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PENICILLINS
1ST antibiotic to be used clinically in 1941
MOA
interferes with cell wall synthesis
bactericidal
Antibacterial spectrum
Oral aerobes and anaerobes
cavity
To be used with precaution in
Patients with hypersensitivity
NATURAL PENICILLINS
Penicillin G
Acid labile
Parenteral route
2-5 million units IM (Adult Dose)
Procaine penicillin G
Longer acting
Adequate serum levels for 8-12 hours, effective
for 1-2 days when administered IM
Penicillin G Benzathine
Even longer duration of serum levels
Drug detectable for 1-3 weeks
Penicillin V
Acid stable
500mg QID orally
infections.
Dosage / administration:
ADVANTAGES
Concentrations that are higher & last longer
DISADVANTAGES
Greater potential to produce superinfections of
Amoxicillin + Cloxacillin
Novaclox, Amoclox, Amotox Tab 250mg + 200
mg TDS
Adverse reactions
Gastritis
Hypersensitivity
Abdominal cramps
Sulbactam
Used with Ampicillin (Unasyn)
H.influenza
CEPHALOSPORINS
Less susceptible to b-lactamases as compared
to penicillin
As the generation increases, gram positive
prophylaxis
Cefadroxil
Cephalexin
Cefazolin
Cephradine
Cefixime
Ceftriaxone
Cefotaxime (0.25, 0.5 & 1 g per vial inj)
Ceftibuten
Cefdinir
Cefpodoxime
generation cephalosporins.
Cefluprenam
Cefozopran
Cefepime ( 0.5, 1 g inj)
Cefpirome
Cefquinome
Adverse effects:
MildStomach upset /
cramps
Nausea, vomitting
Diarrhoea
Sore tongue
Sores in the mouth
Vaginal yeast
infections
MONOBACTAMS
Bactericidal effect similar to other drugs in
this class
Only Aztreonam is approved for use
No activity against g+ organisms, limiting its
CARBAPENEMS
Broad antibacterial spectrum
Commonly used to treat P.aeruginosa
TETRACYCLINES
Bacteriostatic in nature
Limited use because of rapid development of
resistence
MOA binding to 30S ribosomes
Uses
Lower molar osteitis sicca (dry socket )
prevention
Acne therapy
Periodontal disease
Adverse effects:
Teratogenic
Stains developing teeth
Allergic manifestations like rash
Photosensitivity
Hepatic dysfunction
GI disturbance like nausea, vomiting,
epigastric distress
Antianabolic effect
Avoided in patients with renal impairment
can lead to aggravation of aztemia and
exaggerated anabolic effect
Reversible Fanconi-like syndrome
IV administration can lad tolocal thrombosis
VANCOMYCIN
Highly effective against MRSA, gram + cocci
MOA cell wall inhibition
Poor oral absorption and painful IM injection
IV dose 2g daily in divided doses 500mg over 60
CHLORAMPHENICOL
Broad spectrum, bactriostatic agent
Rarely used these days
Useful in ampicillin resistant H.influenza and
anaerobic bacteria
Useful for brain abscess and meningitis
S/E aplastic anaemia (rare)
- gray baby syndrome (neonates)
MACROLIDES
Useful for maxillofacial infections
MOA bacteriostatic and interferes with
ERYTHROMYCIN
Best known macrolide with g + spectrum
CLINDAMYCIN
Bacteriostatic at low concentrations and
AZITHROMYCIN
Broad spectrum coverage including g+ and g-
Adverse reactions :
Diarrhoea
Nausea
Vomiting
Flatulence
Headache
Rashes
NITROIMIDAZOLES METRONIDAZOLE
Stimulates production of toxic products to kill
susceptible bactera
Effective against strict anaerobic bacteria
(most responsible for oral/dental infectionsBacteroides, Prevotella, Porphyromonas,
Veillonella, Fusobacterium, Treponema etc.)
Trade names & dosage:
ORNIDAZOLE
Trade name and dosage Orni, Ornida Tab
500mg BD
Uses:
Pericoronitis
Certain periapical infections
Some cases of osteomyelitis
Infected extraction socket
Adverse reactions :
Anorexia
Nausea
Abdominal cramps
Dizziness
Metallic taste
Adverse effects :
Disulfiram reaction
Can increase the action of anticoagulants
Contraindicated in pregnant patients
FLUOROQUINOLONES:
Quinolones are a family of synthetic broad
spectrum antibiotics.
acid.
Generations:
Quinolones are divided into generations based
on their anti-bacterial spectrum.
1st generation
Cinoxacine
Nalidixic acid
Oxolinic acid
Rosoxacin
Pipemidic acid
Piromidic acid
2nd generation
ciprofloxacin
ofloxacin
norfloxacin
lomefloxacin
nadifloxacin
3rd generation:
(active against streptococci)
Levofloxacin
Sparfloxacin
Balofloxacin
Gatifloxacin
Grepafloxacin
Moxifloxacin
4th generation:
Plurifloxacin
Gemifloxacin
Clinafloxacin
Trade names:
Ciplox, Cifran 250, 500 or 750mg tabs.; 200mg/100ml
i.v.
Norflox 200, 400, 800mg tabs
REFERENCES
1. Pharmacology and pharmacotherapeutics by