SEMINAR

ON
ANTIBIOTICS
PRESENTED
BY
Dr. AMIT BYATNAL
(POST GRADUATE STUDENT)
DEPT. OF ORAL MEDICINE AND RADEIOLOGY,
SIBAR INSTITUTE OF DENTAL SCIENCES,
TAKKELLAPADU, GUNTUR.
CERTIFICATE
This is to certify that the Seminar entitled, ANTIBIOTICS being
submitted by Dr Amit Byatnal, under the guidance and su!er"ision and com!leted
to our full satisfaction
SIGNATURE OF HEAD OF THE DEPARTMENT
CONTENTS CONTENTS
Introduction Introduction
#istory of Antibiotics #istory of Antibiotics
Classification of antimicrobial drugs Classification of antimicrobial drugs
$roblems %ith A&A $roblems %ith A&A
Choice of A&A Choice of A&A
$rinci!les of administration $rinci!les of administration
Indications for antimicrobial agents used in dentistry Indications for antimicrobial agents used in dentistry
Beta lactam antibiotics Beta lactam antibiotics
'uinolones 'uinolones
Tetracyclines Tetracyclines
&acrolides &acrolides
Nitroimida(oles Nitroimida(oles
Antifungal drugs Antifungal drugs
Conclusion Conclusion
)eferences )eferences
INTRODUCTION INTRODUCTION
Antimicr!i"# "$%nt& Antimicr!i"# "$%nt&* Substances that %ill su!!ress the gro%th+ * Substances that %ill su!!ress the gro%th+
multi!lication of bacteria and !re"ent their action multi!lication of bacteria and !re"ent their action
Anti!itic "$%nt& Anti!itic "$%nt&* Chemical substances !roduced by microorganisms that * Chemical substances !roduced by microorganisms that
ha"e the ca!acity, in dilute solutions, to !roduce antimicrobial action ha"e the ca!acity, in dilute solutions, to !roduce antimicrobial action
HISTORYOF ANTIBIOTICS HISTORYOF ANTIBIOTICS
'()) L*i& P"&t%*r In+i!itin , &m% micr!%& !- t+%r&. "nt+r"/ '()) L*i& P"&t%*r In+i!itin , &m% micr!%& !- t+%r&. "nt+r"/
( (Bacillus anthracis) Bacillus anthracis)
'01( G%#m S-nt+%&i2%3 &*#,"ni#"mi3% ('&t &*#,n"mi3% '01( G%#m S-nt+%&i2%3 &*#,"ni#"mi3% ('&t &*#,n"mi3%
'04( F#%min$5 '04( F#%min$5
Penicillin notatum Penicillin notatum in+i!it& $r6t+ in+i!it& $r6t+
7PENICILLINS8 7PENICILLINS8
'09' C+"in n F#r%- '09' C+"in n F#r%-
Di&c:%r%3 ;r;%rti%& , ;%nici##in Di&c:%r%3 ;r;%rti%& , ;%nici##in
'0<4 Dm"$= Prnt&i# '0<4 Dm"$= Prnt&i#
T+%r";%*tic :"#*% &*#,n"mi3%& T+%r";%*tic :"#*% &*#,n"mi3%&
'09<, S%#m"n >"=&m"n i&#"t%3, '09<, S%#m"n >"=&m"n i&#"t%3, Streptomyces griseus Streptomyces griseus 5Str%;tm-cin 5Str%;tm-cin
C#"&&i,ic"tin C#"&&i,ic"tin
C+%mic"# &tr*ct*r%? C+%mic"# &tr*ct*r%?
Sulfonamides and related drugs Sulfonamides and related drugs
Sulfadia(ine and others Sulfadia(ine and others
Sulfones , Da!sone -DDS., $araaminosalicylic acid -$AS. Sulfones , Da!sone -DDS., $araaminosalicylic acid -$AS.
Diamino!yrimidines Diamino!yrimidines
Trimetho!rim Trimetho!rim
$yrimethamine $yrimethamine
'uinolones 'uinolones
Nalidi/ic acid Nalidi/ic acid
Norflo/acin Norflo/acin
Ci!roflo/acin etc Ci!roflo/acin etc
0lactam antibiotics 0lactam antibiotics
$enicillins $enicillins
Ce!halos!orins Ce!halos!orins
&onobactams &onobactams
Carba!enems Carba!enems
Tetracyclines Tetracyclines
O/ytetracycline O/ytetracycline
Do/ycycline etc Do/ycycline etc
Nitroben(ene deri"ati"e Nitroben(ene deri"ati"e
Chloram!henicol Chloram!henicol
Aminoglycosides Aminoglycosides
Stre!tomycin Stre!tomycin
1entamicin 1entamicin
Neomycin etc Neomycin etc
&acrolide antibiotics &acrolide antibiotics
2rythromycin 2rythromycin
)o/ithromycin )o/ithromycin
A(ithromycin etc A(ithromycin etc
$oly!e!tide antibiotics $oly!e!tide antibiotics
$olymy/in0B $olymy/in0B
Colistin Colistin
Bacitracin Bacitracin
Tyrothricin Tyrothricin
1lyco!e!tides 1lyco!e!tides
3ancomycin 3ancomycin
Teico!lanin Teico!lanin
O/a(olidinone O/a(olidinone
4ine(olid 4ine(olid
Nitrofuran deri"ati"es Nitrofuran deri"ati"es
Nitrofurantoin Nitrofurantoin
5ura(olidone 5ura(olidone
Nitroimido(oles Nitroimido(oles
&etronido(ole &etronido(ole
Tinida(ole Tinida(ole
Nicotinic acid deri"ati"es Nicotinic acid deri"ati"es
Isonia(id Isonia(id
$yra(inamide $yra(inamide
2thionamide 2thionamide
$olyene antibiotics $olyene antibiotics
Nystatin Nystatin
Am!hotericin0B Am!hotericin0B
#amycin #amycin
A(ole deri"ati"es A(ole deri"ati"es
&icona(ole &icona(ole
Clotrima(ole Clotrima(ole
6etocona(ole 6etocona(ole
5lucona(ole 5lucona(ole
Others Others
)ifam!in )ifam!in
4incomycin 4incomycin
Clindamycin Clindamycin
S!ectinomycin S!ectinomycin
Sod fusidate Sod fusidate
Cycloserine Cycloserine
3iomycin 3iomycin
2thambutol 2thambutol
Thiaceta(one Thiaceta(one
Clofa(imine Clofa(imine
1riseoful"in 1riseoful"in
Ty!e of organisms against %hich !rimarily acti"e Ty!e of organisms against %hich !rimarily acti"e
Antibacterial Antibacterial
$enicillins $enicillins
Aminoglycosides Aminoglycosides
2rythromycin etc 2rythromycin etc
Antifungal Antifungal
1riseoful"in 1riseoful"in
Am!hotericin B Am!hotericin B
6etocona(ole 6etocona(ole
Anti"iral Anti"iral
Ido/uridine Ido/uridine
Acyclo"ir Acyclo"ir
Amantadine Amantadine
7ido"udine etc 7ido"udine etc
Anti!roto(oal Anti!roto(oal
Chloro8uine Chloro8uine
$yrimethamine $yrimethamine
&etronida(ole &etronida(ole
Dilo/anide etc Dilo/anide etc
Anthelmintic Anthelmintic
&ebenda(ole &ebenda(ole
$yrantel $yrantel
Niclosamide Niclosamide
Diethyl carbama(ine etc Diethyl carbama(ine etc
Bactericidal Bactericidal
Aminoglycosides Aminoglycosides
Bacitracin Bacitracin
Ce!halos!orins Ce!halos!orins
&etronidia(ole &etronidia(ole
3ancomycin 3ancomycin
$enicillins $enicillins
Ci!roflo/acin Ci!roflo/acin
Stre!tomycin Stre!tomycin
Cotrimo/a(ole Cotrimo/a(ole
Bacteriostatic Bacteriostatic
Chloram!henicol Chloram!henicol
Clindamycin Clindamycin
2rythromycin 2rythromycin
Sulfonamides Sulfonamides
Tetracycline Tetracycline
Trimetho!rim Trimetho!rim
S;%ctr*m , "cti:it- S;%ctr*m , "cti:it-
Narro% s!ectrum Narro% s!ectrum
Broad s!ectrum Broad s!ectrum
M%c+"ni&m , "ctin M%c+"ni&m , "ctin
$roblems %ith use of A&A $roblems %ith use of A&A
To/icity To/icity
4ocal irritancy* 4ocal irritancy*
0Systemic to/icity* 0Systemic to/icity*
0Thera!eutic inde/0 high, lo%, "ery lo% 0Thera!eutic inde/0 high, lo%, "ery lo%
#y!ersensiti"ity reactions * #y!ersensiti"ity reactions *
Drug resistance Drug resistance
0 0 Natural0 lac9 of metabolic !rocess or target site Natural0 lac9 of metabolic !rocess or target site
0 0 Ac8uired , due to use o"er a !eriod of time, mutations or gene Ac8uired , due to use o"er a !eriod of time, mutations or gene
transfer transfer
$re"enting )esistance to Drugs $re"enting )esistance to Drugs
4imit the use of antimicrobial agents to the treatment of s!ecific !athogens 4imit the use of antimicrobial agents to the treatment of s!ecific !athogens
sensiti"e to the drug being used sensiti"e to the drug being used
Notorious0&a9e sure doses are high enough, and the duration of drug Notorious0&a9e sure doses are high enough, and the duration of drug
