ANTIBIOTICS IN MAXILLOFACIAL INFECTION

Resource faculty:

Dr.Jyotsna Rimal

Head of department

Department of Oral Medicine and Radiology

Dr.Iccha Kumar Maharjan

Associate Professor

Department of Oral Medicine and Radiology

Presented by:Alka SinghBDS 2011

CONTENTS

• INTRODUCTION

• HISTORY AND CLASSIFICATION

• PRINCIPLES FOR CHOOSING THE APPROPRIATE ANTIBIOTICS

• PRINCIPLES OF ANTIBIOTIC ADMINISTRATION

• COMBINATION ANTIBIOTIC THERAPY

• ANTIBIOTIC PROPHYLAXIS AND ITS PRINCIPLES

• MOST COMMONLY USED ANTIBIOTICS IN MAXILLOFACIAL INFECTION

INTRODUCTION

• An antibiotic is a word derived from the

Ancient Greek meaning:

(anti, i.e., "against", and bios, i.e., "life")

• DEFINITION:

SUBSTANCES PRODUCED BY MICROORGANISMS, WHICH SUPPRESS THE GROWTH OF OR KILL OTHER MICROORGANISMS AT VERY LOW CONCENTRATIONS

HISTORY

Louis Pasteur was one of the first physician who observed that bacteria kill other bacteria.

Penicillin, the first natural antibiotic discovered by Alexander Fleming in 1928.

Chain and Florey followed up this observation in 1939 which culminated the use of Penicillin in clinical use in 1941.

CLASSIFICATION

• ON THE BASIS OF PREPARATION:

- NATURALLY OCCURRING : PENICILLIN , CEPHALOSPORIN, ERYTHROMYCIN.

- SYNTHETIC: SULFONAMIDES

• ON THE BASIS OF FAMILY:

- PENICILLIN

- CEPHALOSPORIN

- SULFONAMIDES

- TETRACYCLINE

- AMINOGLYCOSIDES : GENTAMICIN , NEOMYCIN, STREPTOMYCIN

- MACROLIDES: CLARITHROMYCIN, ERYTHROMYCIN, AZITHROMYCIN

- QUINOLONES: CIPROFLOXACIN , NORFLOXACIN

On the basis of spectrum of activity: - Narrow: Penicillin, Streptomycin - Broad: Ampicillin,Tetracycline,Chloramphenicol

On the basis of effect: - Bacteriostatic: Erythromycin , Tetracycline, Sulfonamides - Bactericidal: Penicillin, Cephalosporin

On the basis of antibiotics obtained from: - Fungi: Penicillin , Cephalosporin - Bacteria : Bacitracin, Polymixin B - Actinomycetes : Aminoglycoside, Chloramphenicol, tetracycline

INDICATIONS• Treatment of established infections;

• infections that persists inspite of local measures• where there is signs of systemic involvement eg.submandibular

lymphadenopathy and fever• when surgical access is difficult e.g severe trismus• when there is a diffuse , spreading infection eg.facial cellulitis

• Prophylaxis against infections:• Immunocompromised patient• Surgical procedures with a high likelihood of infections

» Maxillofacial trauma » Major or difficult surgery » When the consequences of infections are serious » Infective endocarditis» Orthopaedic joint prosthesis

Before antibiotic prescription one should know,

1. Bacterial flora causing most odontogenic infections

2 .The basic mechanism of host defenses

3. The variety of contemporary antibiotics and principles to choose

Once the decision has been made to use antibiotics as an adjunct to treating infection the antibiotics should be properly selected following a set of principles…

