients, including fever eosinophilia, serum sickness,  As with all antibiotics, especially those with a broader • Cross-hypersensitivity with penicillin is about 10% Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Indicated for infections sensitive to these  cephalexin (Keflex) cephradine (Velosef, Anspor)  Especially useful in certain infections caused by  cefaclor (Ceclor, Raniclor) cefuroxime (Ceftin, Kefurox, Zinacef) cefprozil (Cefzil)  cefixime (Suprax) cefpodoxime proxetil (Vantin) cefdinir (Omnicef) Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Acute abscess and cellulitis are primarily the  The progression of most dental infections  The early phase, stage 1, is primarily gram-  The drug of choice is penicillin V for patients who  The mixed stage, stage 2, has both aerobes and  Erythromycin ethylsuccinate or clindamycin for  The last stage, stage 3, is exclusively anaerobes Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Infection is mixed; can be handled by  The organisms have coalesced into one area attacking either the gram-positive organisms  Most often, incision and drainage is sufficient  Gram-positive organisms can be managed with  If chronic infection persists or the patient is immune compromised, use of antibiotic with  For anaerobes, an antiinfective with good • The two antibiotics with the most anaerobic coverage are • Penicillin V also has anaerobic coverage Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 When a prescribed antibiotic is not effective, the patient must be reevaluated to determine why  Patient compliance: they may not be taking the  Ineffective antibiotic: may not be effective against the  Poor debridement: dead tissue, purulent exudate, or foreign bodies were not removed from site of  Resistant organism: the organism may be resistant to  Concentration did not reach the site of infection Host defenses are inadequate Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 An antibiotic elaborated by Streptomyces  Bactericidal, has a narrow spectrum of activity orientalis found in soil samples from India and  Inhibits bacterial cell wall synthesis  Unrelated to any other antibiotic currently  Recently, vancomycin-resistant organisms  When bacterial resistance to antibiotics was  Usually administered only intravenously for • When used by mouth, it is being used to eradicate  After resistance to other antibiotics increased, use  This led to an increase in resistance to Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Significant toxic reactions are infrequent except  In 1943, a strain of Streptomyces griseus was  With oral use, nausea, vomiting, and bitter  Further strains of Streptomyces have furnished  With intravenous use, an erythematous rash on  Bactericidal and appear to inhibit protein face and upper body has been reported (red synthesis and to act on the 30S subunit of the  Hypotension accompanied by flushing, chills, Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Poorly absorbed orally; must be administered  Bactericidal; have a broad antibacterial  Used primarily against aerobic gram-negative  Used orally for their local effect within the infections when other agents are ineffective Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Adverse reactions limit their use in clinical  Indicated for hospitalized patients with  Topical aminoglycosides are used to treat certain • Toxic to the eighth cranial nerve, which can lead to auditory and vestibular (in the ear) disturbances • Can cause kidney damage by concentrating in the renal Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 A broad-spectrum, bacteriostatic antibiotic  Inhibits bacterial protein synthesis by acting  Active against a large number of gram-positive and gram-negative organisms, rickettsiae, and some chlamydia  Fallen into disuse, serious adverse effects include fatal blood dyscrasias and bone marrow suppression Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 The first antibiotics that went on to pave the  The structural similarity between sulfonamide agents and para-aminobenzoic acid (PABA) is the basis for most of their antibacterial activity  Many bacteria are unable to use preformed folic acid, which is essential for their growth  They must synthesize folic acid from PABA  Sulfonamides competitively inhibit the bacterial enzyme that incorporates PABA into an immediate precursor of folic acid Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Bacteriostatic against many gram-positive  The most common side effect is an allergic  Used for otitis media in children, acute exacerbations of chronic bronchitis in adults, and  May manifest as rash, urticaria, pruritus, fever, a fatal exfoliative dermatitis, or periarteritis nodosa  Readily absorbed sulfonamides are used for systemic effects; poorly soluble sulfonamides Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
