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Antibiotics and analgesics in pediatric dentistry (2)
INTRODUCTION
 Most common clinical situations in dentistry
amenable to drug therapy in children are pain and
infection.
 The prescription of medications are more complicated
than in the past.
 The necessity to adjust the dosages of medications to
accommodate their lower weight and body size.
Adjustment of dosages in pediatric
patients
 Following formulas are used to calculate drug dosages
for pediatric patients
Clarks rule
Childs weight in lb/150 x
adult dose = child’s dose
Young’s formula
Age of child / age + 12 = child’s
dose
Dilling’s formula
Age of child/20 x adult dose =
child’s dose
ANLAGESICS USED IN
PEDIATRIC DENTISTRY
ANLAGESICS USED IN PEDIATRIC
DENTISTRY
 Management of dental pain in pediatric patients is
important
 Drugs prescribed to relive pain are called analgesics
CONCEPTS ABOUT PAIN IN
CHILDREN
 Children have high tolerance to pain.
 Pain perception low because of biologic immaturity.
 More sensitive to side effects of analgesics.
 Special risk for addiction to narcotics .
CLASSIFICATION
 Centrally acting( narcotic)
 Peripherally acting (non narcotic)
CENTRALLY ACTING
 More effective against acute pain
 More adverse effects
 No anti inflammatory or antipyretic effects
NON NARCOTIC ANALGESICS
 Mild to moderate pain
 Site of action peripheral nerve endings
 Less drug toxicity
 Absence of drug dependency
 Drugs in this class include
• Acetaminophen,
• Aspirin
• Non-steroidal anti-inflammatory drugs (NSAIDS)
ACETAMINOPHEN
 Antipyretic
 Mild analgesic
 Administer Per oral or Per rectal
 Pediatric Oral dose 10-15 mg/kg/dose every 4 hr
 Infant dose is 10-15 mg/kg/dose every 6-8 hr
 Adult dose 650 mg-1000 mg/dose
 Onset 30 minutes
 MOA: inhibition of the synthesis of prostaglandins
 Contraindications: Hypersensitivity to acetaminophen
 Warnings/Precautions: Do not exceed the maximum
dose. Acute over dosage may cause severe hepatic
toxicity
•SUPPLIED AS:
•Drops: 100 mg/ml (15 ml) or 80 mg/0.8ml (15ml)
•Elixir: 32 mg/ml (120ml)
•Tablets: 80 mg chewable or 325 mg regular or 500
mg extra strength
•Suppository, rectal: 120mg, 325mg, 650mg
NONSTEROIDAL ANTI-INFLAMMATORY
DRUGS – NSAIDS (IBUPROFEN, NAPROXEM)
 Antipyretic
 Analgesic for mild to moderate pain
 Anti-inflammatory
 COX inhibitor  Prostaglandin inhibitor
 Platelet aggregation inhibitor
 Main drugs used are ibuprofen, naproxem
IBUPROFEN
 Propionic acid derivative
 Used in rheumatoid arthritis , osteoarthritis
 Indicated in soft tissue injuries , tooth extraction,
fractures, vasectomy
 Dose for infants : 10 mg/kg/dose every 6 hours
 Adult dose 400-600 mg/dose every 6 hours
 Onset 30-45 minutes
 Maximum daily dosing
 <60 kg: 40 mg/kg
 >60 kg: 2400 mg
 May use higher doses in rheumatologic diseases
Side effects
 Gastric irritation, nausea , vomiting ,
 CNS sideeffects : head ache , tinnitus ,depression
 Rashes itching , hypersensitivity
 Aspirin induced asthma
NAPROXEM
 Another drug of propionic acid family
 Same action that of ibuprofen
 More anti inflammatory action
 Molecular structure different
Combination therapy
 Ibuprofen and paracetomol
 Diclofenac and paracetomol
 Nimesulide and paracetomol
 Mefenamic acid and paracetomol
NARCOTIC DRUGS
 Centrally acting
 Moderate to severe pain
 Infants younger than 3 months have increased risk of
hypoventilation and respiratory depression
 Low risk of addiction among children
