Overview of Antibiotics and Analgesics in Oral Surgery (2023) PDF

Overview of antibiotics and analgesics in oral surgery Dr Fawaz Baig Assistant Professor OMS Dept. KKUCOD ABHA MDS 442 2023  Topics Antimicrobial therapy a. Introduction b. Classifications c....

Overview of antibiotics and analgesics in oral surgery Dr Fawaz Baig Assistant Professor OMS Dept. KKUCOD ABHA MDS 442 2023  Topics Antimicrobial therapy a. Introduction b. Classifications c. Principles of antibiotic therapy - briefly d. B-lactam antibiotics – penicillins and cephalosporins e. Quinolones f. Aminoglycosides g. Metronidazole h. Clindamycin Analgesics a. Commonly used analgesics (Opioids and NSAID) in oral surgery b. Indications and contraindications (cautions) for use of analgesics  Introduction to antibiotics Originally, an antibiotic was a chemical substance produced by a micro- organism, which has the capacity, in dilute solutions, to inhibit the growth of or kill other organisms. They are now also synthesized chemically  Thus, antibiotics..... can be natural or chemical drugs can prevent, control or treat infections may be Bactericidal/bacteriostatic can be allergenic  Classification 1- Source (preparation) ⦿ Naturally occurring, e.g. from fungi, e.g. f penicillins,cephalosporins, erythromycin, tetracycline,chloramphenicol, and aminoglycosides, etc. ⦿ Synthetic, e.g. sulfonamides to  Classification 2 – family/class ⦿ Penicillins ⦿ Cephalosporins ⦿ Tetracyclines ⦿ Sulfonamides is ⦿ Aminoglycosides ⦿ Macrolides  Classification 3- spectrum 2 ⦿ Narrow spectrum: Penicillins to ⦿ Broad spectrum: Ampicillins, tetracyclines  Classification 4 – Bio Effect so ⦿ Bacteriostatic:Erythromycin, tetracycline, sulfonamide, etc. ⦿ Bactericidal: Penicillins, cephalosporins, etc. of Classification 5 – target organisms ⦿ Gram 0 + versus Gram – bacteria ⦿ Aerobic versus anaerobic bacteria to He Mechanism of action Select antibiotic based on: › First ascertain the bacterial cause › Study of culture and sensitivity › Age of medical status of patient › Pregnancy and neonatal period › Severity of disease › Nature of the drug ‹ ‫‹ التأكد أوالً من السبب البكتيري ‹ دراسة الثقافة والحساسية‬ ‹ ‫عمر الحالة الطبية للمريض ‹ فترة الحمل وحديثي الوالدة‬ › Drug resistance ‫شدة املرض ‹ طبيعة الدواء ‹ مقاومة األدوية ‹ تفاعالت‬ › Allergic reactions ‫الحساسية ‹ تسمم الدواء ‹ تكلفة العالج ‹ التركيز على نطاق‬ › Drug toxicity › Cost of therapy › Focused narrow-spectrum therapy  Removal of source of infection ⦿ Antimicrobial therapy is not a substitute for surgery. ⦿ All sources of infections must be adequately dealt with..‫العالج املضاد للميكروبات ليس بديالً عن الجراحة‬.‫⦿ يجب التعامل مع جميع مصادر العدوى بشكل مناسب‬  Principles of antibiotic administrations 1. Dosage and duration of drug. 2. Route and frequency of administration  Uses ⦿ Acute dento-facial infections ⦿ Prevent infection in patients with decreased immunity ⦿ Prophylaxis against endocarditis  Cautions 5 I ⦿ Allergies ⦿ routine extractions ⦿ Liver/kidney failure ⦿ Pregnancy/lactation  β-lactam antibiotics ⦿ Antibiotics of this group are: › Penicillins › semisynthetic derivatives of penicillin › Cephalosporins ⦿ Inhibits cell so wall synthesis ⦿ Bacterial resistance: The bacteria can develop enzymes known as penicillinase ⦿ Allergy is the main adverse reaction. ⦿ excreted unchanged through kidneys.  