thera!y long enough , combination thera!y thera!y long enough , combination thera!y
Be cautious about the indiscriminate, inade8uate or unduly !rolonged use of Be cautious about the indiscriminate, inade8uate or unduly !rolonged use of
anti0infecti"es anti0infecti"es
Su!erinfection Su!erinfection
Nutritional deficiencies Nutritional deficiencies
&as9ing of an infection &as9ing of an infection
Choice of A&A agent0 !atient factors Choice of A&A agent0 !atient factors
:Age * affect 9inetics of drug :Age * affect 9inetics of drug
Con;ugation and e/cretion of chlorem!henicol0 gray baby syndrome Con;ugation and e/cretion of chlorem!henicol0 gray baby syndrome
Sulfonamides dis!lace bilirubin from $BS0 9ernicterus Sulfonamides dis!lace bilirubin from $BS0 9ernicterus
Tetracycline accumulates in bone and teeth Tetracycline accumulates in bone and teeth
< )enal and he!atic failure* cautious use and dose reduction < )enal and he!atic failure* cautious use and dose reduction
= 4ocal factors* = 4ocal factors*
!resence of !us and secretions0 A&As, surgical drainage reduces causati"e !resence of !us and secretions0 A&As, surgical drainage reduces causati"e
bacteria and su!!resses anaerobic bacteria bacteria and su!!resses anaerobic bacteria
$resence of necrotic material and infection $resence of necrotic material and infection
#ematomas , foster gro%th #ematomas , foster gro%th
>Drug allergy >Drug allergy
?Im!aired host defense ?Im!aired host defense
@$regnancy @$regnancy
A1enetic factors A1enetic factors
Organism related considerations Organism related considerations
Drug factors Drug factors
S!ectrum of acti"ity S!ectrum of acti"ity
Ty!e of acti"ity Ty!e of acti"ity
Sensiti"ity of the organism Sensiti"ity of the organism
)elati"e to/icity )elati"e to/icity
$harmaco9inetic !rofile $harmaco9inetic !rofile
)oute of administation )oute of administation
2"idence of clinical efficacy 2"idence of clinical efficacy
Cost Cost
&icroorganisms isolated from !ul!al+!eria!ical infections &icroorganisms isolated from !ul!al+!eria!ical infections
Aerobic Aerobic
1ram B 1ram B
"e "e
cocci cocci
Sta!hylococci Sta!hylococci
1ram B 1ram B
"e "e
Baccili Baccili
4actobaccili 4actobaccili
Corynebacterium Corynebacterium
2i9enella corrodens 2i9enella corrodens
Anaerobic Anaerobic
1ram B 1ram B
"e "e
cocci cocci
$e!tostre!tococcus $e!tostre!tococcus
1ram , 1ram ,
"e "e
cocci cocci
3eillonella 3eillonella
1ram B 1ram B
"e "e
baccilli baccilli
Actinomyces Actinomyces
2ubacterium 2ubacterium
Clostridia Clostridia
$ro!ionibacterium $ro!ionibacterium
1ram 0 1ram 0
"e "e
baccilli baccilli
Bacteriodes Bacteriodes
5usobacteria 5usobacteria
$or!hyromonas $or!hyromonas
$re"otella $re"otella
Tre!onemas Tre!onemas
Tre!onema denticola Tre!onema denticola
Tre!onema macrodentium Tre!onema macrodentium
Tre!onema oralis Tre!onema oralis
Tre!onema "incenti Tre!onema "incenti
PRINCIPLES OF ANTIBIOTIC THERAPY PRINCIPLES OF ANTIBIOTIC THERAPY
$)INCI$42 :* TO D2T2)&IN2 T#2 S232)ITC O5 IN52CTION $)INCI$42 :* TO D2T2)&IN2 T#2 S232)ITC O5 IN52CTION
$)INCI$42 <* TO 23A4DAT2 STAT2 O5 $ATI2NTES #OST $)INCI$42 <* TO 23A4DAT2 STAT2 O5 $ATI2NTES #OST
D252NS2 &2C#ANIS&S D252NS2 &2C#ANIS&S
$)INCI$42 =* TO T)2AT IN52CTION SD)1ICA44C $)INCI$42 =* TO T)2AT IN52CTION SD)1ICA44C
$)INCI$42 >* TO SD$$O)T T#2 $ATI2NT &2DICA44C $)INCI$42 >* TO SD$$O)T T#2 $ATI2NT &2DICA44C
$)INCI$42 ?* C#OOS2 AND $)2SC)IB2 A$$)O$)IAT2 $)INCI$42 ?* C#OOS2 AND $)2SC)IB2 A$$)O$)IAT2
ANTIBIOTIC ANTIBIOTIC
$)INCI$42 @* $)O$2) ANTIBIOTIC AD&INIST)ATION $)INCI$42 @* $)O$2) ANTIBIOTIC AD&INIST)ATION
$)INCI$42S O5 ANTIBIOTIC AD&INIST)ATION $)INCI$42S O5 ANTIBIOTIC AD&INIST)ATION
$ro!er dose * $ro!er dose *
D)D1 DOSA12 D)D1 DOSA12
0 0 FDoseE is the a!!ro!riate amount of a drug needed to !roduce a FDoseE is the a!!ro!riate amount of a drug needed to !roduce a
certain degree of res!onse in a !atient certain degree of res!onse in a !atient
Body si(e * Body si(e *
0 0 Indi"idual dose G Indi"idual dose G BH-9g.+AI / a"erage adult dose BH-9g.+AI / a"erage adult dose
0 0 Indi"idual dose G Indi"idual dose G BSA-m< BSA-m< . +:A/ a"erage adult dose . +:A/ a"erage adult dose
N2ONAT2S AND IN5ANTS N2ONAT2S AND IN5ANTS
1reater !ercentage of body %eight com!ared %ith body %ater 1reater !ercentage of body %eight com!ared %ith body %ater
1reater "olume of distribution 1reater "olume of distribution
Increased serum half li"es Increased serum half li"es
)educed gastric em!tying )educed gastric em!tying
)educed !lasma !rotein binding )educed !lasma !rotein binding
)educed 15) )educed 15)
<. $ro!er time inter"al * <. $ro!er time inter"al *
=. $ro!er route of administration * =. $ro!er route of administration *
$arenteral administration %ill !roduce the necessary serum le"el of $arenteral administration %ill !roduce the necessary serum le"el of
antibiotics antibiotics
Oral route results in the most "ariable absor!tion Oral route results in the most "ariable absor!tion
5or ma/imum absor!tion is ta9en in fasting stage 5or ma/imum absor!tion is ta9en in fasting stage
>. Consistency in regard to route of administration * >. Consistency in regard to route of administration *
Hhen treating a serious, established infections, !arenteral antibiotic thera!y Hhen treating a serious, established infections, !arenteral antibiotic thera!y
is fre8uently the method of choice is fre8uently the method of choice
Combination antibiotic thera!y * Combination antibiotic thera!y *
The rationale for the use of < or more drugs together is to minimi(e The rationale for the use of < or more drugs together is to minimi(e
the emergence of antibiotic resistant microorganisms the emergence of antibiotic resistant microorganisms
to increase the certainty of a successful clinical outcome to increase the certainty of a successful clinical outcome
to treat mi/ed bacterial infections to treat mi/ed bacterial infections
to !re"ent su!erinfection to !re"ent su!erinfection
to treat se"ere infections of un9no%n etiology to treat se"ere infections of un9no%n etiology
to decrease to/icity %ithout decreasing efficacy to decrease to/icity %ithout decreasing efficacy
0 0 2/am!les * 2/am!les *
Isonia(id B ethambutol B stre!tomycin in treatment of tuberculosis Isonia(id B ethambutol B stre!tomycin in treatment of tuberculosis
)ules * )ules *
< bactericidal drugs !roduce, su!raadditi"e effects, not antagonism -:B:J<. < bactericidal drugs !roduce, su!raadditi"e effects, not antagonism -:B:J<.
The combination of a bacteriostatic and a bactericidal drug generally results The combination of a bacteriostatic and a bactericidal drug generally results
in diminished effects -:B:K<. in diminished effects -:B:K<.
< bacteriostatic drugs are ne"er inhibitory -:B:G<. < bacteriostatic drugs are ne"er inhibitory -:B:G<.