SIDE EFFECTS OF OPIOIDS
 All opioid have side effects that should be anticipated &
managed
 Respiratory depression
 Nausea, vomiting
 Constipation
 Pruritis
 Urinary retention
OPIOIDS
 Codeine
 Oxycodone
 Morphine
 Fentanyl
 Hydromorphone
 Methadone
COEDINE
 Oral analgesic (also anti- tussive)
 Weak opioid
 Used often in conjunction with acetaminophen to increase
analgesic effect
 Metabolized in the liver and demethylated to morphine
 Some patients ineffectively convert codeine to morphine so
no analgesia is achieved
 Dose 0.5-1 mg/kg every 4-6 hours
Recent opoid analgesics
 Alfentanil
 Remifentanil
 Tramadol
ALFENTANIL AND RAMIFENTANIL
 Rapid onset
 Metabolized in liver
 Half life is 1 to 2 hr
 Uses : short painful procedures,
 Ramifentanil for long neurosurgical procedures
COMMERCIAL NAMES
 Alfenta
 Ultiva
Tramadol
 Weak agonist of all types of opioid receptors
 Uses
1. Mild to moderate pain
2. Cancer pain
 Dosage
Children:1 – 1.5 mg /kg
CONTRAINDICATIONS
 Respiratory depression
 Acute attack of asthma
 Head injury
 Raised intracranial pressure
COMMERCIAL NAMES
 Contramal
 Contraal DT
 Dolomed
 Dolotram
Antibiotics and analgesics in pediatric dentistry (2)
Antibiotics and analgesics in pediatric dentistry (2)
Antibiotics and analgesics in pediatric dentistry (2)
ANTIBIOTICS USED IN
PEDIATRIC DENTISTRY
Antibiotics
 Drugs that are produced by microbes to produce an
antibacterial action.
 The widespread use of antibiotics has resulted in common
bacteria developing resistance.
 Drug therapy should extend at least 5 days
 If discontinued prematurely, the surviving bacteria can
restart an infection that may be resistant to the original
antibiotic.
 ORAL WOUND MANAGEMENT
 Oral wounds are associated with an increased risk of
bacterial contamination.
 If the oral wound seems to have been contaminated by
extraoral bacteria, antibiotics therapy should be
considered
Antibiotics and analgesics in pediatric dentistry (2)
Dental Infection
 Not indicated if the infection is contained within the
pulpal tissue or the immediately surrounding tissue
 Patients presenting with facial swelling secondary to a
dental infection.
 Infection is of such severity then prescription of
antibiotics for a period of 5-10 days should be
considered before rendering treatment.
Pediatric Periodontal Diseases
 In pediatric periodontal diseases (neutropenias,
Papillon-Fevere syndrome, leukocyte adhesion
deficiency) the immune system is unable to control
the growth of periodontal microbes.
 Effective drug selection may be accomplished by
culture and susceptibility testing.
Viral diseases
 Antibiotics should not be prescribed for viral
conditions (acute primary herpetic gingivostomatitis)
unless there is strong evidence to suggest that a
secondary infection exists.
 Antibiotics can be categorized by the bacteria they
target.
 They are either narrow or wide spectrum.
 Narrow spectrum antibiotics are effective specifically
against either gram-positive or gram-negative
antibiotics.
 Broad spectrum antibiotics are effective against a
wider range of bacteria.
Classification
 Beta-lactam antibiotics
 Macrolides, azalides, streptogramins, prystinamycines.
 Linkozamides.
 Tetracyclines.
 Aminoglycosides.
 Chloramphenicols.
 Glycopeptides.
 Cyclic polipeptides (polimixins).
 Other antibiotics
The choice of antibiotic is
influenced by a number of factors
 Stage of infection development
 medical conditions or allergy.