PRINCIPLES FOR CHOOSING ANTIBIOTIC

1) IDENTIFICATION OF THE CAUSATIVE ORGANISM

2) DETERMINATION OF ANTIBIOTIC SENSITIVITY

3) USE OF A SPECIFIC, NARROW-SPECTRUM ANTIBIOTIC

4) USE OF THE LEAST TOXIC ANTIBIOTIC

5) PATIENT DRUG HISTORY

6) USE OF A BACTERICIDAL RATHER THAN A BACTERIOSTATIC DRUG

7) USE OF THE ANTIBIOTIC WITH A PROVEN HISTORY OF SUCCESS

8) COST OF THE ANTIBIOTIC

9) ENCOURAGE PATIENT COMPLIANCE

Principles of antibiotic administration

•Proper dose (3-4×MIC)

•Proper time interval(4×t1/2)

•Proper route of administration•Consistency in route of administration •Combination in antibiotic therapy

Duration of action of antibioticsDepends on t1/2Uaual dose interval =4×t1/2As at 5t1/2 95%of drugs has been excretedEg. t1/2 for cephazolin 2 hours ,dose interval =8 hrs

Half life of some antibioticsPenicillin=30 minMetronidzole=8 hrsTetracycline=6-10 hrs(given qid)Doxycycline=18- 24 hrs(given od)

RATIONALE• To have an additive synergistic effect.

• In mixed infections when bacteria are sensitive to different drugs.

• To achieve delay in development of resistance.

• To decrease the incidence of adverse reactions to an individual drug , another drug is added so that the doses of individual drug can be reduced and possible toxic effects can be avoided

• To reduce the cost of therapy

COMBINATION ANTIBIOTIC THERAPY

Indications: when its necessary to increase the spectrum ,e.g. life

threatening sepsis of unknown cause

when increased bactericidal effect against a specific organism is desired e.g.. infection caused by group d streptococcus –penicillin and aminoglycosides is given

prevention of rapid emergence of resistance

rapidly progressive odontogenic infection e.g.. Severe cellulitis rapidly progressing posteriorly around retro pharyngeal space, bactericidal activity against Streptococcus and oral anaerobes is important ;

rational approach to treatment would be penicillin G AND metronidazole

Disadvantage of combination therapy

- Increased incidence and variety of adverse effects.

- Increased chances of super infections.

- Emergence of resistance.

- Increased cost of therapy

ANTIBIOTIC AS PROPHYLAXIS

• Use of AMA(Antimirobial) for preventing the setting in

of an infection or suppressing contacted infection

before it becomes clinically manifest.

1. Prophylaxis against specific microorganisms• Rheumatic fever- group. A Streptococci-long acting

Penicillin G• HIV infection- zidovudine+lamivudine+indinavir

(needle stick injury)2. Prevention of infection in high risk situations3. Prevention of infection in general

Prophylactic Antibiotic Regimen*Situation Agent Regimen—Single Dose

30-60 minutes before procedure Adult Children

Oral Amoxicillin 2 g 50 mg/kg

Unable totake oralmedication

Ampicillin or 2 g IM or IV* 50 mg/kg IMor IVCefazolin or

Ceftriaxone1 g IM or IV

50 mg/kg IMor IV

Allergic toPenicillin orAmpicillin—Oral regimen

Cephalexin or 2g 50mg/kg

Clindamycin or 600mg 20mg/kgAzithromycin orClarithromycin

500mg 15mg/kg

Allergic toPenicillin orAmpicillin andunable to takeoral medication

Cefazolin orCeftriaxone

1 g IM or IV 50 mg/kg IMor IV

ORClindamycin

600 mg IMor IV

20 mg/kg IMor IV

*Adapted from Prevention of Infective Endocarditis: Guidelines From the American Heart Association, by the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease. Circulation, 2007

Case Report

A 22 year old boy reported to dental OPD with massive swelling of the cheek to the level of the eyelid.before the onset of swelling ,he had a toothache in molar region .his temperature was 101F ,and the skin of his cheek was warm tender and erythematous.

Diagnisis:buccal space infection

Treatment: percutaneous incision and drainage penicillin(500mg×qid× 10 days) followed by endodontic filling of offending tooth

ideal antibiotic for treating dental infections-bactericidal against gram positive cocci and the major pathogens of mixed anaerobic infections.

with minimal adverse effects and allergic reactions and relatively low in cost.

