ANTIBIOTIC

Antibiotic are used commonly in dentistry for both therapeutic and preventive measures involving oral bacterial infection.
Definition : antibiotic is refer to any compound produced by microorganism that inhibited another microorganism .It include natural ,semisynthesis an manmade antimicrobial.

For an antimicrobial agent to be useful in the the treatment of pathogenic microorganisms the should have the following criteria:
The microorganism must be susceptible to the agent The agent must be capable of penetrate the site of infection Adequate concentration of the agents must be maintain at the site of infection

Agent should be low toxic to the host but should exhibit selective toxicity of microorganism The agent should not readily promote resistance or create imbalance in normal flora of host.

They can divided into two groups

Pharmacology categories of antibiotics
Penicillin and Cephalosporin Macrolides Tetracyclines Local delivered antibiotic Clindamycin Metronidazole Quinolone Sulfamide.
Bactericidal Bacteriostatic

Penicillin: are -lactam antibiotic Penicillin is the drug of choice in for treatment of infections in oral cavity It inhibits specific bacterial enzymes required for the assembly of bacterial cell wall It can become inactive by bacterial production, -lactamase . -lactamases are the primary reason that treatment with penicillin and cephalosprin will fail

Dosage:
Amoxicillin normal dose 250 mg 500mg every 8 hour Chepalosporin(cephalexin*) : 250mg q 6 h 500mg q 12h

Amoxicillin are secreted through breast milk in low concentration .

Metronidazole:

Pharmacology
Amoxicillin
When using amoxicillin more predictable blood level can be obtain if given on empty stomach It widely distributed though out the body including saliva, and gingival crevicular fluid. It does not pass through blood-brain barrier in healthy patients, but it is clinically effective with patient with meningitis.

 Cephalosporin
Pass into most body fluid and tissue in adequate levels to allow their use in treatment of most infection. Passing through placenta , very little in breast mild and excrete in the urine

Use as alternative to Penicillins Active against gram (+) -Erythromycin : use alternative to PNC -Clarythromycin: semisynthetic macrolide that has broader spectrum. +more sensitive to gram(+) microorganism +has relatively good activity again gram(-) Bateria.

In recently studies Azithromycin appear superior to Erythromycin and Clarithromycin: -has better pharmacokentic - Excellent tissue distribution - Longer theraptic half-life - Activity against gram positive and negative

Accepted indication
Mild to moderate infection( upper and lower respiratory tract system and skin infection) Indicate for patients with hypersensitivity of PNC

General dosing
Erythromycin 250mg q 6h ( 1 h before or 2h after the meal is recommended) Clarithromycin 250- 500mg q12h Azithromycin 250mg/day with 500mg of initial loading ( 1 h before or 2h after the meal is recommended)

Drug interaction Concurrent use with theophylline, digoxin,terfenadin,cisapride,pimozide, astemizole > cadiotoxicity Cabamzepine or cyclosporin or hexobabital or phenytoin > may elevated serum level Wafarin > prolong duration of prothrombin time and increase risk of hemorrhage.

Pharmacology
Macrolides inhibits bacterial protein synthesis by binding reversibly to the 50s ribosomal subunit of sensitive bacteria.

The Tetracyclines, which include tetracycline, doxycycline and minocyline. In nomal does it acts as bateriostatic At higher concentration , the Tetracycline are bacteriocidal .

Accepted indication
Is a broad spectrum antibiotic that are frequently indicated for gram positive and negative bacterial infections . Dental application include treatment of
Refractory periodontitis Juvenile periodontitis Dental abscesses and soft tissue abscesses. Use as alternative to PNC

Dosage adjustments
Tetracycline have been shown to depress plasma prothrombin activity ,patients receiving anticoagulant therapy may require downward adjustment of the anticoagulant dosage. Patients with renal impairement should be given with decreased dosage to avoid liver toxicity ,increase in blood urea nitrogen,azotemia ,hyperphosphatemia and acidosis

Special dental consideration

Concurrent use of tetracyclin and methoxylurane has been reported to result in fatal renal toxicity. May interfere with bactericidal action of PNCs and Chephalosporin. Concurrent use with contraceptive may render the contraceptive less effect. Bismuth subsalicylate and antacids containing aluminium should not be ingested at the same time as tetracyline

Cross-senstivitly
A hypersentivity or allergic reaction to one tetracyline is indicate of hypersensitivity to all other tetracyclines.

Special patients
* All Tetratcylines cross the placenta so it is not recommended during the last half of pregnant ,as the drug may casue permanent disscoloration of teeth ,enemel hypoplasia and inhibition of skeletal growth in the fetus. Tetracylines should not be used with children aged 8 because of this drug => permanent discoloration of the teeth.

Pharmacology: This drug are readily absorbed form gastrointestinal tract after oral administration .they are distributed through out the body readily penetrate soft-tissue. At high concentration are also present in breast milk. The primary route of excretion via kidney.

Metronidazole :
At first it was used as treatment for trichomonal vaginitis Later was discover to be effective on acute ulcerative gingivitis It also has been used as treatment of anaerobic bacteria And treatment of anaerobic protozoa (associated with mouth, the intestinal tract and female genital tract)

Metronidazole + Amoxiciline are effective in treatement of periodontal disease. Additionally, Metronidazole and PNC V used as mixed odontogenic infections

Accepted indication:
Usually reserved for serious infections of lower respiratory tract, skin and soft tissue ,female genital tract, intra-abdominal infections and absecessed, bone and joints ,and bacteria septicemia . It also indicated for treatment of trichomoniasis . Use as treatment of antibiotic-associted colitis and in pseudomembraneous colitis .

General dosage
For Adult 250mg every 6hours or 8 hours

Drug interactions in dental interest

It has been reported to potentiated anticoagulant drugs( Ex warfarin) Increased blood level s in the gastroesophageal reflux agent cisapride have been demonstrate with concurrent use of metronidazole , posssibly leading to srious cardiac dysrhymias.

Pharmacology : is usually completely and promptly absorbed after one hour of first dosage. It is distributed through out the body tissues and fluids. Liver is accountable for metabolism of metronidazole with more than 50% of systemic clearance.