)esults * )esults *
Indifference %hen the effect is e8ual to the single most acti"e drug or e8ual Indifference %hen the effect is e8ual to the single most acti"e drug or e8ual
to the arithmetic sum of the t%o, use is not ;ustified to the arithmetic sum of the t%o, use is not ;ustified
Antagonism * %hen the combined drug effect is less than the algebraic sum Antagonism * %hen the combined drug effect is less than the algebraic sum
of the effects on the indi"idual drugs in the mi/ture of the effects on the indi"idual drugs in the mi/ture
Synergism * ability of t%o antibiotics acting together to mar9edly increases Synergism * ability of t%o antibiotics acting together to mar9edly increases
the rate of bactericidal action com!ared to either drug alone the rate of bactericidal action com!ared to either drug alone
Disad"antages * Disad"antages *
Adds nothing to thera!eutic efficacy and may e"en reduce it -antagonism. Adds nothing to thera!eutic efficacy and may e"en reduce it -antagonism.
Increase antibiotic to/icity and allergy Increase antibiotic to/icity and allergy
Increase the li9elihood of su!erinfection Increase the li9elihood of su!erinfection
Discourages s!ecific etiologic diagnosis and !romote false security Discourages s!ecific etiologic diagnosis and !romote false security
2ncourage inade8uate doses, !articularly %ith fi/ed dose combination 2ncourage inade8uate doses, !articularly %ith fi/ed dose combination
thera!y thera!y
Increased cost Increased cost
2mergence of resistant bacterial strains 2mergence of resistant bacterial strains
Increase the en"ironmental s!read of antibiotic resistant bacteria Increase the en"ironmental s!read of antibiotic resistant bacteria
5ACTO)S IN54D2NCIN1 ANTIBIOTIC T#2)A$C 5ACTO)S IN54D2NCIN1 ANTIBIOTIC T#2)A$C
&inimal Inhibitory Concentration &inimal Inhibitory Concentration
Concentration0de!endent 3s Time0de!endent antibiotics Concentration0de!endent 3s Time0de!endent antibiotics
$ost0antibiotic effects $ost0antibiotic effects
&INI&A4 IN#IBITO)C CONC2NT)ATION &INI&A4 IN#IBITO)C CONC2NT)ATION
Is the lo%est antibiotic concentration that !re"ents gro%th of microorganism Is the lo%est antibiotic concentration that !re"ents gro%th of microorganism
after an incubation !eriod of :L , <> hours %ith a standard inoculum of :I> after an incubation !eriod of :L , <> hours %ith a standard inoculum of :I>
to :I? cu+ml to :I? cu+ml
&INI&A4 BACT2)ICIDA4 CONC2NT)ATION &INI&A4 BACT2)ICIDA4 CONC2NT)ATION
Is the lo%est concentration of drug that causes the com!lete destruction of Is the lo%est concentration of drug that causes the com!lete destruction of
the organisms or !ermits sur"i"al of less than I:M of the inoculum the organisms or !ermits sur"i"al of less than I:M of the inoculum
)D42 O5 T#D&B )D42 O5 T#D&B
The concentration of the antibiotic in the blood should e/ceed the &IC by a The concentration of the antibiotic in the blood should e/ceed the &IC by a
factor of <0L times to offset the tissue barriers that restrict access to the factor of <0L times to offset the tissue barriers that restrict access to the
infected site infected site
CONC2NT)ATION D2$2ND2NT CONC2NT)ATION D2$2ND2NT
3s 3s
TI&2 D2$2ND2NT ANTIBIOTICS TI&2 D2$2ND2NT ANTIBIOTICS
Aminoglycosides, metronida(ole, fluoro8uinolones Aminoglycosides, metronida(ole, fluoro8uinolones
Concentration de!endent Concentration de!endent
Bactericidal acti"ity de!ends on the Bactericidal acti"ity de!ends on the
drug concentration drug concentration
Beta0lactams and "ancomycin Beta0lactams and "ancomycin
4ong time of e/!osure of the 4ong time of e/!osure of the
organisms organisms
Better the bactericidal acti"ity Better the bactericidal acti"ity
$OSTANTIBIOTIC 2552CTS $OSTANTIBIOTIC 2552CTS
Is the !ersistent su!ression of microbial gro%th after short time e/!osure to Is the !ersistent su!ression of microbial gro%th after short time e/!osure to
an antimicrobial agent an antimicrobial agent
&2C#ANIS& * &2C#ANIS& *
Is the time necessary to reco"er from sublethal structural and Is the time necessary to reco"er from sublethal structural and
metabolic alterations that !re"ents resum!tion of bacterial metabolic alterations that !re"ents resum!tion of bacterial
regro%th regro%th
Indications for antimicrobial agents in dentistry Indications for antimicrobial agents in dentistry
Thera!eutic indications Thera!eutic indications
$ro!hylactic indications $ro!hylactic indications
Dental !rocedure for %hich antibiotic !ro!hyla/is is recommended to Dental !rocedure for %hich antibiotic !ro!hyla/is is recommended to
!re"ent infecti"e endocardititis !re"ent infecti"e endocardititis
-A#A recommendation. -A#A recommendation.
Dental e/tractions Dental e/tractions
$eriodontal !rocedures $eriodontal !rocedures
)e!lantation !rocedure )e!lantation !rocedure
Im!lant !lacement Im!lant !lacement
Initial !lacement of orthodontic bands Initial !lacement of orthodontic bands
Intra ligamentary local anesthetic in;ection Intra ligamentary local anesthetic in;ection
Incision and drainage Incision and drainage
Not recommended * Not recommended *
:)estorati"e dentistry :)estorati"e dentistry
<4A in;ections <4A in;ections
=Intracanal endodontic treatment =Intracanal endodontic treatment
>$ost0o! suture remo"al >$ost0o! suture remo"al
?Oral radiogra!hs ?Oral radiogra!hs
C4ASSI5ICATION O5 $2NICI44IN C4ASSI5ICATION O5 $2NICI44IN
Natural !enicillins * Natural !enicillins *
$enicillin 1 -Ben(yl !enicillin. $enicillin 1 -Ben(yl !enicillin.
Acid resistant !enicillins * Acid resistant !enicillins *
$heno/ymethyl !enicillin -!enicillin 3. $heno/ymethyl !enicillin -!enicillin 3.
$enicillinase , resistant !enicillins * $enicillinase , resistant !enicillins *
Acid labile * &ethicillin, naficillin, clo/acillin, diclo/acillin Acid labile * &ethicillin, naficillin, clo/acillin, diclo/acillin
2/tended s!ectrum !enicillins * 2/tended s!ectrum !enicillins *
Carbo/y!enicillins * Carbenicillin, ticarcillin Carbo/y!enicillins * Carbenicillin, ticarcillin
Amino!enicillins * Am!icillin, amo/icillin Amino!enicillins * Am!icillin, amo/icillin
Dreido!enicillins Dreido!enicillins
B2N7C4 $2NICI44IN -$2NCI44IN 1. B2N7C4 $2NICI44IN -$2NCI44IN 1.
Antibacterial acti"ity Antibacterial acti"ity
Inhibits the gro%th of susce!tible organism Inhibits the gro%th of susce!tible organism
&ainly gram B"e, gram ,"e cocci and some gram B"e bacilli %ith e/ce!tion &ainly gram B"e, gram ,"e cocci and some gram B"e bacilli %ith e/ce!tion
of enterococci of enterococci
Cocci , #ighly sensiti"e , Stre!tococci, $neumococci, Sta!h aureus, N Cocci , #ighly sensiti"e , Stre!tococci, $neumococci, Sta!h aureus, N
gonorrhoeae, N meningitis gonorrhoeae, N meningitis
Bacilli , B anthracis, Corynebacterium di!htheriae, clostridium tetany and Bacilli , B anthracis, Corynebacterium di!htheriae, clostridium tetany and
s!irochetes s!irochetes
Actinomyces israelii is moderately sensiti"e Actinomyces israelii is moderately sensiti"e
$re!aration and dose * $re!aration and dose *
$n1 in; I?0? &D im or i" @0:< hours $n1 in; I?0? &D im or i" @0:< hours
$rocaine !encillin in; I?, : &D dry !o%der in "ial $rocaine !encillin in; I?, : &D dry !o%der in "ial
AD32)S2 )2ACTIONS * AD32)S2 )2ACTIONS *
&iscellaneous reactions * &iscellaneous reactions *
Nausea and "omiting on oral $n1 Nausea and "omiting on oral $n1
Sterile inflammatory reaction at the site of I& in; Sterile inflammatory reaction at the site of I& in;
$rolonged I3 administration may cause thrombo!hlebitis $rolonged I3 administration may cause thrombo!hlebitis
Accidental I3 administration of !rocaine $$ cause an/iety, mental Accidental I3 administration of !rocaine $$ cause an/iety, mental
disturbances !araesthesia and con"ulsions disturbances !araesthesia and con"ulsions
Intolerance * Intolerance *
&a;or !roblem %ith $n1 includes idiosyncratic, ana!hylactic and allergic &a;or !roblem %ith $n1 includes idiosyncratic, ana!hylactic and allergic
reactions reactions
Other allergic reactions are Other allergic reactions are
S9in rashes S9in rashes
Serum sic9ness Serum sic9ness
)enal disturbance )enal disturbance
#emolytic disturbance #emolytic disturbance
Ana!hyla/is Ana!hyla/is
Narisch her/heimer reaction Narisch her/heimer reaction
Su!er infection Su!er infection
#y!er9alemia #y!er9alemia
Dses * Dses *
$n1 is the drug of choice for infections $n1 is the drug of choice for infections
Stre!tococcal infections Stre!tococcal infections
$neumococcal infections $neumococcal infections
&eningococcal infections &eningococcal infections
1onorrhoea 1onorrhoea
Sy!hilis Sy!hilis
Di!htheria Di!htheria
Tetanus and gas gangrene Tetanus and gas gangrene
$ro!hylactic uses $ro!hylactic uses
The ma;or dra%bac9s of ben(yl !enicillin are The ma;or dra%bac9s of ben(yl !enicillin are
Inacti"ation by the gastric hydrochloric acid Inacti"ation by the gastric hydrochloric acid
Short duration of action Short duration of action
$oor !enetration into CS5 $oor !enetration into CS5
Acti"ity mainly against gram B"e organism Acti"ity mainly against gram B"e organism
$ossibility of ana!hyla/is $ossibility of ana!hyla/is
Aci3 r%&i&t"nt ;%nci##in& ? Aci3 r%&i&t"nt ;%nci##in& ?