SOME MAXILLOFACIAL INDICATION OF ANTIBIOTICS

1. Acute periapical cellulitis and abscess/ Acute dentoalveolar abscessMicrobiology: Treponema spp.

T.forsythia, P. endodontalis P. gingivalis F. nucleatum

Drug of choice: Penicillin2. Acute pericoronitis

Microbiology: Anaerobic bacteria including gram positive cocci( Peptostreptococcus) and gram negative rods( Prevotella)Drug of choice: Penicillin

4. Fractures• for compound maxillofacial fractures• Antibiotics to be given in therapeutic doses as soon as possible and

continued until active fracture treatment is completed( open/closed reduction, rigid fixation)

• Drug of choice: Penicillin

5. Soft tissue woundsExtensive, deep or old( >6 hours) orofacial lacerations

Microbiology: Animal bites- Staphylococcus, Streptococcus, Bacteroides Fusobacterium , and Pasteurella multocida

Drug of choice: Amoxicillin and clavulanic acid .

. 6). Sinusitis

Microorganisms: S. pneumoniae, H. influenza, Bacteroides spp., Fusobacterium spp., StreptococcusDrugs used:Amoxicillin- 1st line antibiotic given for a minimum of 10 daysSecond generation cephalosporins, azithromycin and amoxicillin- clavulanate: resistant cases

7)OsteomyelitisMicrobiology: Staphylococcus aureus, S. epidermidis

hemolytic StreptococciActinomyces,Ekinella corrodens

Drug of choice: Penicillin+Metronidazole Clindamycin

8) Space infections Microbiology:• Mixed aerobic and anaerobic flora( 65-70%)• Exclusively anaerobic(25-30%)• Exclusively aerobic (5%)

Microorganisms organisms:• Aerobic- Streptococci(Alpha, beta and gamma)

Corynebacterium• Anaerobic- Streptococci( Peptostreptococcus) Bacteroides( Porphyromonas, Prevotella)

Fusobacterium Eikenella Propionibacterium

Drugs:• Empirical antibiotic of choice: Penicillin• Penicillin+Metronidazole( enhances killing of anaerobes)• Penicillin resistant: Clindamycin• Azithromycin• First and second generation cephalosporins• Minocycline and doxycycline(low grade dentoalveolar infections)

ANTIBIOTICS FOR IMMUNOCOPROMISED PATIENT

suppressed immunity ↑ risk for dentoalveolar infection

Immunosuppression determined by ANC(Absolute neutrophil count)

ANC<500ml indicates severe neutropenia

gingival disease in immunosuppressed:chlorhexidine

Use of broad spectrum antibiotic is appropriate

penicillin vk,amoxicillin,clindamycin,azithromycin commonly used

Prior consultation form oncologist is recommended

SOME ANTIBIOTICS COMMONLY USED IN MAXILLOFACIAL INFECTION

Penicillin

Semisynthetic derivative of Penicillin

Cephalosporins

βlactam antibiotics

MECHANISM OF ACTION

B-lactam antibiotics Mechanism of action :Acts by inhibiting the synthesis of bacterial cell walls. It inhibits cross-linkage between the linear peptidoglycan polymer chains that make up a major component of the cell walls of both Gram-positive and Gram-negative bacteria

PENICILLIN

• NATURAL: PENICILLIN G

PENICILLIN V

• SEMISYNTHETIC: AMPICILLIN,

AMOXICILLIN,

METHICILLIN,

COAMOXYCLAV,

PROCAINE PENICILLIN,

BENZATHENE PENICILLIN

• ADMINISTRATION:

The route of administration is determined by the stability of drug to gastric acid and the severity of the infection.

• ROUTES OF ADMINISTRATION:

-ORAL:

Penicillin VK, amoxicillin, amoxicillin in combination with clavulanic acid.

