ANTIBIOTICS IN TREATMENT OF

ORAL MAXILLOFACIAL
INFECTIONS

PRAVEENA
IV BDS
ROLL NO 38
 CONTENTS
INTRODUCTION
HISTORY AND CLASSIFICATION
PRINCIPLES OF CHOOSING APPROPRIATE ANTIBIOTICS
PRINCIPLES OF ANTIBIOTIC ADMINSTRATION
SOME ANTIBIOTICS COMMONLY USED IN DENTISTRY
ANTIBIOTIC PROPHYLAXIS
INDICATIONS FOR USE OF ANTIBIOTICS IN DENTISTRY
CONCLUSION
 INTRODUCTION

• ANTIBIOTIC :- Greek word – ‘’ANTI :- Against ‘’ ; ‘’BIOS – Life ‘’

• DEFINITON :- They are substances produced by microorganisms which
supress the growth or kill other micro oraganisms at very low concentrations
• Selective toxicity
• Miracle drugs used in dental practice
 HISTORY
• LOUIS PASTEUR :- ‘’Bacteria kill other bacteria ‘’ ( 1877)
• ALEXANDER FLEMING – Penicillin (1928)
• CHAIN AND FLOREY – Clinical use of penicillin ( 1941)
• SELMAN WAKSMAN – term antibiotic ( 1942)
 CLASSIFICATION
ON THE BASIS OF PREPARATION
NATURAL :- Pencillin , cephalosporins , erythromycin …
SYNTHETIC :- sulphonamides…
ON THE BASIS OF SPECTRUM OF ACTIVITY :-
NARROW SPECTRUM :- pencillin G , streptomycin , erythromycin …
BROAD SPECTRUM :- amoxycilllin , ampicillin,
tetracycline,azithromycin ….
ON THE BASIS OF ACTION
ON THE BASIS OF MECHANISM OF ACTION
ON THE BASIS OF FAMILY
 PRINCIPLES OF CHOOSING APPROPRIATE
ANTIBIOTICS

• Identification of causative organism

• Determination of antibiotic sensitivity
• Use of specific narrow spectrum antibiotic
• Use of least toxic antibiotic
• Patient drug history
• Bactericidal rather than bacteriostatic
• With a proven history of success
• Cost
• Patient compliance
 PRINCIPLES OF ANTIBIOTIC ADMINSTRATION

• Administration of proper dose ( 3-4 * MIC )

• Proper time interval (4* t1/2)
• Proper route of administration
• Consistency in route of administration
• Combination antibiotic therapy
 COMBINATION ANTIBIOTIC THERAPY

RATIONALE:-
Additive synergistic effect
Mixed infections
Delay n development of resistance
Decrease the incidence of adverse reactions to an individual drug
reduce the cost of therapy
 INDICATIONS

• To increase the spectrum

• Increased bactericidal effect against a specific organism is desired
• Prevention of rapid emergence of resistance
• Rapidly progressive odontogenic infections
Some antibiotics commonly
used in maxillofacial
infections
BETA-LACTAM ANTIBIOTICS
• PENICILLIN
• SEMISYNTHETIC DERIVATIVES OF PENICILLIN
• CEPHALOSPORINS
• B-LACTAMASE INHIBITORS
• MONOBACTAM
• CARBAPENEMS
• Mechanism of action :- Act by inhibiting the synthesis of bacterial cell wall
 PENCILLINS