: $otassium !heno/ymethyl !enicillin -!enicillin 3. : $otassium !heno/ymethyl !enicillin -!enicillin 3.
Dose * infants @I mg, children :<?0<?I mg gi"en @ hourly Dose * infants @I mg, children :<?0<?I mg gi"en @ hourly
C)CSTA$2N03, 6AC$2N, $2NI3O)A4 @?, :=I, :<?, <?I mg tablets C)CSTA$2N03, 6AC$2N, $2NI3O)A4 @?, :=I, :<?, <?I mg tablets
:<? mg+? ml dry ser :<? mg+? ml dry ser
II. $encillinase resistant !encillins * II. $encillinase resistant !encillins *
&ethicillin &ethicillin
2ffecti"e in sta!hylococci 2ffecti"e in sta!hylococci
It is gi"en I& or I3 -slo%. in the dose of : gm e"ery >0@ hours It is gi"en I& or I3 -slo%. in the dose of : gm e"ery >0@ hours
#aematuria, albuminuria and re"ersible interstitial ne!hritis are the s!ecial #aematuria, albuminuria and re"ersible interstitial ne!hritis are the s!ecial
ad"erse effect of methicillin ad"erse effect of methicillin
Clo/acillin Clo/acillin
Hea9er antibacterial acti"ity Hea9er antibacterial acti"ity
Distrubuted throught out the body, but highest concentration in 9idney and Distrubuted throught out the body, but highest concentration in 9idney and
li"er =IM e/creted in urine li"er =IM e/creted in urine
Oral dose for adults <0> gm di"ided into > !ortions children ?I0 Oral dose for adults <0> gm di"ided into > !ortions children ?I0
:IImg+9g+day :IImg+9g+day
I& adults <0:< gm+day, children :II0=II mg+9g+day e"ery >0@ hours I& adults <0:< gm+day, children :II0=II mg+9g+day e"ery >0@ hours
BIOC4OO, 64OO, C4OCI4IN I<?, I? gm ca!, I? gm+"ial BIOC4OO, 64OO, C4OCI4IN I<?, I? gm ca!, I? gm+"ial
III. 2/tended s!ectrum !encillins * III. 2/tended s!ectrum !encillins *
Amino !encillins Amino !encillins
0 0 Am!icillin , Am!icillin ,
Antibacterial acti"ity is similar to that of $n1 that is more effecti"e than Antibacterial acti"ity is similar to that of $n1 that is more effecti"e than
$n1 against a "ariety of gram0"e bacteria $n1 against a "ariety of gram0"e bacteria
Drug is effecti"e against #influen(ae stre!"iridans, Ngonorrhea, Drug is effecti"e against #influen(ae stre!"iridans, Ngonorrhea,
Salmonella, shigellae, 6lebsilla and enterococci Salmonella, shigellae, 6lebsilla and enterococci
0 0 Absor!tion, fate and e/cretion * Absor!tion, fate and e/cretion *
Oral absor!tion is incom!lete but ade8uate Oral absor!tion is incom!lete but ade8uate
5ood interferes %ith absor!tion 5ood interferes %ith absor!tion
$artly e/creted in bile and !artly by 9idney $artly e/creted in bile and !artly by 9idney
Dose * I?0< gm oral+I& or I3 de!ending on se"erity of infection e"ery @ Dose * I?0< gm oral+I& or I3 de!ending on se"erity of infection e"ery @
hours hours
0 0 Children * <?0?I mg+9g+day Children * <?0?I mg+9g+day
0 0 A&$I4IN, )OSCI44IAN, BIOCI4IN , <?I, ?II mg ca! :IImg+ml A&$I4IN, )OSCI44IAN, BIOCI4IN , <?I, ?II mg ca! :IImg+ml
!ed dro!s, <?I mg+ml dry syr, : gm+"ial in; !ed dro!s, <?I mg+ml dry syr, : gm+"ial in;
DS2S * DS2S *
Drinary tract infections Drinary tract infections
)es!iratory tract infections )es!iratory tract infections
&eningitis &eningitis
1onorrhoea 1onorrhoea
Bacillary dysentry Bacillary dysentry
Se!ticaemias Se!ticaemias
SAB2 SAB2
Ad"erse effects * Ad"erse effects *
Diarrhoea is fre8uent Diarrhoea is fre8uent
S9in rashes is more common S9in rashes is more common
Dnabsorbed drug irritates lo%er intestines Dnabsorbed drug irritates lo%er intestines
$atient %ith history of hy!ersensiti"ity to $n1 should not be gi"en $atient %ith history of hy!ersensiti"ity to $n1 should not be gi"en
am!icillin am!icillin
A&OOICI44IN * A&OOICI44IN *
This is a semisynthetic !enicillin This is a semisynthetic !enicillin
-amino0!0hydro/y0ben(yl!enicillin. -amino0!0hydro/y0ben(yl!enicillin.
Antibacterial s!ectrum is similar to am!icillin Antibacterial s!ectrum is similar to am!icillin
Oral absor!tion is betterP food does not interfereP higher and more sustained Oral absor!tion is betterP food does not interfereP higher and more sustained
blood le"els are !roduced blood le"els are !roduced
It is less !rotein bond and urinary e/cretion is higher than that of am!icillin It is less !rotein bond and urinary e/cretion is higher than that of am!icillin
Incidence of diarrhoea is less Incidence of diarrhoea is less
Dose * I<?0: g TDS oralP Dose * I<?0: g TDS oralP
A&OOC4IN, NO3A&OO, SCNA&OO, &OO, A&OOI4 <?I, ?II mg A&OOC4IN, NO3A&OO, SCNA&OO, &OO, A&OOI4 <?I, ?II mg
ca!, :<? mg+?ml dry syr, ?II mg+"ial in; ca!, :<? mg+?ml dry syr, ?II mg+"ial in;
DS2S * DS2S *
Oro0dental infections Oro0dental infections
D!!er )TI D!!er )TI
Bronchitis Bronchitis
Drinary infection Drinary infection
SB2 SB2
1onorrhoea 1onorrhoea
B2TA 4ACTA&AS2 IN#IBITO)S B2TA 4ACTA&AS2 IN#IBITO)S
C4A3D4ANIC ACID C4A3D4ANIC ACID
Obtained from ST)2$TO&CC2S C4A3D4I12)DS Obtained from ST)2$TO&CC2S C4A3D4I12)DS
Betalactam ring , no antibacterial acti"ity Betalactam ring , no antibacterial acti"ity
Suicide inhibitor ,inacti"ated after binding to en(yme Suicide inhibitor ,inacti"ated after binding to en(yme
$ermeates the outer layers of cell %all of gram0"e bacteria $ermeates the outer layers of cell %all of gram0"e bacteria
Ad"erse effects * Ad"erse effects *
$ain0thrombo!hebitis $ain0thrombo!hebitis
)ashes and diarrhoea )ashes and diarrhoea
Dses * Dses *
&i/ed aerobic0anaerobic infections &i/ed aerobic0anaerobic infections
Dental infections caused by beta lactamase !roducing bacteria Dental infections caused by beta lactamase !roducing bacteria
1onorrhoea 1onorrhoea
S9in+soft tissue infections S9in+soft tissue infections
SD4BACTA& SD4BACTA&
C2$#A4OS$O)INS C2$#A4OS$O)INS
Ce!halos!orium acremonium %as the first source Ce!halos!orium acremonium %as the first source
They contain A amino ce!halos!oronic acid nucleus They contain A amino ce!halos!oronic acid nucleus
Structurally they contain betalactam and dihydro thia(ine rings Structurally they contain betalactam and dihydro thia(ine rings
&echanism of action * &echanism of action *
Act by inhibiting bacterial cell %as synthesis and are bactericidal Act by inhibiting bacterial cell %as synthesis and are bactericidal
Classification Classification
Classified according to its antibacterial acti"ity Classified according to its antibacterial acti"ity
5irst generation ce!halos!orin 5irst generation ce!halos!orin
1ood acti"ity against gram B"e bacteria -e/ce!t enterococci. 1ood acti"ity against gram B"e bacteria -e/ce!t enterococci.