-Iv/im: Methicillin,ticarcillin,carbenicillin,mezlocillin , piperacillin.

RECOMMENDED DOSES

Generic name- Penicillin VKBrand name- CRYSTAPEN-V, KAYPENIndications- Bacterial infectionAdministration- TabletsDosage- 500mg qid x 7-10dContraindications- Documented hypersensitivityCommon side effects-Rash(hypersensitivity), nausea, abdominal pain, diarrhoeaDrug interactions-Chloroquine phosphate, methotrexate

AMOXICILLIN

GENERIC NAME- AMOXICILLIN

BRAND NAME- AMOXYLIN, NOVAMOX

INDICATIONS- BACTERIAL INFECTION

ADMINISTRATION-CAPSULE

DOSAGE- 250-500MG T.D.S. X 7D(HALF LIFE 30 MIN

COMMON SIDE EFFECTS-RASH, NAUSEA, ABDOMINAL PAIN, DIARRHEA

DRUG INTERACTIONS- CHLORAMPHENICOL, MACROLIDES, SULFONAMIDES, TETRACYCLINES

1. First

generation(1960s):

Cephalothin,

Cephalexin, Cefazolin,

Cefadroxil

-high activity against

gram +ve but weaker

against gram –ve

bacteria

-Effective against Gram

+ve cocci except

enterococci

2. Second generation(1970s): Cefuroxime, Cefaclor

-Greater activity against Gram -ve than 1st generation

-some members active against anaerobes

3.Third generation(1980s): Ceftriaxone, cefotaxime, Ceftazidime, Cefixime

-highly augmented

activity against gram-ve

CEPHALOSPORINS

4. Fourth generation(1997): Cefpirome, Cefipime

-Highly resistant to β-Lactamases

-covers pseudomonal infections

5. Fifth generation: Ceftobiprole

-used to treat MRSA

MOAlInhibition of bacterial cell wall peptidoglycan synthesis by inhibition of penicillin-sensitive enzymes which form the rigid bacterial cell wall.

USEInfections caused by staphylococci and streptococci.

Surgical and endocarditis prophylaxis

Osteomyelitis

ADRHypersensitivity reactionNephrotoxicityNeutropenia Thrombocytopenia

TETRACYCLINES

• MECHANISM OF ACTION: Inhibits protein synthesis by binding to 30s ribosomes

• Bacteriostatic

• They are effective in treating periodontal diseases because their concentration in the gingival crevice is 2-10 times that in serum

• Besides they exert an anticollagenase effect that can inhibit tissue destruction and may aid bone regeneration

USES

- Localized aggressive periodontitis

(inhibits the growth of Actinobacillus actinomycetemcomitans)

- Refractory periodontitis

- Actinomycosis

- Juvenile periodontitis

- Chronic periodontal disease

- Desquamative gingivitis

- vomiting, diarrhoea

-Renal toxicity

-Phototoxicity

-Hypersensitivity

-Superinfection

-Tooth discoloration

-Temporary suppression of bone growth

-Furry darkening or blackish discoloration

of tongue

ADR

Minocyclin

e

•Used in adult periodontitis•Dose: 200 mg initially,then,100-200 mgOD•Half life =16 to 24 hrs

• Doxycycline:

• - Subantimicrobial dose i.e.,20 mg is used in host modulation therapy for 3-9 months.

• - Indicated when topical and intralesional therapy is not successful in controlling desquamative gingivitis.

•

• Doxycycline hyclate(20 mg capsule) is used as a subantimicrobial dose for:

- suppression of collagenase activity,esp. that produced by the PMN leucocytes, matrix metalloproteinase and osteoclastic resorption,

CAUSING - decreased tissue destruction HENCE HELPING IN - bone regeneration

• No antimicrobial effects because 20 mg BD is too low dose to affect the bacteria.