 Antibiotics may also be categorized by their method of
attack:
 Bactericidal antibiotics
 Bacteriostatic antibiotics
PENCILLIN
 Beta-lactam antibiotic
 Bactericidal against gram-positive cocci and the
major microbes of mixed anaerobic infections.
Mechanism of penicillins action
They form complexes with enzymes - trans- and carboxypeptidases
(PCP), which control synthesis of peptidoglycan – component of cell-
wall of microorganisms
 Adverse drug reactions
mild diarrhea
 nausea
oral candidiasis.
Severe reactions of angioedema
 The alternative antibiotic is clindamycin.
 The preferred dosing is one hour before meals or two hours
after meals.
 Contraindications: Hypersensitivity to penicillin
 Warnings/Precautions:
• Caution in patients with severe renal impairment
(modify dosage)
• History of seizures
• Hypersensitivity to cephalosporins.
The usual daily dose of penicillin for
treating odontogenic infections is:
 Children ≤ 12 years of age: 25-50 mg/kg of body weight
in divided does every 6-8 hours.
 Children > 12 years of age and adults: 250-500 mg
every 6 hours for at least 10 days.
 Supplied as 125 or 250 mg/5ml solution or 250 and 500
mg tablets
CLINDAMYCIN
 Alternative choice in treating mild or early odontogenic
infection.
 Broad spectrum of activity
 Resistance to beta-lactamase degradation
 It is not effective against mycoplasma or gram-negative
aerobes..
 Adverse effects :
• Abdominal pain
• Nausea
• Vomiting
• Diarrhea
 Contraindications:
• Hypersensitivity to clindamycin
• Previous pseudomembranous colitis
• Regional enteritis,
• Ulcerative colitis.
 Warnings/Precautions:
• Use with caution in patients with liver
dysfunction (modify dosage);
• Can cause severe and fatal colitis;
• Discontinue drug if significant diarrhea,
abdominal cramps or blood and mucus passage
occurs.
The usual daily oral dose for treating
odontogenic infections in children is:
 Children under 12 years: 10-25 mg/kg/day in 3 equally
divided doses for 10 days.
 Children over 12 years and adults: 600-1800 mg/ day in 3
divided doses for 10 days. The maximum dose is 2-3
gms/day.
 Supplied as a 75 mg/5ml solution or 150, 300, 450, 600,
750, 900 mg tablets.
AMOXICILLIN
 More convenient dosing regimen e.g.; 2-3 doses daily
for amoxicillin versus 4 doses daily for penicillin VK
 Less effective than penicillin against aerobic gram
positive cocci
 Contraindications: Hypersensitivity to amoxicillin,
penicillin or any component of the formulation
 Warnings/Precautions:
• Use with caution in patients with severe renal
impairment (modify dosage)
• Low incidence of cross-allergy with other beta-lactams
and cephalosporins exists.
The usual daily oral dose for treating
odontogenic infections in children is:
 Children under 12 years: 20-40 mg/kg divided in 2-3
doses daily for 10 days.
 Children over 12 years and adults: 250 –500mg 3
times/day, maximum 2-3 gm/day for 10 days.
 Clavulanate potassium can be administered in
conjunction with amoxicillin (Augmentin®).
 Contraindications: Hypersensitivity to amoxicillin,
clavulanic acid, penicillin or any history of hepatic
dysfunction.
Warnings/Precautions:
• Prolonged use may result in superinfection.
• Use with caution in patients with severe renal
impairment
• Incidence of diarrhea
The usual daily oral dose of
Augmentin® for treating odontogenic
infections in children is:
 Children ≥ 3 months and < 40 kg: 20-40 mg/kg/day in
3 divided doses.
 Children > 40 kg and adults: 250-500 mg every 8 hours
or 875 mg every 12 hours.
 Augmentin® is supplied as 125, 200, 250 400 mg /5ml
solution, chewable tablets and tablets.
