Antibiotics

• ·      History

  o   1929- Fleming of England saw that mold produced substance that stopped bacterial growth

  o   1935- Domagk of Germany discovered prontosil (first sulfa based drug) and how it protects against strep

  o   1940- chain and florey developed penicillin to be sold as drug 
• ·      Bactericidal

  o   Can kill bacteria

  o   Inhibits cell wall synthesis

  o   Penicillins, cephalosporins, nitroimadazoles/metronidzole
• o   GI effects

  ·      Erythromycin has the highest incidence
• o   Allergy

  ·      Hives, wheezing, anaphylaxis

  ·      Drug must be discontinued immediately, avoid drug family
• o   Photosensitivity

  ·      Exaggerated sunburn

  ·      Ciprofloxacin

  ·      Doxycycline
• o   Drug interactions

  ·      Oral contraceptives can become less effective during course

  ·      Warfarin (increased anticoagulant effect)

  ·      Grapefruit juice

  ·      More than one antibiotic can cause issues
• o   Pregnancy

  ·      Tetracycline contraindicated
• ·      Indications for antibiotics for dental infections

  o   Not needed for healthy immune system

  o   If the patient has a fever and infection is rapidly spreading, yes

  o   If the pocket remains active despite repeated NSPT, yes (arestin) 
• ·      Common microorganisms in dentistry

  o   Caries- streptococcus mutans

  o   Periodontitis- A.A, s. Pyongenes
• antibiotic taken if there is no contraindication- amoxicillin 2g (adult) or 50 mg/kg
• Unable to take oral medication

  Ampicillin 2 g IM or IV 50 mg/kg IM or IV OR

  Cefazolin / ceftriaxone 1 g IM or IV 50 mg/kg IM or IV
• Allergic to penicillin or ampicillin-oral:

  Cephalexin 2 g (adult) 50 mg/kg (child) OR

  Azithromycin or Clarithromycin 500 mg (adult) Or 15 mg/kg (child) OR

  Doxycycline 100 mg (adult)<45 kg, 2.2 mg/kg

  >45 kg, 100 mg (child)
• Allergic to penicillin or ampicillin and unable to take oral medication:

  Cefazolin or ceftriaxonet 1 g IM or IV (adult) 50 mg/kg IM or IV(child)