Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
1.
Introduction
2.
Definition
3.
Mechanism of Action
4.
5.
Spectrum of activity
6.
Types of Action
7.
8.
9.
10.
11.
b)
c)
In Exodontia
d)
e)
f)
For perimplantitis
g)
h)
i)
Skeletal anchorage
j)
In mandibular surgery
k)
l)
12.
Conclusion
13.
References
Introduction
Antimicrobial drugs are the greatest contribution of the 20 th century to therapeutics.
Their advance changed the outlook of the physician about the power drugs can have
on diseases. They are one of the few curative drugs. Then importance in magnified
in the developing countries where infective disease predominate. As aelavs they are
one of the most frequently used as well as misused drug. Drugs in this class differ
from all others in that. They are designed to indirect kill the expecting organism and
to have no minimal effect on the recipient. This type of therapy is generally called
chemotherapy.
Antibiotics
-
These are substances produced by micro organism which selectively select the
growth of or kill the other microorganism at very low concentration.
Classification
Antimicrobial drugs can be classified in many ways :
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Oxazoliolinone : Linezolid
12.
13.
14.
15.
16.
17.
18.
Mechanism of Action
1.
2.
3.
4.
5.
6.
7.
2.
3.
4.
5.
Spectrum of Activity
Narrow Spectrum
Broad Spectrum
Penicillin G
Tetracycline
Streptomycin
Chloramyhenicol
Erythromycin
Types of Action
Primarily Bacteriostatic
Sulfonamide
Erythromycin
Tetracycline
Ethambulol
Chloramphenicol
Clindamycin
Linezolid
Primarily Bactericidal
Penicillin
Cephalosporin
Aminoglycuside
Vancomycin
Polypeplides
Naledixie Acid
Rifampin
Cejrofloxacin
Isoniazid
Metronidazole
Pyrazinamide
Cotrimoxazole
Toxicity
(a)
General
Systemic Toxicity - Almost all AMA's produces dose related and preclitest
organ toxicities characteristic toxicities are exhibited by different AMAs.
Some have high therapeutic index-dose upto 100-fold range may be given
without apparent damage to host cell.
Tetracycline
Chlorampliemiet
Some other have very low therapeutic use is highly restricted to conditions where no
suitable alternative is available eg. :
2)
Polymyxin B
Vancomycin
Azithromycin B
Hypersensitivity
Practically all AMAs are capable of causing hypersensitivity reactions. There
are unpredictable and unrelated dose. The whole range of reaction from rashes
to anaphylactic shall can be produced. The commonly involved AMA's are
penicillin, cephalosporin, sulfonamides, flurogunolones.
3)
Natural Remittances
Some microbes have always been reinstant to certain AMA.
metasolie process or the forget site, which is affected by the particular drug eg. gram
negative bacilli are normally unaffected by penicillin 4 or M. tuberculosis is
insorritive to tetracyclines.
Acquired Resistance
It is developed by an organic resistance to drugs. Due to use of an AMA over a period
of time this can happen with any microbe and is a major clinical problem.
-
However in the past 30 years highly penicillin remittance gonococci have been
appeared.
Among the
microorganism.
4)
Superinfection (Suprainfection)
Corticuslenoid therapy
AIDS
Agramulocytosis
5)
Nutritional Deficiencies
Prolonged use of antimurids which alter this flora may result in vitamin
deficiencies.
6)
Marking of an infection
A short course use of AMA may be sufficient to treat one infection but only
briefly syppren another one contacted communally.
The other infection will be marked initially only to manifest later in a severe
form eg. Sychillin is marked by use of single box of penicillin which is
sufficient to one gonorrhoea.
Patient Factor
1.
The t of amino glycosides is prolonged in elderly and they are more prone
to develop VIII new toxicity.
Tetracyclino depends in the developing teeth and bone, direction and weaken
them, are contraindication below age of 6 year.
2.
Caution use and modification of dose of an AMA becomes necessary when the
organ of its disposed is defection.