CEPHALOSPORINS
 First Generation
 Alternatives to penicillin for the treatment of
odontogenic infections.
 Bacterially effective against aerobes but not anaerobes.
 They are active against gram-positive staphylococci
and streptococci, but ineffective against enterococci.
Cefazolin
 Contraindications: hypersensitivity to cephalexin, any
component of the formulation, or other
cephalosporin's.
 Warnings/precautions: severe renal impairment;
prolonged use may result in super infection.
 Cephalexin (Keflex®) is the first generation
cephalosporin most often used to treat odontogenic
infections.
The usual daily oral dose for treating
odontogenic infections in children is:
 Children under 12 years: 25-50 mg/kg/day in divided
doses every 6 hours.
 Children over 12 and adults: 250-1000 mg every 6 hours
with a maximum of 4 g/day.
 Supplied as a 125, 250 mg/5ml suspension and 250 and
500mg capsule
 Second generation
• More effective against some of the anaerobes
• Contraindications: hypersensitivity to cefaclor,
• Warnings/precautions: modify dosage in patients with
severe renal impairment; prolonged use may result in
superinfection.
The usual daily oral dose for treating
odontogenic infections is:
 Children under 12 years: 20-40 mg/kg/day divided
every 8-12 hours with a maximum dose of 2 g/day.
 Children over 12 years and adults: 250-500 mg divided
every 8-12 hours.
 Cefaclor and cefuroxine are supplied as 125, 187, 250,
375 mg/5ml suspensions and 250 and 500 mg capsules.
Cefotaxime (C III)
Cefobid (Cefoperazone, C III)
Claphoran (cefotaxime, C III)
Macrolides (Erythromycin,
Clarithromycin, Azithromycin)
 The macrolides are antibiotics with a spectrum of
coverage similar to penicillin, with the addition of
some penicillanase-producing staphylococci,
chlamydiae, Legionella, mycoplasma and others
 Its most common side effect is gastrointestinal upset.
 Clarithromycin and azithromycin are structural
derivates of erythromycin
 Macrolides are bacteriostatic rather than
bacteriocidal
 Not recommended in immuno-compromised
patients.
 Contraindications: Hypersensitivity to erythromycin or any
component of the formulation.
 Warnings/Precautions: Use with caution in patients with
hepatic impairment. Administration may be accompanied by
malaise, nausea, vomiting, abdominal colic and fever.
The oral dosages and dosage forms of
the macrolides are:
 Erythromycin
o Infants and children < 12 years
i. Base: 30-50 mg/kg/day in 2-4 divided does; do not
exceed 2 g/day.
ii. Estolate: 30-50 mg/kg/day in 2-4 divided doses; do
not exceed 2g/day
iii. Ethylsuccinate: 30-50 mg/kg/day in 2-4 divided
doses; do not exceed 3.2 g/day
iv. Stearate: 30-50 mg/kg/day in 2-4 divided doses; do
not exceed 2 g/day
Clarithromycin (Biaxin®)
 Children ≥ 1 month: 15 mg/kg/day divided every 12
hours for 7 days; maximum 1 gm/day
 Adults: 250-500 mg every 12
 Supplied as:
1. Granules for oral suspension: 125 mg/5ml,
250mg/5ml (50 ml, 100 ml)
2. Tablet: 250 mg, 500 mg
3. Tablet, extended release: 500 mg
Antibiotics and analgesics in pediatric dentistry (2)
Azithromycin (Zithromax®)
 Children > 6months: 10 mg/kg -day 1, followed by 5
mg/kg/day for 4 days.