&ost oral ca"ity anaerobes are sensiti"e &ost oral ca"ity anaerobes are sensiti"e
$arental $arental Oral Oral
C2$#A4OT#IN C2$#A4OT#IN C2$#A42OIN C2$#A42OIN
C25A7O4IN C25A7O4IN C2$#)ADIN2 C2$#)ADIN2
C25AD)OOI4 C25AD)OOI4
Ce!hala/in and Ce!hadro/il * Ce!hala/in and Ce!hadro/il *
Dseful in treating community ac8uired, res!iratory and urinary tract Dseful in treating community ac8uired, res!iratory and urinary tract
infections and in surgical !ro!hyla/is infections and in surgical !ro!hyla/is
Infections of head and nec9 region Infections of head and nec9 region
Dose* Oral I<? 0 :g @0L hrly Dose* Oral I<? 0 :g @0L hrly
Children * <?0:IImg+9g+day Children * <?0:IImg+9g+day
I& , I<?g L hrly -mild cases. :g @ hrly -se"ere cases. I& , I<?g L hrly -mild cases. :g @ hrly -se"ere cases.
Dro!s , ce!ha/in :<?mg+?ml syru! Dro!s , ce!ha/in :<?mg+?ml syru!
:IImg +ml !ed dro!s :IImg +ml !ed dro!s
S$O)ID2O, C2$#AOIN, C2$#ACI44IN, C25AD)OO, D)OOC4 S$O)ID2O, C2$#AOIN, C2$#ACI44IN, C25AD)OO, D)OOC4
Second generation ce!halos!orins * Second generation ce!halos!orins *
Increased acti"ity against gram ,"e organism Increased acti"ity against gram ,"e organism
&ore acti"e against anaerobes &ore acti"e against anaerobes
0 0 $arenteral $arenteral Oral Oral
C25D)OOI&2 C25D)OOI&2 C25AC4O) C25AC4O)
C25OOITIN C25OOITIN C25D)OOI&2 AO2TI4 C25D)OOI&2 AO2TI4
&ore acti"e against # influen(ae, 2 coli &ore acti"e against # influen(ae, 2 coli
Dose * <?Img, :<?mg, :<?mg+?ml syr and Dose * <?Img, :<?mg, :<?mg+?ml syr and
?I mg +ml !ed dro!s ?I mg +ml !ed dro!s
6254O), C25TD&, C25O12N, 5D)OOI4 6254O), C25TD&, C25O12N, 5D)OOI4
Third 1eneration Ce!halos!orins Third 1eneration Ce!halos!orins
#igh acti"ity against gram ,"e entrobacteriaceae, some inhibit #igh acti"ity against gram ,"e entrobacteriaceae, some inhibit
$seudomonas as %ell $seudomonas as %ell
$arenteral Oral $arenteral Oral
Cefata/ime Cefi/ime Cefata/ime Cefi/ime
Cefti(o/ime Cef!odo/ime !ro/etil Cefti(o/ime Cef!odo/ime !ro/etil
Ceftria/one Cefdinir Ceftria/one Cefdinir
Cefta(idime Ceftibuten Cefta(idime Ceftibuten
Cefo!era(one Cefo!era(one
Dose* <?Img, ?IImg, :IIImg !er "ial in; Dose* <?Img, ?IImg, :IIImg !er "ial in;
C4A5O)AN, C25I7OO,&ONOC25,C25A7ID C4A5O)AN, C25I7OO,&ONOC25,C25A7ID
5ourth 1eneration Ce!halos!orins 5ourth 1eneration Ce!halos!orins
Similar to = Similar to =
rd rd
generation ,but is highly resistant to beta0 lactamases generation ,but is highly resistant to beta0 lactamases
Due to high !otency and e/tended s!ectrum, it is effecti"e in many serious Due to high !otency and e/tended s!ectrum, it is effecti"e in many serious
infections li9e hos!ital ac8uired !neumonia, bacteremia, se!ticaemia infections li9e hos!ital ac8uired !neumonia, bacteremia, se!ticaemia
$arentral $arentral
Cefe!ime Cefe!ime
Cef!irome Cef!irome
Dose* :0< g im+i" :<hrly Dose* :0< g im+i" :<hrly
C25)O&, C25)OT#, 625A12 C25)O&, C25)OT#, 625A12
Ad"erse reactions * Ad"erse reactions *
4ocal reactions , cause !ain -I&. and cause thrombo!hlebitis -I3. 4ocal reactions , cause !ain -I&. and cause thrombo!hlebitis -I3.
Allergy , s9in rashes Allergy , s9in rashes
Ne!hroto/icity Ne!hroto/icity
Bleeding disorders Bleeding disorders
Intolerance to alcohol Intolerance to alcohol
Dses * Dses *
Alternati"es to !enicillins Alternati"es to !enicillins
)TI, DTI and soft tissue infection )TI, DTI and soft tissue infection
$enicillinase !roducing sta!h infection $enicillinase !roducing sta!h infection
Se!ticaemias Se!ticaemias
Surgical !ro!hyla/is Surgical !ro!hyla/is
&eningitis, gonorrhoea &eningitis, gonorrhoea
Ty!hoid Ty!hoid
&i/ed aerobic and anaerobic infections &i/ed aerobic and anaerobic infections
Infection by odd organism or hos!ital infections Infection by odd organism or hos!ital infections
$ro!hylactic treatment in neutro!enic !atients $ro!hylactic treatment in neutro!enic !atients
Dental infections Dental infections
Alternati"e to !encillins0 hy!ersensiti"ity and resistance Alternati"e to !encillins0 hy!ersensiti"ity and resistance
Oral , : Oral , :
st st
and < and <
nd nd
generation generation
Sulfonamides Sulfonamides
Short acting->0Lhr.0 Sulfadia(ine Short acting->0Lhr.0 Sulfadia(ine
Intermediate acting -L0:<hr.0 Sulfametho/a(ole, Intermediate acting -L0:<hr.0 Sulfametho/a(ole,
Sulfamo/ole Sulfamo/ole
4ong acting-A days.0 Sulfado/ine, Sulfametho!yra(ine 4ong acting-A days.0 Sulfado/ine, Sulfametho!yra(ine
S!ecial !ur!ose Sulfonamides , Sulfacetamide sod, S!ecial !ur!ose Sulfonamides , Sulfacetamide sod,
Sulfasala(ine, Sulfasala(ine,
&afenide, &afenide,
Sil"er sulfadia(ine Sil"er sulfadia(ine
&echanism of action &echanism of action
In In bacteria bacteria, antibacterial sulfonamides act as , antibacterial sulfonamides act as com!etiti"e inhibitors com!etiti"e inhibitors of the of the
en(yme en(yme dihydro!teroate synthetase dihydro!teroate synthetase, D#$S D#$S catalyses the con"ersion , D#$S D#$S catalyses the con"ersion
of $ABA - of $ABA -para para 0aminoben(oate 0aminoben(oate . to . to dihydro!teroate dihydro!teroate, a 9ey ste! in , a 9ey ste! in folate folate
synthesis 5olate is necessary for the cell to synthesi(e synthesis 5olate is necessary for the cell to synthesi(e nucleic acids nucleic acids -nucleic -nucleic
acids are essential building bloc9s of acids are essential building bloc9s of DNA DNA and and )NA )NA., and in its absence ., and in its absence
cells %ill be unable to di"ide #ence the sulfonamide antibacterials e/hibit a cells %ill be unable to di"ide #ence the sulfonamide antibacterials e/hibit a
bacteriostatic bacteriostatic rather than rather than bactericidal bactericidal effect effect
Si3% %,,%ct& Si3% %,,%ct&
Sulfonamides ha"e the !otential to cause a "ariety of unto%ard reactions, Sulfonamides ha"e the !otential to cause a "ariety of unto%ard reactions,
including urinary tract disorders, haemo!oietic disorders, including urinary tract disorders, haemo!oietic disorders, !or!hyria !or!hyria and and
hy!ersensiti"ity reactions Hhen used in large dose, it may de"elo! a strong hy!ersensiti"ity reactions Hhen used in large dose, it may de"elo! a strong
allergic reaction One of the most serious is allergic reaction One of the most serious is Ste"ens Nohnson syndrome Ste"ens Nohnson syndrome-or -or
to/ic e!idermal necrolysis. to/ic e!idermal necrolysis.