• Penicillin G
• Penicillin VK
NATURAL

• Ampicillin
• Amoxicillin
SEMISYNTHETIC • Methicillin
• Oxacillin
 PENICILLIN G( Benzyl penicillin )
• Narrow spectrum
• Primarily against gram +ve bacteria
• Acid labile
• T1/2 – 30 min
• Distributed extracellularly ,reaches most body fluids, but penetration in serous
cavities and CSF is poor.
• Preparations :- benzyl pen 0.5 -1 MU inj , procaine penicillin 0.5-1 MU dry powder
 ADVERSE EFFECTS :-
Local irritation
Direct toxicity
Hypersensitivity
Superinfection
Jarisch herxiheimer reaction
DENTAL INDICATIONS
Periapical periodontal , pericoronal abscesses
ANUG
Oral cellulitis
Prophylactically to cover dental procedures in dental pts predisposed to SABE
 PENICILLIN V
• Brand name :- CRYSTAPEN ,KAYPEN
• DOSAGE :- 125-250 mg tab ,125mg/5ml syr.
• Acid stable
• Plasma t1/2 :- 30-60 min
• Antibacterial spectrum :- identical to PnG
 AMOXICILLIN
• Broader spectrum of action
• Active against gram +ve and –ve aerobic as well as anaerobic bacteria
• Most widely used in dentistry
• Dosage :- 0.25 -1 gm TDS oral /IM
• Brand name :- AMOXYLIN , NOVAMOX, AMOXIL, - 250,500mg caps
• First choice of drug for prophylaxis of local wound infection as well as distant
infection (endocarditis) following dental surgery .
• Safer antibiotic in lactating and pregnant women
 BETA LACTAMASE INHIBITORS
• CLAVULINIC ACID :-
Contains a beta lactam ring but no antibiotic activity on its own
given in combination with amoxicillin
Used against β lactamase producing resistant staph.aureus
AMOXICILLIN + CLAVULANIC ACID – 500+ 125 mg TID ,5-7 days
( AUGMENTIN )- used in treatment of odontogenic infections
CEPHALOSPORINS
• They are similar to penicillins ,but more stable to may beta lactamases and so have a broader
spectrum of activity
• Bactericidal drugs
• USES :-
Dental infections
In penicillin/amoxicillin resistant infection
First gen :- popular for surgical prophylaxis
second gen :- cefuroxime , cefaclor – are only ones with good acivity against oral anaerobes
ADVERSE REACTIONS :-
Local reactions may occur
Allergic reactions
Nephrotoxicity , CNS toxicity , Blood tocicity
 TETRACYCLINES
• MECHANIS OF ACTION - inhibit protein synthesis by binding to 30s
ribosomes
• ON THE BASIS OF CHRONOLOGY OF DEVELOPMENT :-
 1ST GEN :- chlortetracycline, oxytetracycline
 2nd GEN :- democycline, methacycline
 3rd GEN :- doxycycline ; minocycline SEMISYNTHETIC
 TIGECYCLINE newer tetracycline
Uses in dentistry
Drugs of first choice in :-
 chronic periodontitis ( not recommended in acute conditions )
Doxycycline polymer gels --- periodontal pockets
Juvenile periodontitis
Refractory periodontitis
Desquamative gingivitis
Conjunction with surgical therapy
Preparations :-
• TERRAMYCIN : 250,500 mg ( oxytetracyclines ) t1/2 :- 6-10 hr
• TETRADOX,NOVADOX 100mg ( doxycylines ) t1/2 :- 16-24hr
• CYNOMYCIN 50- 100 mg ( minocyclines ) t1/2 :- 18- 24hr
 ADVERSE EFFECTS
 TEETH & BONE :-
• binds to ca deposited in newly bone or teeth
mid pregnancy – 5 months :- deciduous dentition
3 months – 5 yrs :- crowns of permanent anteriors
late pregnancy or childhood temporary suppression of bone growth
 OTHERS :-
• Gastric irritation and local toxicity
• Liver & kidney damage
• Photosensitivity
• Vestibular reactions
• Hypersensitvity
• Superinfection
 AMINOGLYCOSIDES
• NATURAL :- streptomycin , gentamycin , kanamycin , amikacin
• SEMISYNTHETIC :- neomycin , framycein
MECHANISM OF ACTION :- binds at several sites at 30s and 50s ribosomes
Effective against gram negative bacteria
Bactericidal
 Uses :-
• Gentamycin 2mg/kg im /iv single dose to supplement amoxicillin /vancomycin in
endocarditid prophylaxis
• Hard & soft tissue trauma
• Orthognathic & reconstructive maxillofacial surgery
• Odontogenic infection
• Pericorinitis
• Osteomyelitis
SHARED TOXICITIES
OTOTOXICITY
NEPHROTOXIXITY
NEUROMUSCULAR BLOCKADE
 MACROLIDES
• MACROCYCLIC RING WITH ATTACHED SUGARS
• Bacteriostatic
• Erythromycin, azithromycin , vanamycin, clarithromycin
• MECHANISM OF ACTION :- bind to 50s ribosomes and interfere with
translocation
FLOUROQUINOLONES
• BACTERICIDAL ,but not as potent as beta-lactams and aminoglycosides
• MECHANISM OF ACTION :- Inhibits bacterial DNA gyrase
• Active mainly against gram –ve
 Uses
• Osteomyelitis
• ANUG
• Recurrent periodontitis
ADVERSE EFFECTS :-
GI symptoms :- nausea ,vomiting
hypersensitivity reaction
arrhythmias
 LINCOSAMIDE
• CLINDAMYCIN
• Bacteriostatic effect
• Primarily active against anaerobes
• MECHANISM OF ACTION :- inhibit protein synthesis
• Preparations :- DALCAP , CLINCIN ( 300mg qid – 7 days )
• Second choice in patients allergic to pencillins
• High oral absorption , significant tissue penetration, stimulatory effects on host
immune system
 METRONIDAZOLE
• Effective against anaerobic bacterial infections
• MECHANISM OF ACTION :- converted to highly reactive nitroradical form
by reduction of nitro group exerts cytotoxicity by damaging DNA
and other biomolecules .
USES :-
ANUG
Orodental infections
• PREAPARATIONS :- metrogyl, flagyl, aristogyl
• Orally :-400mg 8 hrly
• IV –inj 500mg/100ml
 ADVERSE REACTIONS:-
GI symptoms
glossitis , dryness of mouth
unpleasant metallic taste
furry tongue
‘’disulfiram like reaction’’
 ANTIBIOTIC PROPHYLAXIS

• It is administration of antibiotics to patients who have no known infection, for the

purpose of preventing microbial colonization and reducing the potential for
postoperative complications .
 INDICATIONS

 Infective endocarditis
Prosthetic joints
Neurosurgical shunts and implants
Prevention of local infection in surgical or operative sites
Prevention of generalized spread of infection in patients with compromised
immune systems
Prophylactic antibiotic regimen
 INDICATIONS FOR USE OF
ANTIBIOTICS IN DENTISTRY
 CONCLUSION
Antibiotic selection remains as much as an art as it is a science .
Although antibiotics do not prevent all post operative infections,
they can reduce the incidence significantly when administered correctly .
Future treatment strategies will not only include aggressive use of traditional
management methods but also understanding normal immune system and
associated defects, new antimicrobials .
ultimately, we should provide a shorter course of treatment and
improved outcomes for our patients.
THANK YOU