AMINOGLYCOSIDES• Systemic-Streptomycin,Gentamicin,Kanamycin,Amikacin

• Topical-Neomycin,Framycein

Mechanism of action : Binds at several sites at 30s and 50s as well as their juncture and inhibits protein synthesis

Use: gentamycin 2mg/kg i.m/i.v single dose to supplement

amoxicillin or vancomicin in endocarditis prophylaxis

SHARED TOXICITY:

Ototoxicity

Nephrotoxicity

Neuromuscular blocked

MACROLIDES

• MECHANISM OF ACTION:

-inhibits protein synthesis by binding to 50s ribosomes and interfering with translocation.

Azithromyci

n

• Generic name- Azithromycin

• Brand name- AZITHRAL, AZIWOK

• Indications- Bacterial infection

• Administration-Capsule

• Dosage- 500mg 1 day, then 250 mg for 2-5 day

• Common side effects-Rash, nausea, abdominal pain, diarrhoea

erythromyci

n

• active against gram +ve and a few gram –ve bacteria.

• It is widely distributed in the body, enters cells and into abscesses, crosses serous membranes and placenta but not the blood brain barrier.

• It is used in patients with refractory periodontitis and as a prophylaxis against endocarditis.

• It causes mild epigastric pain, diarrhoea and allergic reactions.

• It is contraindicated in hypersensitivity.

• Dose: 250-500 mg 8 hourly.

clarith

romycin

• Mechanism is similar to that of erythromycin.

• It is more active against gram positive cocci and anaerobes (Actinomyces, Lactobacillus).

• First line of drugs in combination regimens for Mycobacterium Avium Complex infection.

• Other uses and properties are similar to that of erythromycin.

Mechanism of action :

• Clindamycin has a bacteriostatic effect. It is a bacterial protein synthesis inhibitor by inhibiting ribosomal translocation.

• It does so by binding to the 50S rRNA of the large bacterial ribosome subunit.

NOTE: It readily enters hard and soft tissues because of its relatively small molecular

size( greater bone permeability)

LINCOSAMIDE

CLINDAMYCIN

Generic name- ClindamycinBrand name- DALCAP, CLINCINIndications- Bacterial infectionAdministration-CapsulePrescription/OTC-PrescriptionDosage- 300mg q.i.d. x 7daysCommon side effects-Rash, nausea, abdominal pain, diarrhoea

FLUOROQUINOLONES• 1st Generation: Norfloxacin, Ofloxacin, Ciprofloxacin

• 2nd Generation: Lomefloxacin, Sparfloxacin, Moxifloxacin, Gatifloxacin

• 3RD Generation:Gemifloxacin,prulifloxacin

• Mechanism of action:• Inhibits the enzyme bacterial DNA gyrase which nicks the double

stranded DNA

Uses– Osteomyelitis– ANUG– Recurrent periodontitis

Adverse effects– GI symptoms: Nausea, vomiting, anorexia– Hypersensitivity reaction– Arthritis

• Metronidazole• Prototype drug

of nitroimidazole

• MOA-bactericidal to anaerobes

• Enters cell by diffusion

• nitro group• Highly active

nitro radical(electron sink)

• Disturbs metabolism of anaerobes

Ccertain redox protein of anerobic microbes

Routes of administrationMetronidazole can be given via following routes: - Oral tablets - Topical gels

Oral: Tab.500mg tds .

Uses

Acute necrotizing ulcerative gingivitis(ANUG)

-Aggressive periodontitis

-Abscesses

Adverse effect

nausea,vomiting,abdominal cramp

-Dry mouth, unpleasant metallic taste

-Dark or reddish-brown urine

-Furry tongue: mouth or tongue irritation

“disulfiram interaction” with alcohol

ANTI FUNGAL

ANTIFUNGAL DRUGSCLASSIFICATION:

1. ANTIBIOTICS

A. POLYENES: AMPHOTERICIN-B(AMB), NYSTATIN, HAMYCIN, NATAMYCIN

B. HETEROCYCLIC BENZOFURAN: GRISEOFULVIN

2. ANTIMETABOLITES: FLUCYTOSINE(5-FC)

3. AZOLES

C. IMIDAZOLES(TOPICAL): CLOTRIMAZOLE, ECONAZOLE, MICONAZOLE, OXICONAZOLE

D. TRIAZOLES(SYSTEMIC): FLUCONAZOLE, ITRACONAZOLE,VORICONAZOLE

4. ALLYLAMINE: TERBINAFINE

5. OTHER TOPICAL AGENTS: BENZOIC ACID, SOD.THIOSULFATE

MECHANISM OF ACTION

Inhibits the fungal cytochrome P450 enzyme 14α-demethylase. conversion of lanosterol

ergosterol an essential component of the fungal cytoplasmic membrane and subsequent accumulation of 14α-methyl sterols.

• Generic name: Amphotericin-B

• Brand name: Fungisome, Fungizone

• Indications: Oral, vaginal and cutaneous candidiasis, otomycosis; antifungal therapy

• Administration: Topical/oral/iv

• Dosage: 50-100mg QID oral; 10mg,25mg,50mg per vial inj.

• Contraindication: renal deficiency

• Common side effects: Acute reaction ->chills, fever, aches; nephrotoxicity

Topical antifungal

• Generic name: Clotrimazole

• Brand name: SURFAZ, CLOTRIN

• Indications: Oropharengeal candidiasis

• Administration: Troche

• Dosage: 10mg troche: dissolve slowly over 15-30min• 5

times daily: apply to affected area b.i.d. for 7d

• cream can be applied to the tissue contact areas of the denture

• Common side effects: Abnormal liver function test, nausea, vomiting local mild burning

• Generic name: Nystatin

• Brand name: NYSTIN, MYCOSTATIN

• Indications: Oropharyngeal candidiasis

• Administration: Oral suspension, powder, cream, lozenge

• Dosage: Oral suspension (100,000U/ml): 400,000-600,000 units 4-5 times/d(swish

and swallow)

• 100,000U/g cream and oinment: Apply to affected area 4-5 times/d

• Powder (50 million U): Sprinkle on tissue contact area of denture

• Common side effects: Nausea, vomiting, diarrhoea, stomach pain

SYSTEMIC ANTIFUNGAL

Use

Administration

Dosage

Side effects

Monitoring

Ketoconazole

Oral and oesophageal Candidiasis

Tablets

200mg on 1st day100mg daily for 7-10

Headache,nausea,vomiting,rash,diarrhea

Liver function test,potasium

Itraconazole

Oral and oesophagealCandidiasis

Suspension

100-200mg/10ml od 1- 2 wk

Nausea,pruritus,diarrhea,Incresed liver enzyme

Liver function test

Fluconazole

Oral and oesophageal Candidiasis

Tablets

200-400mg/d as single doseFor 7-14 days

Pruritus,vomitimg,abdominal pain

Liver function test

RESEARCH ON EFFICACY OF COMBINATION THERAPY

Title Comparison of clinical efficacy between 3-day combined clavulanate/ amoxicillin preparation treatment and 10-day amoxicillin treatment in children with pharyngolaryngitis or tonsillitis. Links Export Central Citation

Author(s) Kuroki H, Ishiwada N, Inoue N, Ishikawa N, Suzuki H, Himi K, Kurosaki T

Source Journal of infection and chemotherapy

Date of Publication 2013

Volume 19

Issue 1

Pages 12-9

Publisher Name Springer Japan (1-11-11 Kudan-kita, Chiyoda-ku, No. 2 Funato Bldg., Tokyo 102-0073, Japan)