@UINOLONES @UINOLONES
2ntirely synthetic antimicrobials are acti"e !rimarily against gram ,"e 2ntirely synthetic antimicrobials are acti"e !rimarily against gram ,"e
bacteria bacteria
Nalidi/ic acid0 lo% !otency, modest blood and tissue le"els, limited Nalidi/ic acid0 lo% !otency, modest blood and tissue le"els, limited
s!ectrum, high resistance s!ectrum, high resistance
5luoro8uinolones , high !otency, e/!anded s!ectrum, better tissue 5luoro8uinolones , high !otency, e/!anded s!ectrum, better tissue
!enetrance, slo% resistance !enetrance, slo% resistance
CI$)O54OOACIN CI$)O54OOACIN
5irst generation 5' acti"e against a broad range of bacteria es!ecially 5irst generation 5' acti"e against a broad range of bacteria es!ecially
gram ,"e aerobic bacilli gram ,"e aerobic bacilli
&icrobiological features * &icrobiological features *
)a!id bactericidal acti"ity and high !otency )a!id bactericidal acti"ity and high !otency
)elati"ely long !ost antibiotic effect )elati"ely long !ost antibiotic effect
4o% fre8uency of mutational resistance 4o% fre8uency of mutational resistance
$rotecti"e intestinal stre!tococci and anaerobes are s!ared $rotecti"e intestinal stre!tococci and anaerobes are s!ared
4ess acti"e at acidic !# 4ess acti"e at acidic !#
Ad"erse effect * Ad"erse effect *
1IT , Nausea, "omiting, bad taste, anore/ia, diarrhoea is infre8uent 1IT , Nausea, "omiting, bad taste, anore/ia, diarrhoea is infre8uent
CNS0 Di((iness, headache, restlessness, an/iety, insomnia and sei(ures are CNS0 Di((iness, headache, restlessness, an/iety, insomnia and sei(ures are
rare rare
S9in+hy!ersensiti"ity , rashes, !ruritis, urticaria S9in+hy!ersensiti"ity , rashes, !ruritis, urticaria
Tendonitis and tendon ru!ture Tendonitis and tendon ru!ture
Dses * Dses *
Broad range of infections Broad range of infections
&inor cases, orodental 0not indicated &inor cases, orodental 0not indicated
DTI DTI
Bacterial gastroenteritis Bacterial gastroenteritis
$ro!hyla/is 0Ty!hoid $ro!hyla/is 0Ty!hoid
Bone, soft tissue, %ound infection Bone, soft tissue, %ound infection
Combinations0 gram ,"e se!ticaemias Combinations0 gram ,"e se!ticaemias
Tuberculosis Tuberculosis
CI5)AN, CI$4OO, CI$)OBID, CI$)O42T CI5)AN, CI$4OO, CI$)OBID, CI$)O42T
<?I, ?II,A?I mg tab, <IImg+:II ml I3 infusion =mg+ml eye dro!s <?I, ?II,A?I mg tab, <IImg+:II ml I3 infusion =mg+ml eye dro!s
Norflo/acin Norflo/acin
0 0 4ess !otent than Ci!roflo/acin 4ess !otent than Ci!roflo/acin
0 0 Dsed for $seudomonas, Drinary and genital tract infections Dsed for $seudomonas, Drinary and genital tract infections
NO)54OO 0<II,>IImg NO)54OO 0<II,>IImg
Oflo/acin Oflo/acin
0 0 Acti"ity against gram ,"e bacteria Acti"ity against gram ,"e bacteria
0 0 Chlamydia and &yco!lasma Chlamydia and &yco!lasma
0 0 Alternati"e drug for Tuberculosis Alternati"e drug for Tuberculosis
0 0 Dsed mainly for 1onorrhea Dsed mainly for 1onorrhea
7ANOCIN 0<II,>IImg 7ANOCIN 0<II,>IImg
4e"oflo/acin 4e"oflo/acin
0 0 Sinusitis, $ylone!hritis, soft tissue infections Sinusitis, $ylone!hritis, soft tissue infections
4O&250 >IImg 4O&250 >IImg
1atiflo/acin 1atiflo/acin
0 0 2/cellent acti"ity against Stre!tococci !neumoniae 2/cellent acti"ity against Stre!tococci !neumoniae
0 0 Indicated in community ac8uired !neumonia, e/acerbation of chronic Indicated in community ac8uired !neumonia, e/acerbation of chronic
bronchitis, and other res!iratory tract infections bronchitis, and other res!iratory tract infections
0 0 Dsed in urinary tract infectons and gonorrhhoea Dsed in urinary tract infectons and gonorrhhoea
1ATI'IN , <II,>II mg tab 1ATI'IN , <II,>II mg tab
S!arflo/acin S!arflo/acin
02nhanced acti"ity against gram ,"e bacteria, Bacteroides 02nhanced acti"ity against gram ,"e bacteria, Bacteroides
fragilis, anaerobes and mycobacteria fragilis, anaerobes and mycobacteria
0 0 Indicated in $neumonias, chronic bronchitis, sinusitis and other 2NT Indicated in $neumonias, chronic bronchitis, sinusitis and other 2NT
infections infections
0 0 1ood efficacy in &ycobacterium a"ium infection in AIDS !atients 1ood efficacy in &ycobacterium a"ium infection in AIDS !atients
and 4e!rosy and 4e!rosy
0 0 #igher incidence of !hototo/ic reactions #igher incidence of !hototo/ic reactions
S$A)TA, S$A)DAC 0:II,<II mg tab S$A)TA, S$A)DAC 0:II,<II mg tab
NIT)OI&IDA7O42S NIT)OI&IDA7O42S
&2T)ONIDA7O42 * &2T)ONIDA7O42 *
Introduced in :Q?Q Introduced in :Q?Q
Broad s!ectrum0 ehistolytica, giardia lamblia Broad s!ectrum0 ehistolytica, giardia lamblia
Anaerobic infections0 chance disco"ery Anaerobic infections0 chance disco"ery
Tinida(ole, secnida(ole, ornida(ole, satranida(ole Tinida(ole, secnida(ole, ornida(ole, satranida(ole
Cidal acti"ity against !roto(oa and anaerobic bacteria such as B fragilis, Cidal acti"ity against !roto(oa and anaerobic bacteria such as B fragilis,
5usobacterium, h!yroli, s!irochetes 5usobacterium, h!yroli, s!irochetes
&etronida(ole is selecti"ely to/ic to anaerobic microorganisms &etronida(ole is selecti"ely to/ic to anaerobic microorganisms
$harmaco9inetics * $harmaco9inetics *
Com!letely absorbed from the small intestine Com!letely absorbed from the small intestine
Hidely distributed in the body Hidely distributed in the body
It is metaboli(ed in li"er It is metaboli(ed in li"er
2/creted in urine Lhr 2/creted in urine Lhr
Ad"erse effects * Ad"erse effects *
Anore/ia, nausea, metallic taste and abdominal cram!s Anore/ia, nausea, metallic taste and abdominal cram!s
4ooseness of stool is occasional, 4ooseness of stool is occasional,
#eadache, glossitis, dryness of mouth, di((iness, rashes and transient #eadache, glossitis, dryness of mouth, di((iness, rashes and transient
neutro!enia neutro!enia
$rolonged administration may cause !eri!heral neuro!athy and CNS effects $rolonged administration may cause !eri!heral neuro!athy and CNS effects
Thrombo!hlebitis Thrombo!hlebitis
Contraindications * Contraindications *
In neurological disease, blood dyscrasias, chronic alcoholism In neurological disease, blood dyscrasias, chronic alcoholism
5irst trimister of !regnancy 5irst trimister of !regnancy
Ornida(ole Ornida(ole
Acti"ity similar to &etronida(ole but it is slo%ly metabolised Acti"ity similar to &etronida(ole but it is slo%ly metabolised
Dsed in anaerobic infections, Amoebiasis, 1iardiasis, Trichomonasis, and Dsed in anaerobic infections, Amoebiasis, 1iardiasis, Trichomonasis, and
bacterial "aginosis bacterial "aginosis
DA7O4IC 0?IImg tab, ?IImg+:IIml "ial for i" infusion DA7O4IC 0?IImg tab, ?IImg+:IIml "ial for i" infusion
Dses0 Orodental infections Dses0 Orodental infections
&7 <II0>IImg TDS-:?0=Img+9g+day. , anaerobes not inhibited by &7 <II0>IImg TDS-:?0=Img+9g+day. , anaerobes not inhibited by
!encillin !encillin
AND10 &7BAmo/ 0 ?days AND10 &7BAmo/ 0 ?days
$eriodontitis, !ericoronitis, acute a!ical infections, endodontic infections0 ?0 $eriodontitis, !ericoronitis, acute a!ical infections, endodontic infections0 ?0
A days A days
Aerobic and facultati"e bacteria0 &7B!encillin+ce!halos!orin+macrolides Aerobic and facultati"e bacteria0 &7B!encillin+ce!halos!orin+macrolides
54A1C4, &2T)O1C4, &2T)ON, A4D27O42 <II, >II mg tab, <II 54A1C4, &2T)O1C4, &2T)ON, A4D27O42 <II, >II mg tab, <II
mg+?ml sus! mg+?ml sus!