 Dose should be given 1 hour before a meal or 2 hours
after. Maximum 250 mg/day
 Adolescents ≥ 16 years or adult: 500 mg – day 1 then
250 mg days 2-5
Antibiotics and analgesics in pediatric dentistry (2)
Side affects of macrolides
 Dispeptic disorders, disbacteriosis, superinfection
 Cholestasis, cholestatic jaundice (erythromycin)
 Depression of liver microsome enzyme activity
(erythromycin, oleandomycin can not be combined
with theophylline, ergot alkaloids, carbamazepine)
 Development of resistance in process of treatment
Antibiotics and analgesics in pediatric dentistry (2)
Antibiotics and analgesics in pediatric dentistry (2)
THANK YOU

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Antibiotics and analgesics in pediatric dentistry (2)

  • 2. INTRODUCTION  Most common clinical situations in dentistry amenable to drug therapy in children are pain and infection.  The prescription of medications are more complicated than in the past.  The necessity to adjust the dosages of medications to accommodate their lower weight and body size.
  • 3. Adjustment of dosages in pediatric patients  Following formulas are used to calculate drug dosages for pediatric patients Clarks rule Childs weight in lb/150 x adult dose = child’s dose
  • 4. Young’s formula Age of child / age + 12 = child’s dose Dilling’s formula Age of child/20 x adult dose = child’s dose
  • 6. ANLAGESICS USED IN PEDIATRIC DENTISTRY  Management of dental pain in pediatric patients is important  Drugs prescribed to relive pain are called analgesics
  • 7. CONCEPTS ABOUT PAIN IN CHILDREN  Children have high tolerance to pain.  Pain perception low because of biologic immaturity.  More sensitive to side effects of analgesics.  Special risk for addiction to narcotics .
  • 8. CLASSIFICATION  Centrally acting( narcotic)  Peripherally acting (non narcotic)
  • 9. CENTRALLY ACTING  More effective against acute pain  More adverse effects  No anti inflammatory or antipyretic effects
  • 10. NON NARCOTIC ANALGESICS  Mild to moderate pain  Site of action peripheral nerve endings  Less drug toxicity  Absence of drug dependency
  • 11.  Drugs in this class include • Acetaminophen, • Aspirin • Non-steroidal anti-inflammatory drugs (NSAIDS)
  • 12. ACETAMINOPHEN  Antipyretic  Mild analgesic  Administer Per oral or Per rectal  Pediatric Oral dose 10-15 mg/kg/dose every 4 hr  Infant dose is 10-15 mg/kg/dose every 6-8 hr  Adult dose 650 mg-1000 mg/dose
  • 13.  Onset 30 minutes  MOA: inhibition of the synthesis of prostaglandins  Contraindications: Hypersensitivity to acetaminophen  Warnings/Precautions: Do not exceed the maximum dose. Acute over dosage may cause severe hepatic toxicity
  • 14. •SUPPLIED AS: •Drops: 100 mg/ml (15 ml) or 80 mg/0.8ml (15ml) •Elixir: 32 mg/ml (120ml) •Tablets: 80 mg chewable or 325 mg regular or 500 mg extra strength •Suppository, rectal: 120mg, 325mg, 650mg
  • 15. NONSTEROIDAL ANTI-INFLAMMATORY DRUGS – NSAIDS (IBUPROFEN, NAPROXEM)  Antipyretic  Analgesic for mild to moderate pain  Anti-inflammatory  COX inhibitor  Prostaglandin inhibitor  Platelet aggregation inhibitor  Main drugs used are ibuprofen, naproxem
  • 16. IBUPROFEN  Propionic acid derivative  Used in rheumatoid arthritis , osteoarthritis  Indicated in soft tissue injuries , tooth extraction, fractures, vasectomy
  • 17.  Dose for infants : 10 mg/kg/dose every 6 hours  Adult dose 400-600 mg/dose every 6 hours  Onset 30-45 minutes  Maximum daily dosing  <60 kg: 40 mg/kg  >60 kg: 2400 mg  May use higher doses in rheumatologic diseases
  • 18. Side effects  Gastric irritation, nausea , vomiting ,  CNS sideeffects : head ache , tinnitus ,depression  Rashes itching , hypersensitivity  Aspirin induced asthma