Penicillins ⦿ discovered in 1929 by Alexander Flemming ⦿ derived from a mould,Penicillium notatum ⦿ First antibiotic ever used ⦿ Classification: › Naturally occurring, eg Penicillin G, Penicillin V › Semisynthetic Penicillins Short-acting: Ampicillin, Amoxicillin, Piperacillin, Long-acting: procaine penicillin Proving  Administration ⦿ Oral route is safest and used routinely in OPD setting ⦿ Where IV injections are indicated, it is safer to hospitalize and observe for 30 minutes ⦿ The spectrum of bactericidal activity is much greater following IV use of penicillins; because of higher serum levels achieved  Oral administration ⦿ Ampicillin and amoxycillin ⦿ Atleast 1 hour after meals or 3-4 hours after for best absorption ⦿ 4-5 days in doses split either 6 or 8 hourly ⦿ Broad spectrum effect if clavulanic acid is added by inhibition of b-lactamase enzyme eg Augmentin E ⦿ Amoxycillin adult dose: 250-500mg TID ⦿ Safe in pregnancy and lactation  Cephalosporins ⦿ Similar structure, mechanism of action and effect like penicillins ⦿ used as an alternative drug to penicillin ⦿ Classification: › 1st generation (cephalothin and cephalexin) 00 › 2nd generation (cefotaxime) › 3rd generation (Ceftazidime and cefixime) iii A ⦿ Cefixime can be used in cases with true penicillin allergy (200-400mg BD) twotimesdai.ly a  Quinolones ⦿ Inhibit synthesisof bacterial DNA ⦿ Broad spectrum and bactericidal ⦿ effective against MRSA, streps, E. coli, Klebsiella and Proteus mirabilis ⦿ Fluoroquinolones chemically related to nalidixic acid; and have fluorine in their chemical structure ⦿ Commonly used: norfloxacin, So Ciprofloxacin (500mg BD), ofloxacin  Aminoglycosides ⦿ Bactericidal ⦿ Effective against gram negative bacteria, especially those, resistant to penicillins ⦿ Eg: gentamycin,vancomycin, streptomycin, kanamycin, neomycin and tobramycin ⦿ Ototoxicity! iris ⦿ Gentamycin 40-80 mg i.v. used in severe anerobic infections or surgical prophylaxis e  Metronidazole vi ⦿ effective in anaerobic infections and acute necrotizing ulcerative gingivitis (ANUG). 0 ⦿ Used with one of the penicillins, usually, amoxycillin to treatacute orofacial infections with an anaerobic component of causative micro-organisms. a ⦿ Teratotoxic! ⦿ Nausea, vomiting and change of taste ⦿ Dosage: 250-500mg TID ⦿ Caution in patients on anticoagulants 0  Analgesics G ⦿ natural or chemical drugs 0 ⦿ prevent, control or treat pain ⦿ NSAIDs / Opioids It 00 ⦿ Some NSAIDs – allergy, asthma, gastric ⦿ irritation/ulcer ⦿ Opioids – sedation and addiction v3.6  Commonly used analgesics ⦿ Ibuprofen ⦿ Acetaminophen 80 (Paracetamol) ⦿ Diclofenac Sodium  Uses ⦿ Any surgery/extraction-> inflammation-> Pain ⦿ Oral route takes time to act, consider administration before the procedure ⦿ Major surgery/severe pain – consider opioids  Cautions ⦿ Allergies O ⦿ Liver and kidney disease ⦿ Peptic ulcer O ⦿ Pregnancy/lactation ⦿ Bone marrow suppression O  Muscle relaxants ⦿ To treat Muscle spasm/ trismus ⦿ Can cause sedation ⦿ Eg. Chloraxazone o  References ⦿ Textbook of oral and maxillofacial surgery- 3rd edition- Prof. Neelima Malik - Chapter 9 – page 119-132 , pg 135 ⦿ Clinical implications of prescribing nonsteroidal anti-inflammatory drugs in oral health care- a review; Ravleen et al; Oral Surg Oral Med Oral Pathol Oral Radiol 2015;119:264-271