TINIDA7O42 TINIDA7O42
It is an e8ually efficacious congener of metronida(ole It is an e8ually efficacious congener of metronida(ole
&etabolism is slo%er and duration of action is longer &etabolism is slo%er and duration of action is longer
Incidence of side effects is lo%er0&etallic taste, nausea, rashes Incidence of side effects is lo%er0&etallic taste, nausea, rashes
TINIBA, T)IDA7O42, =II, ?II, :III mg tab, LII mg+>II ml i" TINIBA, T)IDA7O42, =II, ?II, :III mg tab, LII mg+>II ml i"
Dental infections* I?g-:Img+9g. BD for ? days Dental infections* I?g-:Img+9g. BD for ? days
<g orally follo%ed I?g BD for ?days <g orally follo%ed I?g BD for ?days
LIImg i" until oral thera!y LIImg i" until oral thera!y

T2T)ACCC4IN2S T2T)ACCC4IN2S
Na!thacene deri"ati"es made u! by fusion of > !artially unsaturated Na!thacene deri"ati"es made u! by fusion of > !artially unsaturated
cyclohe/ane radicals cyclohe/ane radicals
Tetracyclines are bacteriostatic Tetracyclines are bacteriostatic
Classification Classification
Antimicrobial acti"ity * Antimicrobial acti"ity *
1ramB"e and ,"e cocci are sensiti"e0) 1ramB"e and ,"e cocci are sensiti"e0)
1ramB"e bacilli are inhibited 1ramB"e bacilli are inhibited
2ntero bacteriaceae are highly resistant 2ntero bacteriaceae are highly resistant
S!irochetes are 8uite sensiti"e S!irochetes are 8uite sensiti"e
All ric9ettsiae and chlamydiae are highly sensiti"e All ric9ettsiae and chlamydiae are highly sensiti"e
M%c+"ni&m , "ctin M%c+"ni&m , "ctin
Tetracycline antibiotics inhibit Tetracycline antibiotics inhibit !rotein synthesis !rotein synthesis by inhibiting the binding of by inhibiting the binding of
aminoacyl0t)NA aminoacyl0t)NA to the to the m)NA0ribosome m)NA0ribosome com!le/ They do so mainly by com!le/ They do so mainly by
binding to the binding to the =IS ribosomal subunit =IS ribosomal subunit in the in the m)NA translation m)NA translation com!le/ com!le/
R R
Tetracyclines are %idely used in treatment of !eriodontal diseases Tetracyclines are %idely used in treatment of !eriodontal diseases
Dsed in the treatment of 4ocalised aggressi"e !eriodontitis Dsed in the treatment of 4ocalised aggressi"e !eriodontitis
Ad"erse effects * Ad"erse effects *
1IT0e!igastric burning, nausea, "omiting, diarrhea 1IT0e!igastric burning, nausea, "omiting, diarrhea
4i"er damage 4i"er damage
)enal failure )enal failure
$hototo/icity $hototo/icity
2ffects on teeth S bones0 Ca tetracycline chelate 2ffects on teeth S bones0 Ca tetracycline chelate
#y!ersensiti"ity )eactions #y!ersensiti"ity )eactions
Su!erinfectionP Antianabolic effect Su!erinfectionP Antianabolic effect
DOS2 DOS2
Tetracycline , :0<g !er day in adults Tetracycline , :0<g !er day in adults
Children o"er Lyrs 0<? to ?Img +9g daily in < to> di"ided dose Children o"er Lyrs 0<? to ?Img +9g daily in < to> di"ided dose
T2))A&CCIN,)2ST2C4IN0<?I,?IImgca!,?Img+ml in:Iml "ial in; T2))A&CCIN,)2ST2C4IN0<?I,?IImgca!,?Img+ml in:Iml "ial in;
4edermycin :?I,=IImg ca!+tab 4edermycin :?I,=IImg ca!+tab
DOOT, NO3ADOO, T2T)ADOO0:IImg ca! DOOT, NO3ADOO, T2T)ADOO0:IImg ca!
Cyanomycin ?I,:II mg ca! Cyanomycin ?I,:II mg ca!
$recaution * $recaution *
Not to be used in !regnancy, lactation and in children Not to be used in !regnancy, lactation and in children
A"oided in !atients on diuretics A"oided in !atients on diuretics
Dsed cautiously in renal and he!atic insufficiency Dsed cautiously in renal and he!atic insufficiency
Beyond e/!iry date should not be used Beyond e/!iry date should not be used
Do not mi/ in;ectable Tc %ith $n0 inacti"ation occurs Do not mi/ in;ectable Tc %ith $n0 inacti"ation occurs
4ocal Drug Deli"ery Systems 4ocal Drug Deli"ery Systems
Subgingi"al Do/ycycline Subgingi"al Do/ycycline
05DA a!!ro"ed :IM of Do/ycycline in gel system using a syringe 05DA a!!ro"ed :IM of Do/ycycline in gel system using a syringe
Atrido/ Atrido/
)eduction in oral microbes No o"ergro%th of foreign !athogens )eduction in oral microbes No o"ergro%th of foreign !athogens
Subgingi"al &inocycline Subgingi"al &inocycline
0 0 Sustained release form of &inocycline micros!heres-Arestin. for Sustained release form of &inocycline micros!heres-Arestin. for
subgingi"al !lacement as an ad;u"ant to scaling and root !laning subgingi"al !lacement as an ad;u"ant to scaling and root !laning
0<M 2nca!sulated into bioresorbable micros!heres is used 0<M 2nca!sulated into bioresorbable micros!heres is used
O)OD2NTA4 CONDITIONS O)OD2NTA4 CONDITIONS
4imited use0 acute dental infections 4imited use0 acute dental infections
$eriodontal diseases , collagenase $eriodontal diseases , collagenase
)efractory !eriodontal disease , <%ee9 tetracycline-:g+day. or )efractory !eriodontal disease , <%ee9 tetracycline-:g+day. or
do/ycycline-I:0I<g+day. do/ycycline-I:0I<g+day.
Nu"enile !eriodontitis , <0> %ee9 Nu"enile !eriodontitis , <0> %ee9
&AC)O4ID2S &AC)O4ID2S
&acrocyclic lactone ring %ith attached sugars &acrocyclic lactone ring %ith attached sugars
2)CT#)O&CCIN0Stre!tomyces erythreus 2)CT#)O&CCIN0Stre!tomyces erythreus
Alternati"e to !encillin Alternati"e to !encillin
Hater solubility is limited0stable in cold Hater solubility is limited0stable in cold
Antibacterial acti"ity * static0 cidal Antibacterial acti"ity * static0 cidal
Narro% s!ectrum antibiotic Narro% s!ectrum antibiotic
against !enicillin resistant sta!hylococci against !enicillin resistant sta!hylococci
Acti"e against more gramB"e Acti"e against more gramB"e
&echanism of action * &echanism of action *
Dose * Dose *
Adults <?I 0 ?IImg @hrly Adults <?I 0 ?IImg @hrly
Children =I , @Img+9g+day Children =I , @Img+9g+day
2rythromycin -base. 0 2)CSA52 <?I mg tab 2rythromycin -base. 0 2)CSA52 <?I mg tab
2rythromycin stearate 02)CT#)OCIN , <?I,?IImg tab 2rythromycin stearate 02)CT#)OCIN , <?I,?IImg tab
:IImg+?ml sus!P:IImg+ml !ed dro!s :IImg+?ml sus!P:IImg+ml !ed dro!s
2 estolate0 A4T#)OCIN :<?mg 9id tab 2 estolate0 A4T#)OCIN :<?mg 9id tab
2 ethylsuccinate0 2)CNAT2 2 ethylsuccinate0 2)CNAT2
Ad"erse effects * Ad"erse effects *
1IT , e!igastric !ain 1IT , e!igastric !ain
On high doses , hearing im!airment On high doses , hearing im!airment
#y!ersensiti"ity reactions , rare #y!ersensiti"ity reactions , rare
Dses * Dses *
Substitute for !enicillin, !encillin resistant infections Substitute for !enicillin, !encillin resistant infections
Oral adm, safe and effecti"e Oral adm, safe and effecti"e
$erio+!eria!ical+ND1+e/traction $erio+!eria!ical+ND1+e/traction
$ro!hylactic use $ro!hylactic use
)OOIT#)O&CCIN )OOIT#)O&CCIN
Semisynthetic 0 long acting, stable macrolide Semisynthetic 0 long acting, stable macrolide
Antibacterial s!ectrum similar to erythromycin Antibacterial s!ectrum similar to erythromycin
Dose Dose 0 :?I0=IImg BD =Imin before food 0 :?I0=IImg BD =Imin before food
Children 0 <?0?mg+9g BD Children 0 <?0?mg+9g BD
)OOID, )OOIBID :?I,=IImg tab )OOID, )OOIBID :?I,=IImg tab
?Img 9id tab,:?I mg tab ?Img 9id tab,:?I mg tab
Clarithromycin , C4A)I&AC <?I,?IImg tab Clarithromycin , C4A)I&AC <?I,?IImg tab
C4INDA&CCIN C4INDA&CCIN
It is lincosamide antibiotic ha"ing similar action -macrolide ?Is. It is lincosamide antibiotic ha"ing similar action -macrolide ?Is.
Bacteriostatic , lo% concPBacteriocidal , high conc Bacteriostatic , lo% concPBacteriocidal , high conc
&ost acti"e against gramB"e cocci, Cdi!htheriae, Actinomyces &ost acti"e against gramB"e cocci, Cdi!htheriae, Actinomyces
#ighly acti"e against , anaerobes -B fragilis. #ighly acti"e against , anaerobes -B fragilis.