  • 19. NAPROXEM  Another drug of propionic acid family  Same action that of ibuprofen  More anti inflammatory action  Molecular structure different
  • 20. Combination therapy  Ibuprofen and paracetomol  Diclofenac and paracetomol  Nimesulide and paracetomol  Mefenamic acid and paracetomol
  • 21. NARCOTIC DRUGS  Centrally acting  Moderate to severe pain  Infants younger than 3 months have increased risk of hypoventilation and respiratory depression  Low risk of addiction among children
  • 22. SIDE EFFECTS OF OPIOIDS  All opioid have side effects that should be anticipated & managed  Respiratory depression  Nausea, vomiting  Constipation  Pruritis  Urinary retention
  • 23. OPIOIDS  Codeine  Oxycodone  Morphine  Fentanyl  Hydromorphone  Methadone
  • 24. COEDINE  Oral analgesic (also anti- tussive)  Weak opioid  Used often in conjunction with acetaminophen to increase analgesic effect  Metabolized in the liver and demethylated to morphine  Some patients ineffectively convert codeine to morphine so no analgesia is achieved  Dose 0.5-1 mg/kg every 4-6 hours
  • 25. Recent opoid analgesics  Alfentanil  Remifentanil  Tramadol
  • 26. ALFENTANIL AND RAMIFENTANIL  Rapid onset  Metabolized in liver  Half life is 1 to 2 hr  Uses : short painful procedures,  Ramifentanil for long neurosurgical procedures
  • 28. Tramadol  Weak agonist of all types of opioid receptors  Uses 1. Mild to moderate pain 2. Cancer pain  Dosage Children:1 – 1.5 mg /kg
  • 29. CONTRAINDICATIONS  Respiratory depression  Acute attack of asthma  Head injury  Raised intracranial pressure
  • 30. COMMERCIAL NAMES  Contramal  Contraal DT  Dolomed  Dolotram
  • 35. Antibiotics  Drugs that are produced by microbes to produce an antibacterial action.  The widespread use of antibiotics has resulted in common bacteria developing resistance.  Drug therapy should extend at least 5 days  If discontinued prematurely, the surviving bacteria can restart an infection that may be resistant to the original antibiotic.
  • 36.  ORAL WOUND MANAGEMENT  Oral wounds are associated with an increased risk of bacterial contamination.  If the oral wound seems to have been contaminated by extraoral bacteria, antibiotics therapy should be considered
  • 38. Dental Infection  Not indicated if the infection is contained within the pulpal tissue or the immediately surrounding tissue  Patients presenting with facial swelling secondary to a dental infection.  Infection is of such severity then prescription of antibiotics for a period of 5-10 days should be considered before rendering treatment.
  • 39. Pediatric Periodontal Diseases  In pediatric periodontal diseases (neutropenias, Papillon-Fevere syndrome, leukocyte adhesion deficiency) the immune system is unable to control the growth of periodontal microbes.  Effective drug selection may be accomplished by culture and susceptibility testing.
  • 40. Viral diseases  Antibiotics should not be prescribed for viral conditions (acute primary herpetic gingivostomatitis) unless there is strong evidence to suggest that a secondary infection exists.
  • 41.  Antibiotics can be categorized by the bacteria they target.  They are either narrow or wide spectrum.  Narrow spectrum antibiotics are effective specifically against either gram-positive or gram-negative antibiotics.  Broad spectrum antibiotics are effective against a wider range of bacteria.
  • 42. Classification  Beta-lactam antibiotics  Macrolides, azalides, streptogramins, prystinamycines.  Linkozamides.  Tetracyclines.  Aminoglycosides.  Chloramphenicols.  Glycopeptides.  Cyclic polipeptides (polimixins).  Other antibiotics
  • 43. The choice of antibiotic is influenced by a number of factors  Stage of infection development  medical conditions or allergy.