City of Publication Japan

Abstract The efficacy of 3-day treatment with a combined clavulanate/amoxicillin preparation (Clavamox combination dry syrup for pediatric cases) and 10-day treatment with amoxicillin against pediatric pharyngolaryngitis and tonsillitis caused by Group A beta-hemolytic Streptococcus was compared. Among the patients included in the efficacy evaluation (54 from the clavulanate/ amoxicillin group and 43 from the amoxicillin group), the clinical response rate on completion of treatment was 98.1 % in the clavulanate/amoxicillin group and 92.9 % in the amoxicillin group, thus supporting the equivalent efficacy of these two therapies. The Group A beta-hemolytic Streptococcus eradication rate at approximately 1-2 weeks after completion/discontinuation of treatment was 65.4 % in the clavulanate/amoxicillin group and 85.4 % in the amoxicillin group. Even in cases from which the pathogen continued to be isolated, relapse/recurrence of clinical symptoms was seldom seen. Urinalysis, conducted to assess the presence or absence of acute glomerulonephritis, revealed no abnormality in any patient. These results suggest that 3-day treatment with this clavulanate/amoxicillin preparation is expected to provide a valid means of treating pediatric pharyngolaryngitis and tonsillitis caused by Group A beta-hemolytic Streptococcus. 2012 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases.

EMBASE keywords adolescent // antibiotic sensitivity // article // body temperature // child // controlled study // diarrhea/si [Side Effect] // drug efficacy // drug eruption/si [Side Effect] // drug safety // drug withdrawal // eradication therapy // female // Haemophilus influenzae // human // *laryngitis/dt [Drug Therapy] // major clinical study // male // minimum inhibitory concentration // Moraxella catarrhalis // multicenter study // Neisseria // nonhuman // open study // patient compliance // *pharyngitis/dt [Drug Therapy] // preschool child // randomized controlled trial // respiratory tract inflammation/si [Side Effect] // school child // Streptococcus group A // Streptococcus pneumoniae // *tonsillitis/dt [Drug Therapy] // urinalysis // urticaria/si [Side Effect] // *amoxicillin/ae [Adverse Drug Reaction] // *amoxicillin/ct [Clinical Trial] // *amoxicillin/cm [Drug Comparison] // *amoxicillin/dt [Drug Therapy] // *amoxicillin plus clavulanic acid/ae [Adverse Drug Reaction] // *amoxicillin plus clavulanic acid/ct [Clinical Trial] // *amoxicillin plus clavulanic acid/cm [Drug Comparison] // *amoxicillin plus clavulanic acid/dt [Drug Therapy] // cefcapene pivoxil

Correspondence Address H. Kuroki, Sotobo Children's Clinic, 1880-4 Izumi Misaki-machi, Isumi Chiba, Japan. E-mail: kuroki-haruo@krc.biglobe.ne.jp

Accession Number EMBASE 2013118760

DOI 10.1007/s10156-012-0444-1

Language eng

Publication Type Journal: Article

ID CN-00911958

Title Comparison of clinical efficacy between 3-day combined clavulanate/ amoxicillin preparation treatment and 10-day amoxicillin treatment in children with pharyngolaryngitis or tonsillitis. Links Export Central Citation

Author(s) Kuroki H, Ishiwada N, Inoue N, Ishikawa N, Suzuki H, Himi K, Kurosaki T

Source Journal of infection and chemotherapy

Date of Publication

2013

Volume 19

Issue 1

Pages 12-9

Publisher Name

Springer Japan (1-11-11 Kudan-kita, Chiyoda-ku, No. 2 Funato Bldg., Tokyo 102-0073, Japan)