antimalarial agent, and sulfamethoxazole, a sulfonamide, are commonly used in combination  Inhibits two separate steps in the essential metabolic pathway of the bacteria, delaying resistance and leading to a synergistic effect  Bacteriostatic against a wide variety of gram- Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Most adverse reactions involve skin disorders  A wide antibacterial spectrum, including  Indicated in the treatment of selected urinary tract infections and selected respiratory and  Bacteriostatic against many common urinary tract  Pediatric patients may be taking it prophylactically  Most common adverse reactions are nausea,  Associated with many hypersensitivity reactions  Used in the treatment or prophylaxis of certain Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 A group of orally effective antibacterial agents  Mechanism of action involves antagonism of the A subunit of DNA gyrase; the enzyme is  Bactericidal against most gram-negative  DNA gyrase found only in microorganisms; human organisms and many gram-positive organisms cells are unaffected by quinolones’ action  The first orally active agents against certain Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Ciprofloxacin is well absorbed orally  Ciprofloxacin is bactericidal against a wide  Both antacids and probenecid interfere with range of gram-negative and gram-positive ciprofloxacin’s absorption and serum concentration  Patients should be well hydrated to prevent  Special spectrum is against Pseudomonas  Unlike other antiinfective agents, an additive action may result when ciprofloxacin is combined with other antimicrobial agents Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Other effects: disturbed vision, joint pain,  GI effects: nausea, diarrhea, vomiting, painful renal problems, and palpitations have rarely oral mucosa, bad taste, oral candidiasis, and  Associated with possibility of tendonitis and  CNS effects: headache, restlessness,  Pregnancy and nursing: contraindicated in  Hypersensitivity: rash, pruritus, urticaria, Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Indicated for lower respiratory tract, skin, bone and joint, and urinary tract infections  May be used for periodontal disease in the future  Their unique mechanism of action makes the development and transfer of resistance more Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Tuberculosis (TB) is caused by the acid-fast bacterium Mycobacterium tuberculosis  Treatment is difficult for several reasons • Patients with TB often have inadequate defense mechanisms • Tubercle bacilli develop resistant strains easily and have long periods of inactivity when they are resistant to treatment • Most of the drugs available are not bactericidal and because of their toxicity often cannot be used in sufficient doses • People using antituberculosis agents often do not take them  Multidrug-resistant TB (MDR TB) has increased because of its spread in patients with human immunodeficiency virus and homeless patients Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Because of the problem of resistance, at least  Bactericidal only against actively growing three drugs are administered concurrently in  The mechanism of action may relate to inhibition  Isoniazid (INH), rifampin, and pyrazinamide are of mycolic acid synthesis, resulting in disruption of combined for the treatment of pulmonary TB  “Resting” bacilli exposed to the drug are able to resume normal growth when the drug is removed Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 INH is readily absorbed from the GI tract and  The incidence of all adverse reactions to INH  The most common adverse reaction (20% of  Metabolism varies by race into fast and slow patients who have a reaction) involves the  The ability is inherited as an autosomal-dominant • Includes peripheral and optic neuritis, muscle twitching, toxic encephalopathy, insomnia, restlessness, sedation, incoordination, convulsions, and even psychoses  Hepatotoxicity: 1% of patients taking INH exhibit clinical hepatitis, and up to 10% develop abnormal Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 INH is used alone for prophylaxis or for  A semisynthetic derivative of rifamycin, an antibiotic produced by Streptomyces mediterranei  The mechanism of action involves inhibition of DNA-dependent ribonucleic acid (RNA) polymerase, which suppresses initiation of chain formation Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Absorbed from the GI tract and eliminated in  The most common adverse reactions are GI, the bile, where enterohepatic circulation including anorexia, stomach distress, nausea,  Rifampin gives a red-orange color to body Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Used in combination with other agents for  A relative of nicotinamide, well absorbed and  Used to treat meningococcal carriers prophylactically  Hepatotoxic and can produce rash, hyperuricemia, in