  • 44.  Antibiotics may also be categorized by their method of attack:  Bactericidal antibiotics  Bacteriostatic antibiotics
  • 45. PENCILLIN  Beta-lactam antibiotic  Bactericidal against gram-positive cocci and the major microbes of mixed anaerobic infections.
  • 46. Mechanism of penicillins action They form complexes with enzymes - trans- and carboxypeptidases (PCP), which control synthesis of peptidoglycan – component of cell- wall of microorganisms
  • 47.  Adverse drug reactions mild diarrhea  nausea oral candidiasis. Severe reactions of angioedema  The alternative antibiotic is clindamycin.  The preferred dosing is one hour before meals or two hours after meals.
  • 48.  Contraindications: Hypersensitivity to penicillin  Warnings/Precautions: • Caution in patients with severe renal impairment (modify dosage) • History of seizures • Hypersensitivity to cephalosporins.
  • 49. The usual daily dose of penicillin for treating odontogenic infections is:  Children ≤ 12 years of age: 25-50 mg/kg of body weight in divided does every 6-8 hours.  Children > 12 years of age and adults: 250-500 mg every 6 hours for at least 10 days.  Supplied as 125 or 250 mg/5ml solution or 250 and 500 mg tablets
  • 50. CLINDAMYCIN  Alternative choice in treating mild or early odontogenic infection.  Broad spectrum of activity  Resistance to beta-lactamase degradation  It is not effective against mycoplasma or gram-negative aerobes..
  • 51.  Adverse effects : • Abdominal pain • Nausea • Vomiting • Diarrhea  Contraindications: • Hypersensitivity to clindamycin • Previous pseudomembranous colitis • Regional enteritis, • Ulcerative colitis.
  • 52.  Warnings/Precautions: • Use with caution in patients with liver dysfunction (modify dosage); • Can cause severe and fatal colitis; • Discontinue drug if significant diarrhea, abdominal cramps or blood and mucus passage occurs.
  • 53. The usual daily oral dose for treating odontogenic infections in children is:  Children under 12 years: 10-25 mg/kg/day in 3 equally divided doses for 10 days.  Children over 12 years and adults: 600-1800 mg/ day in 3 divided doses for 10 days. The maximum dose is 2-3 gms/day.  Supplied as a 75 mg/5ml solution or 150, 300, 450, 600, 750, 900 mg tablets.
  • 54. AMOXICILLIN  More convenient dosing regimen e.g.; 2-3 doses daily for amoxicillin versus 4 doses daily for penicillin VK  Less effective than penicillin against aerobic gram positive cocci  Contraindications: Hypersensitivity to amoxicillin, penicillin or any component of the formulation
  • 55.  Warnings/Precautions: • Use with caution in patients with severe renal impairment (modify dosage) • Low incidence of cross-allergy with other beta-lactams and cephalosporins exists.
  • 56. The usual daily oral dose for treating odontogenic infections in children is:  Children under 12 years: 20-40 mg/kg divided in 2-3 doses daily for 10 days.  Children over 12 years and adults: 250 –500mg 3 times/day, maximum 2-3 gm/day for 10 days.
  • 57.  Clavulanate potassium can be administered in conjunction with amoxicillin (Augmentin®).  Contraindications: Hypersensitivity to amoxicillin, clavulanic acid, penicillin or any history of hepatic dysfunction.
  • 58. Warnings/Precautions: • Prolonged use may result in superinfection. • Use with caution in patients with severe renal impairment • Incidence of diarrhea
  • 59. The usual daily oral dose of Augmentin® for treating odontogenic infections in children is:  Children ≥ 3 months and < 40 kg: 20-40 mg/kg/day in 3 divided doses.  Children > 40 kg and adults: 250-500 mg every 8 hours or 875 mg every 12 hours.  Augmentin® is supplied as 125, 200, 250 400 mg /5ml solution, chewable tablets and tablets.
