Questions and Answers
Which macrolide is preferred as a penicillin-alternative drug in patients who are allergic to penicillin?
When combined with anticoagulant drugs, which macrolide increases the risk of bleeding?
What is the role of Azithromycin in endocarditis prophylaxis?
What is the adverse effect of macrolides on the GIT?
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Which macrolide increases the level of Theophylline leading to toxicity?
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What is the dose of Azithromycin used in endocarditis prophylaxis?
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What is a potential adverse effect of clindamycin on a breastfed infant?
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Which of the following is a therapeutic use of Azithromycin?
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What is the dosage of clindamycin for prophylactic use in a penicillin allergic patient?
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What is the effect of combining macrolides with penicillin?
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What is the mechanism of action of tetracyclines?
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Why do tetracyclines have poor absorption when taken with calcium?
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What is a dental use of tetracyclines?
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What is a side effect of tetracyclines in growing children?
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How are tetracyclines eliminated from the body?
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Why are tetracyclines not effective in treating central nervous system infections?
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Which of the following antibiotics is known to be effective against anaerobic bacteria?
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Which of the following is a potential adverse drug effect associated with metronidazole?
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What is the primary mechanism of action of metronidazole?
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In which body fluids can therapeutic levels of metronidazole be found?
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What is a common reason for combining metronidazole with penicillin in the treatment of odontogenic infections?
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Why is it important to avoid combining penicillin and aminoglycosides in the same syringe?
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Which of the following is a common symptom associated with metronidazole use?
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What is a possible consequence of administering metronidazole to a patient who consumes alcohol?
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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
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Prophylactic Use:
- Endocarditis prophylaxis: 500 mg orally or parenterally 1 hour before the procedure.
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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.
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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.