and children exposed to Haemophilus influenzae  Centers for Disease Control and Prevention recommends PZA for use during the first 2 months with INH and rifampin to treat TB Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 One treatment regimen includes use of isoniazid and rifampin every day for 9 to  Resistance develops rapidly when this drug is  Pyrazinamide is continued for 2 months  The most important side effect is optic neuritis  Others include rash, joint pain, GI upset, malaise, usually becomes noninfective within 2 to 3 weeks to 2 to 3 months Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 In general, the use of topical antibiotics is  If an agent is used topically, it should be one that  Rifater (isoniazid + rifampin + pyrazinamide) Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 A topical antibacterial produced by Pseudomonas neomycin, and two polypeptide antibiotics,  Indicated for the topical treatment of impetigo  Neomycin affects gram-negative organisms  Can be used to treat the bacterial infection from  Polymyxin and bacitracin affect gram-positive streptococci or staphylococci that are occasionally  Because angular cheilitis most commonly is a fungal infection, antifungal agents should be used first Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Infective endocarditis is caused by an infection of the heart valves or endocardium  Antibiotic regimens for dental procedures  Often begins with sterile vegetative cardiac lesions consisting of amalgamations of platelets, fibrin,  When bacteria are introduced into the bloodstream, they may infect the damaged valves Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 “Prophylaxis for infective endocarditis is  For every situation, three factors must be based on the concept that giving certain antibiotics to certain patients before certain procedures can prevent these patients from  The cardiac and medical condition of the patient Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 All dental procedures that involve manipulation of  Organisms are more likely to enter the blood gingival tissue or the periapical region of teeth or supply when dental treatment is rendered and  Bacteremia is also produced when eating potato  Routine anesthetic injections through uninfected tissue  Oral radiographs Placement of removable prosthodontic or orthodontic  Adjustment of orthodontic appliances Placement of orthodontic brackets  Shedding of deciduous teeth Bleeding from trauma to the lips or oral mucosa Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Except for the conditions listed above, antibiotic prophylaxis is no longer recommended for any • Unrepaired cyanotic CHD, including palliative shunts and Completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first 6 months after the procedure • Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or device (which inhibit  Cardiac transplantation recipients who develop Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 No allergies to penicillin or amoxicillin (oral)  Allergic to penicillins or ampicillin and can take  cephalexin*† 2 gm OR clindamycin 600 mg OR  *Or other first- or second-generation oral cephalosporin in equivalent adult or pediatric doses  † Cephalosporins should not be used in an individual with a history of anaphylaxis, angioedema, or urticaria with penicillins or ampicillin Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
 Recommended that patients with prosthetic  Patients with noncardiac medical conditions joints receive antibiotic prophylaxis for 2 may also require prophylactic antibiotic coverage before dental procedures, “but lack  “Whether the use of antibiotics is indicated after of agreement among practitioners for these the patient is 2 years postreplacement surgery should be determined by those involved most closely with the patient’s condition” Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.

Source: http://www.cabrillo.edu/~sreddy/DH162B/Chapter%207%20-%20Pharm.pdf

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Application for a Licence to Deal in Controlled Drugs F Forward completed application to: Medicines Control, PO Box 5013, WELLINGTON 6145 Pursuant to regulation 3 of the Misuse of Drugs Regulations 1977, I hereby apply for a Licence to Deal in the Controlled Drugs indicated on OR Name and postal address of body Name and postal address of individual cor

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HK J Paediatr (new series) 2002; 7 :187-189 Instruction: 1. Please use pencil to shade the correct box for the answer sheet (see loose leaf page). 2. Send back the answer sheet to the Hong Kong College of Paediatricians for the award of 4 CME points for those with The following statements are true / false (A) Non-ketotic Hyperglycinaemia: A Case Report 5. Which of the following is incorr

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