  • 60. CEPHALOSPORINS  First Generation  Alternatives to penicillin for the treatment of odontogenic infections.  Bacterially effective against aerobes but not anaerobes.  They are active against gram-positive staphylococci and streptococci, but ineffective against enterococci.
  • 62.  Contraindications: hypersensitivity to cephalexin, any component of the formulation, or other cephalosporin's.  Warnings/precautions: severe renal impairment; prolonged use may result in super infection.  Cephalexin (Keflex®) is the first generation cephalosporin most often used to treat odontogenic infections.
  • 63. The usual daily oral dose for treating odontogenic infections in children is:  Children under 12 years: 25-50 mg/kg/day in divided doses every 6 hours.  Children over 12 and adults: 250-1000 mg every 6 hours with a maximum of 4 g/day.  Supplied as a 125, 250 mg/5ml suspension and 250 and 500mg capsule
  • 64.  Second generation • More effective against some of the anaerobes • Contraindications: hypersensitivity to cefaclor, • Warnings/precautions: modify dosage in patients with severe renal impairment; prolonged use may result in superinfection.
  • 65. The usual daily oral dose for treating odontogenic infections is:  Children under 12 years: 20-40 mg/kg/day divided every 8-12 hours with a maximum dose of 2 g/day.  Children over 12 years and adults: 250-500 mg divided every 8-12 hours.  Cefaclor and cefuroxine are supplied as 125, 187, 250, 375 mg/5ml suspensions and 250 and 500 mg capsules.
  • 69. Macrolides (Erythromycin, Clarithromycin, Azithromycin)  The macrolides are antibiotics with a spectrum of coverage similar to penicillin, with the addition of some penicillanase-producing staphylococci, chlamydiae, Legionella, mycoplasma and others
  • 70.  Its most common side effect is gastrointestinal upset.  Clarithromycin and azithromycin are structural derivates of erythromycin  Macrolides are bacteriostatic rather than bacteriocidal  Not recommended in immuno-compromised patients.
  • 71.  Contraindications: Hypersensitivity to erythromycin or any component of the formulation.  Warnings/Precautions: Use with caution in patients with hepatic impairment. Administration may be accompanied by malaise, nausea, vomiting, abdominal colic and fever.
  • 72. The oral dosages and dosage forms of the macrolides are:  Erythromycin o Infants and children < 12 years i. Base: 30-50 mg/kg/day in 2-4 divided does; do not exceed 2 g/day. ii. Estolate: 30-50 mg/kg/day in 2-4 divided doses; do not exceed 2g/day iii. Ethylsuccinate: 30-50 mg/kg/day in 2-4 divided doses; do not exceed 3.2 g/day iv. Stearate: 30-50 mg/kg/day in 2-4 divided doses; do not exceed 2 g/day
  • 73. Clarithromycin (Biaxin®)  Children ≥ 1 month: 15 mg/kg/day divided every 12 hours for 7 days; maximum 1 gm/day  Adults: 250-500 mg every 12  Supplied as: 1. Granules for oral suspension: 125 mg/5ml, 250mg/5ml (50 ml, 100 ml) 2. Tablet: 250 mg, 500 mg 3. Tablet, extended release: 500 mg
  • 75. Azithromycin (Zithromax®)  Children > 6months: 10 mg/kg -day 1, followed by 5 mg/kg/day for 4 days.  Dose should be given 1 hour before a meal or 2 hours after. Maximum 250 mg/day  Adolescents ≥ 16 years or adult: 500 mg – day 1 then 250 mg days 2-5
  • 77. Side affects of macrolides  Dispeptic disorders, disbacteriosis, superinfection  Cholestasis, cholestatic jaundice (erythromycin)  Depression of liver microsome enzyme activity (erythromycin, oleandomycin can not be combined with theophylline, ergot alkaloids, carbamazepine)  Development of resistance in process of treatment