$harmaco9inetics * $harmaco9inetics *
Oral absor!tion , good Oral absor!tion , good
Distribution , s9eletal and soft tissues Distribution , s9eletal and soft tissues
2/creted in urine 2/creted in urine
Ad"erse effects * Ad"erse effects *
)ashes ,Drticaria )ashes ,Drticaria
Abdominal !ain Abdominal !ain
Su!erinfection 02nterocolitis SDiarrhoea Su!erinfection 02nterocolitis SDiarrhoea
Dses * Dses *
Anaerobic and mi/ed infections0 alternati"e to $n S macro Anaerobic and mi/ed infections0 alternati"e to $n S macro
Abscess and bone infections0sta!hy and bacteroids Abscess and bone infections0sta!hy and bacteroids
Infecti"e endocarditis Infecti"e endocarditis
Doses * :?I0=II mg 'ID oral P <II0@IImg I" L hourly Doses * :?I0=II mg 'ID oral P <II0@IImg I" L hourly
DA4CA$, C4INCIN, DA4CIN, :?I, =II mg ca!, =IImg+<ml and @II DA4CA$, C4INCIN, DA4CIN, :?I, =II mg ca!, =IImg+<ml and @II
mg+>ml in; mg+>ml in;
Anti fungal drugs Anti fungal drugs
F*n$*& F*n$*&
Com!osed of a rigid cell %all made u! of chitin and "arious Com!osed of a rigid cell %all made u! of chitin and "arious
!olysaccharides, and a cell membrane containing ergosterol !olysaccharides, and a cell membrane containing ergosterol
$rotecti"e layers of the fungal cell ma9e the organism resistant to antibiotics $rotecti"e layers of the fungal cell ma9e the organism resistant to antibiotics
)elated grou!s of anti fungal agents )elated grou!s of anti fungal agents
:Antibiotics :Antibiotics
A $olyenes A $olyenes
B #eterocyclic ben(ofuram B #eterocyclic ben(ofuram
<Antimetabolites <Antimetabolites
= A(oles = A(oles
AImida(oles AImida(oles
BTria(oles BTria(oles
>Allylamine >Allylamine
?To!ical agents ?To!ical agents
Nystatin Nystatin
A !olyene deri"ed from A !olyene deri"ed from Streptomyces noursei Streptomyces noursei
Binds to sterols of fungal cell membrane Binds to sterols of fungal cell membrane
To!ical antifungal agent To!ical antifungal agent0 fungicidal 0 fungicidal
< <
nd nd
choice to clotrima(ole choice to clotrima(ole
: lac units0> times a day, :I0:> days : lac units0> times a day, :I0:> days
Sus!ended %ith glycerine Sus!ended %ith glycerine
C4OT)I&A7O42 C4OT)I&A7O42
2ffecti"e in the to!ical treatment 2s!, athletes foot, otomycosis and oral, 2ffecti"e in the to!ical treatment 2s!, athletes foot, otomycosis and oral,
cutaneous candidiasis cutaneous candidiasis
:Img 0=0>times a day 1el or lotion0denture stomatitis :Img 0=0>times a day 1el or lotion0denture stomatitis
Angular chelitis Angular chelitis
%ell tolerated although 4ocal irritation and burning %ell tolerated although 4ocal irritation and burning
No systemic to/icity is seen after to!ical use No systemic to/icity is seen after to!ical use
SD)5A7, C4OT)IN, C4OD2)&, :M lotion, cream, !o%der :IImg tab SD)5A7, C4OT)IN, C4OD2)&, :M lotion, cream, !o%der :IImg tab
ANTI3I)A4 D)D1S ANTI3I)A4 D)D1S
Anti0her!es "irus Anti0her!es "irus
Ido/uridine,acylo"ir,famiclo"ir Ido/uridine,acylo"ir,famiclo"ir
Anti0retro"irus Anti0retro"irus
N)TI N)TI
7ido"udine 7ido"udine
4ami"udine 4ami"udine
NN)TI NN)TI
ne"ira!ine ne"ira!ine
$I $I
)itona"ir )itona"ir
Indina"ir Indina"ir
Antiinnfluen(a "irus Antiinnfluen(a "irus
Amantadine Amantadine
Nonselecti"e anti"iral drugs0riba"irin Nonselecti"e anti"iral drugs0riba"irin
Acyclo"ir Acyclo"ir
In3ic"tin&? In3ic"tin&? #er!es sim!le/ "irus -#S3. : and < infectionsP #S3 #er!es sim!le/ "irus -#S3. : and < infectionsP #S3
ence!halitisP shingles and chic9en!o/P ointment for her!es infectionsP cream ence!halitisP shingles and chic9en!o/P ointment for her!es infectionsP cream
for cold sores for cold sores
Actin&? Actin&? Inhibits "iral DNA re!lication Inhibits "iral DNA re!lication
Sym!toms Sym!toms
)a!id !rogressing0 facial cellulitis0#I+S$ )a!id !rogressing0 facial cellulitis0#I+S$
Chronic+ slo%ly !rogressing0odontogenic0 sta!hylococcal+mi/ed Chronic+ slo%ly !rogressing0odontogenic0 sta!hylococcal+mi/ed
J:I: 5 ,nonodontogenic0 hos!itali(ation J:I: 5 ,nonodontogenic0 hos!itali(ation
Colour*red+ "iolecious Colour*red+ "iolecious
S%elling* indurated, non fluctuant or erythematous , cellulitis S%elling* indurated, non fluctuant or erythematous , cellulitis
$ointed, fluctuant or !roducti"e0 abscess $ointed, fluctuant or !roducti"e0 abscess
&anagement &anagement
D!!er face D!!er face
Out!atient* amo/icillin cla"ulanate or cefaclor orally Out!atient* amo/icillin cla"ulanate or cefaclor orally
Ceftria/one0 : day i" Ceftria/one0 : day i"
In!atient * cefuro/ime+ am!icillinB sulbactam A0:I days In!atient * cefuro/ime+ am!icillinB sulbactam A0:I days
Odontogenic ,!encillin+ clindamycin, surgical inter"ention Odontogenic ,!encillin+ clindamycin, surgical inter"ention
4o%er face 4o%er face
Out!atient* ce!hale/in, amo/icillin cla"uanate, erythromycin Out!atient* ce!hale/in, amo/icillin cla"uanate, erythromycin
In!atient * i" cefa(olin, clindamycin In!atient * i" cefa(olin, clindamycin
Some of the commonly used drugs Some of the commonly used drugs
Amo/0<?I,?IImg0tid Amo/0<?I,?IImg0tid
<?Img0)s @A?I <?Img0)s @A?I
?IImg0)s:<ILI ?IImg0)s:<ILI
Children<I0>Img+9g body %eight0tid Children<I0>Img+9g body %eight0tid
0:<?,<?Img 0:<?,<?Img
Ce!hale/in-s!oride/. Ce!hale/in-s!oride/.
<?I,?IImg <?I,?IImg
<?Img0:Itab0)s@@?I <?Img0:Itab0)s@@?I
?IImg0:Itab0)s:<I?I ?IImg0:Itab0)s:<I?I
:<?mg,<?Img+?ml :<?mg,<?Img+?ml
:<?mgP=Iml0)s=>?I :<?mgP=Iml0)s=>?I
<?ImgP=Iml0)s?<@I <?ImgP=Iml0)s?<@I
S!oride/ dis!ersible tabs S!oride/ dis!ersible tabs
:<?mg0:Itabs0)s=<<? :<?mg0:Itabs0)s=<<?
<?Img0:Itabs0)s@QQ? <?Img0:Itabs0)s@QQ?
$aed dro!s0:IImg+ml $aed dro!s0:IImg+ml
:Iml0)s== :Iml0)s==
&etrogyl &etrogyl
<IImgPtab :I0)s=@> <IImgPtab :I0)s=@>
>IImgPtab :I0@=:0 gi"en tid for ?0:I days >IImgPtab :I0@=:0 gi"en tid for ?0:I days
Sus!ensionP <IImg +?ml0=Iml0)sLIQ Sus!ensionP <IImg +?ml0=Iml0)sLIQ
@Iml0)s0:<<A @Iml0)s0:<<A
4ist of references 4ist of references
2ssentials of medical !harmacology * 2ssentials of medical !harmacology *
6D T)I$AT#IP ?th edi 6D T)I$AT#IP ?th edi
Clinical !harmacology , Bennet S Bro%n Q Clinical !harmacology , Bennet S Bro%n Q
th th
ed ed
Oral S ma/illofacial infections , To!a(ian > Oral S ma/illofacial infections , To!a(ian >
th th
ed ed
Te/t boo9 of !ediatric dentistry , Damle = Te/t boo9 of !ediatric dentistry , Damle =
rd rd
ed ed
Caran(a Te/t boo9 of !eriodontology :I Caran(a Te/t boo9 of !eriodontology :I
th th