Ampholencin B
Cephalorporni
Ethambulol
Vancomycin
Flucytorine
Carbenicillin
Cotrimoxazole
Fluoroquimolunes
Aztreonam
Catrithomycin
Meropenem
Imipenem
Drug to be avoided
Cephalothin
Talampicillin
Nalidixic Acid
Tetracycline
Nitrofuranlosis
(except doxycycline)
Tetracycline
Pyrazinomide
Nalidixic Acid
Talampicillin
Defloxacin
Isomiazid
Metromdazole
Rifampicin
Clindamycin
3)
Local Factors
Presence of pin and secretion decreases the efficacy of most AMAs especially
sulfonamides and aminoglycoxides.
4)
5)
6)
Pregnancy
All AMA should be avoided in the pregnant because many cephalosporim and
azithromycin are safe, while safety data in most is available.
contrimoxarole,
ehlaramphemicol,
sulfonamide
and
introfenantoin.
-
Though metronide zole has not been found terafogenie its mutagenic potential
warrants caution in its use during pregnancy.
7.
Genetic Factors
In Implant Dentistry
Clindamycin broad spectrum actively against the aerobic, anaerobic & Blactum producing pathogen plus high oral absorption, significant soft and bone
tissue penetration and stimulatory effect on the host immune system make it
an excellent choice for antibiotic prophylaxis.
b)
Aminoglycosides (gentacin) are the most frequently used antibiotics for local
treatment of bone infection and affect the mitochondrial protein synthesis but
not effect on PHO.
c)
In Exodontia
d)
g)
For Periimplantitis
The antibiotic must remain at the site of action for at least 7 to 10 days in a
concentration high enough to penetrate the submucosal biofilm.
Tetracycline
periodontal
fibres
(actisite),
minocycline
hydrochloride
The patient should be started on prophylactic acyclovir at 400 mg. bid starting
2 days before the treatment and maintained until 5 days after the procedure, or
alternatively nalacyclovir 500 mg. bid with the same regimen.
i)
Skeletal Anchorage
Because the implants used for skeletal anchorage are transmucosal and involve
a portion of hardware that remain exposed to the oral cavity, antiinfective
coverage is employed during the post operative phase.
The patients are given a 5 day course of antinfectives orally and then surgical
placement.
j)
In Mandibular Surgery
The treatment of non complicated fractures do not seen to improve versus not
using antibiotic therapy.
In Trauma Patient
-
Third mid and upper fracture third generation cephalosporin are used treating
those cases with liquosshea though the majority of facture in this region of the
face are considered complex or compounded, communicating the oral mucosa
with other parts such as paranasal sinuses.
In this sense under improper we would rather use propylactic antibiotic since
the very beginning of these fractures.
Recurrent Cellulites
-
04-432 absolute ethanol, doxycycline and bleonycin have all been used as
sclerosing agent.
In Osteomyelitis
-
Culture driven antimicrobial therapy should be ideal but often the osteomyelitis
wound is contaminated via intra-oral/extranal fisnuralim or teeth.
Empiried treatment should begin with penicillin in relatively high dose (4-6
million units) four times a day.
Conclusion
Antibiotic prophylasis in oral and maxillofacial surgery aims the prevention of the
infection of the surgery wound either due to characteristic of the surgery or the
general slate of the patient. This risk increases with the contamination of the surgical
operation area, making it necessary to imply in a pleophylactic treatment of the
infection in clean contaminated and contaminated surgeons and treatment of the
infection in dirty surgery. Moreoever a proper surgical technique helps to reduce the
development of post surgical infection. The elective antibiotic chemotherapy ranges
from penicillin derivative tooth betalactamase inhibities to second and third
generation cephalosporis, quinolone or clindamycin. So the antibiotic has a very
important role in pre-operative preparation and postoperative infection control in oral
and maxillofacial surgery.
References
1)
2)
K.D. Tripathi
3)
Laskin
4)
Peterson
Fonseca