City of Publication

Japan

Abstract The efficacy of 3-day treatment with a combined clavulanate/amoxicillin preparation (Clavamox combination dry syrup for pediatric cases) and 10-day treatment with amoxicillin against pediatric pharyngolaryngitis and tonsillitis caused by Group A beta-hemolytic Streptococcus was compared. Among the patients included in the efficacy evaluation (54 from the clavulanate/ amoxicillin group and 43 from the amoxicillin group), the clinical response rate on completion of treatment was 98.1 % in the clavulanate/amoxicillin group and 92.9 % in the amoxicillin group, thus supporting the equivalent efficacy of these two therapies. The Group A beta-hemolytic Streptococcus eradication rate at approximately 1-2 weeks after completion/discontinuation of treatment was 65.4 % in the clavulanate/amoxicillin group and 85.4 % in the amoxicillin group. Even in cases from which the pathogen continued to be isolated, relapse/recurrence of clinical symptoms was seldom seen. Urinalysis, conducted to assess the presence or absence of acute glomerulonephritis, revealed no abnormality in any patient. These results suggest that 3-day treatment with this clavulanate/amoxicillin preparation is expected to provide a valid means of treating pediatric pharyngolaryngitis and tonsillitis caused by Group A beta -hemolytic Streptococcus. 2012 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases.

ANTIVIRAL

CLASSIFICATION

1. Anti-herpes virus agents:Acyclovir, Valacyclovir, Famcyclovir,Gancyclovir, Idoxuridine,

2. Anti-retrovirus agents: Nucleoside Reverse transcriptase inhibitors- Zidovudine(AZT), Didanosine, Stavudine, Lamivudine, Abacavir

Non-nucleoside Reverse transcriptase inhibitors-Nevirapin, Efavirenz

Protease inhibitors- Ritonavir, Indinavir, Nelfinavir

3. Anti-influenza virus agents: Amantadine, Rimantadine

4. Nonselective antiviral drugs: Ribavirin, interferon-alpha

SOME INDICATIONS

Primary herpetic gingivostomatitis

HERPES LABIALIS

INFECTIOUS MONONUCLEOSIS

ERYTHEMA MULTIFORME

Acyclovir

Acyclovir monophosphate

Acyclovir triphosphate

Herpes virus specific thymidine kinase

Inhibits herpes virus DNA polymerase competitively

Gets incorporated in viral DNA and stops lengthening of DNA strand. The terminated DNA inhibits DNA-polymerase irreversibly

Mechanism of action

Brand name

Incication

Administrtion

Dosage

A.D.R

ACYCLOVIR

Zovirax

herpes labialis

Cream

5%cream qid for 4 days

Pain ,burning,stinging

VALACYCLOVIR

Valtrex

Herpes labialisErythema multiforme

Tablet

RHL: 2g bid for 1d (separate doses by 12h)EM 500mg bd

Headache ,dizzinessAbdominal pain

FAMCICLOVIR

Brand name-Famvir

Indication-Herpes zoster, recurrent HSVin immunocompromised Tablets

Dosage-500mg t.i.d. for 7dRecurrent HSV in immunocompromised patients: 125mg b.i.d. for 5 days

ADR-arthralgia,rigor,upper respiratory tract infection

CONCLUSION

• WHEN?• WHY?• HOW? • And What?

THANK YOU

ANY QUESTIONS?

MCQS

1)Which of the following drugs acts by inhibiting the synthesis of bacterial cell walls?

A) Tetracyclines

B) Penicillins

C) Macrolides

D) Metronidazole

B)Penicillins

2)Which of these drug have chelating property?

A) Tetracyclines

B) Penicillins

C) Macrolides

D) Metronidazole

A)Tetracyclines

3)Dose of amoxicillin in antibiotic prophylaxis according to AHA?

A)3gB)1gC)2gD)none

C)2g

Which drug causes disulfuram like action?

• A)Metronidazole

• B)Amoxcillin

• C)Azitromycin

• D)Gentamycin

A)METRONIDAZOLE

REFERENCES

• ESSENTIALS OF MEDICAL PHARMACOLOGY-K.D TRIPATHI -6 EDITION

• ESSSENTIALS F PHARMACOLOGY FOR DENTISTRY-K.D TRIPATHI -2ND EDITION

• BURKET’S ORAL MEDICINE-11TH EDITION

• TEXT BOOK OF ORAL AND MAXILLOFACIAL SURGREY-NEELIMA ANIL MALLIK-3RD EDITION

• ORAL AND MAXILLOFACIAL INFECTION- TOPAZION 4TH EDITION