ANTIBIOTICS USED IN DENTISTRY

                                                                                                                  

                                                  ANTIBIOTICS USED IN DENTISTRY                       

I)                    BETA- LACTAM ANTIBIOTIOCS;

PENICIILINS ;

1)      AMOXICILLIN;  Is one of the most frequently used antibiotics for treatment of dental infections

Dose; 250-500mg TDS given for 5 days.

2)      Clavulanic acid ; addition of CV re-established the activity of amoxicillin against bacterias.

CEPHALOSPORINS;

     FIRST GENERATION;  it is highly active against  gram positive  but less active against gram negative bacteria.

1)      Cephalexin ;  commonly use as alternative of amoxicillin.

Dose ; 0.25-1g 6-8 hourly  and in childrens ; 25-100mg/kg/day

2)      Cefadroxil ;  it has good tissue penetration including that in alveolar bone ( tooth socket); exerts more susutained action at the site of infection.

Dose; 500mg  BD

      SECOND GENERATION;  more active against gram negative organisms and some anaerobes.

1)      Cefuroxime axetil;  frequently used in dental infections

Dose ; 250-500mg BD and in children gives half dose

2)      Cefaclors ; active against anaerobes found in oral cavity.

Dose ; 250mg bd

     THIRD GENERATION; active against both gram positive and gram negative bacteria

1)      Cefixime ; 

Dose ; 200mg bd

2)      Cefpodoxime proxetil;  mainly used soft tissue infections.

Dose; 200mg bd

 

II)                   NITROIMIDAZOLES;  broad spectrum antiprotozoal drugs.             .

1)      Metronidazoles; is an effective drug against anaerobic bacterial infections.

 Drug of chice for acute necrotizing gingivitis in which it is often combined with either penicillin v , amoxicillin, erythromycin or tetracycline.

Used in periodontitis, pericoronitis, acute apical infections and some endodontics infection etc for  5-7 days.

Because of it is not active against aerobic and facultative bacteria, metronidazole is mostly combined with  a penicillins, cephalosporins or macrolide antibiotics.

Dose; 200-400mg TDS.

2)      Tinidazole ; is equally efficacious congener of metronidazole

Dose; 500mg bd for 5 days.

III)                TETRACYCLINE  ;

       GROUP  I-  tetracycline, oxytetracycline                              

GROUP-II- demeclocycline

GROUP-III- doxycycline, minocycline

TETRACYCLINE used in oro-dental infections, it have an adjuvant role in the management of chronic periodontitis.

In refractory periodontal diseases 2-week tetracycline (1gm/day) or doxycycline(100mg-200mg/day)  therapy control gingival inflammation and helps to normalize the periodontal microflora.

It is highly active against Actinobacillus sp. that is help responsible for destruction of gums and bone loss in juvenile periodontitis.

ADVERSE EFFECT OF TETRACYCLINE;

Tetracycyline have chelating properties, calcium –tetra cycline chelates gets deposited in developing teeth and bones.

Given from midpregnanacy to 5 months of extrauterine life, the deciduous teeth are affected ; brown discolouration , ill formed teeth, more susceptible to caries.

Given during  late pregnancy  or childhood , it can causes temperory suppression of bone growth.

IV)               MACROLIDES ANTIBIOTICS;                                                

1)      ERYTHROMYCIN;

It is used against aerobic and anaerobic  gram positive bacteria.

Used in periodontal/ pariapical abscess, necrotizing ulcerative gingivitis , post-extraction infections , gingival cellulitis etc.

IT IS ALSO USED IN PATIENTS THOSE ARE ALLERGY TO BETA LACTAM ANTIBIOTICS LIKE PENICILLS OR CEPHALOSPORINS

Dose;250-500mg 6 hourly TDS and in children 30-60mg/kg/day.

2)      AZITHROMYCIN; used in orodental infection in place of erythromycin.

Dose; 500mg once daily .

ANTIFUNGAL

1)      FLUCONAZOLE ;  given orally 150mg/day for 2 weeks is highly effective in Candida infections of mouth.

2)      KETOCONAZOLE  also used for dental infection.