Antibiotics in Dental Care

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Questions and Answers

Which macrolide is preferred as a penicillin-alternative drug in patients who are allergic to penicillin?

Cephalosporin

Clindamycin

Erythromycin

Azithromycin (correct)

When combined with anticoagulant drugs, which macrolide increases the risk of bleeding?

Azithromycin

Clarithromycin

Erythromycin (correct)

Cephalosporin

What is the role of Azithromycin in endocarditis prophylaxis?

Prophylactic use (correct)

Treatment of Syphilis

Therapeutic use

Treatment of acute orofacial infections

What is the adverse effect of macrolides on the GIT?

Nausea, vomiting, and diarrhea Signup and view all the answers

Which macrolide increases the level of Theophylline leading to toxicity?

Erythromycin Signup and view all the answers

What is the dose of Azithromycin used in endocarditis prophylaxis?

500 mg Po ac 1 hour before the procedure Signup and view all the answers

What is a potential adverse effect of clindamycin on a breastfed infant?

Gastrointestinal flora imbalance Signup and view all the answers

Which of the following is a therapeutic use of Azithromycin?

Treatment of acute orofacial infections Signup and view all the answers

What is the dosage of clindamycin for prophylactic use in a penicillin allergic patient?

600mg PO 1 hour before the procedure Signup and view all the answers

What is the effect of combining macrolides with penicillin?

Antagonistic effect Signup and view all the answers

What is the mechanism of action of tetracyclines?

Inhibition of protein synthesis Signup and view all the answers

Why do tetracyclines have poor absorption when taken with calcium?

They chelate with calcium Signup and view all the answers

What is a dental use of tetracyclines?

Treatment of periodontal and peri-implant disease Signup and view all the answers

What is a side effect of tetracyclines in growing children?

Intrinsic tooth staining Signup and view all the answers

How are tetracyclines eliminated from the body?

Through the kidneys Signup and view all the answers

Why are tetracyclines not effective in treating central nervous system infections?

They cannot penetrate the CSF Signup and view all the answers

Which of the following antibiotics is known to be effective against anaerobic bacteria?

Metronidazole Signup and view all the answers

Which of the following is a potential adverse drug effect associated with metronidazole?

Disulfiram-like reaction Signup and view all the answers

What is the primary mechanism of action of metronidazole?

Inhibition of DNA synthesis Signup and view all the answers

In which body fluids can therapeutic levels of metronidazole be found?

Saliva, breast milk, and cerebrospinal fluid Signup and view all the answers

What is a common reason for combining metronidazole with penicillin in the treatment of odontogenic infections?

To provide coverage for both anaerobic and aerobic bacteria Signup and view all the answers

Why is it important to avoid combining penicillin and aminoglycosides in the same syringe?

They may form an inactive complex Signup and view all the answers

Which of the following is a common symptom associated with metronidazole use?

Metallic taste Signup and view all the answers

What is a possible consequence of administering metronidazole to a patient who consumes alcohol?

Disulfiram-like reaction Signup and view all the answers

Study Notes

Erythromycin vs. Azithromycin

Erythromycin is not preferred for severe infections or immunocompromised patients requiring bactericidal activity.
Azithromycin is the preferred alternative for penicillin-allergic patients and those intolerant to clindamycin due to better pharmacokinetics.
Erythromycin enhances the effect of anticoagulant Warfarin, increasing bleeding risk.
Azithromycin is concentrated in neutrophils and macrophages, allowing for a longer half-life and once-daily dosing.

Dental Uses of Azithromycin

Prophylactic Use:
- Endocarditis prophylaxis: 500 mg orally or parenterally 1 hour before the procedure.
Therapeutic Uses:
- Second-line treatment for Syphilis.
- Effective for acute orofacial infections such as periapical abscesses: 500 mg orally once daily for 3 days.

Drug Interactions

Macrolides can antagonize the bactericidal effect of penicillin.
Erythromycin increases the effects of oral anticoagulants, heightening bleeding risk.
Anticonvulsants may have their effectiveness altered with macrolide presence.
Theophylline levels may rise, leading to toxicity when combined with Erythromycin or Clarithromycin.

Adverse Effects of Antibiotics

Common gastrointestinal issues include nausea, vomiting, and diarrhea, with potential for colitis.
Clindamycin can be prescribed during lactation, but may affect the gastrointestinal flora of the breastfed infant.

Dental Uses of Clindamycin

Prophylactic Use in Penicillin Allergic Patients:
- Oral administration: 600 mg (300 mg x 2 capsules) 1 hour before procedure.
- Parenteral administration: 600 mg IV/IM 1 hour before procedure.
Therapeutic Uses in Penicillin Allergic Patients:
- Treatment regimen: Clindamycin 300 mg capsules orally four times daily for 5 days.

Tetracyclines Overview

Broad-spectrum bacteriostatic antibiotics that inhibit bacterial protein synthesis.
Poor absorption when taken with calcium, and cannot penetrate cerebrospinal fluid, even during infections.
Highest bioavailability in gingival sulcus makes them effective against periodontal diseases.

Dental Uses for Tetracyclines

Exhibit anticollagenase effect, inhibiting tissue breakdown, particularly useful for periodontal and peri-implant disease.
Can cause intrinsic tooth staining in children due to calcium chelation.

Metronidazole (Flagyl)

Inhibits DNA synthesis, effective only against anaerobic bacteria.
Absorbed rapidly after oral administration, distributing well in body fluids including saliva and breast milk.
Therapeutic uses include management of periodontal diseases and anaerobic odontogenic infections.

Routes of Administration for Metronidazole

Oral dosage: 500 mg three times daily for 7 to 10 days.
Can be administered parenterally via slow intravenous infusion.

Adverse Effects of Metronidazole

Gastrointestinal disturbances, epigastric distress, and unpleasant metallic taste are common.
Side effects include hairy tongue, glossitis, dry mouth, stomatitis, and disulfiram-like reactions with alcohol intake.

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Description

Compare the uses of Erythromycin and Azithromycin in dental care, especially in patients with severe infections or allergies.