Antibiotics & Analgesics Used in Dentistry

ANTIBIOTICS COMMONLY USED IN DENTISTRY
1. ANTIBIOTIC PROPHYLAXIS:
Amoxycillin 2g orally (p.o.) 1 hour before treatment in adults (kids 50mg/kg up to 2g).
Amoxy/Ampicillin 2g in adults IV (kids 50mg/kg up to 2g i.v.). Given just before
procedure. OR same doses given IM 30min before procedure.
Clindamycin 600mg p.o. 1 hour before treatment in adults, 15mg/kg in kids. Given if
allergy to penicillin/cephalosporin.
Vancomycin 25mg/kg IV over 1 hour or lincomycin 600mg/kg IV 20mg/kg and initially
the 10mg subsequenty kids).
Note: 7-18% of patients allergic to penicillin are allergic to cephalosporins.
Therapeutic Guidlines 2008 Prevention of endocarditis update: AB prophylaxis is now only recommended for patient with
cardiac conditions associated with the highest risk of adverse outcomes from endocarditis. These high risk cardiac conditions
are:
Prosthetic cardiac valves or prosthetic material used for cardiac valve repair.
Congenital heart disease including unrepaired cyanotic defects, (shunts and conduits)
Completely repaired defects with prosthetic material within 6mth of surgery.
Cardiac transplant
Rheumatic heart disease in indigenous aboriginals
Previous hx of endocarditis.

2. FOR TREATMENT OF ODONTOGENIC INFECTION
Antibiotics
Amoxycillin: Actue: 500mg t.i.d, p.o. 250mg if low grade infection.
Penicillin V: Same as above. (less incidence of thrush compared with other penicillins)
Ceflexin: 250mg q.i.d, p.o.
Metronidazole: Acute: 400mg t.i.d, po 200mg if low grade infection.
Erythromycin: Acute:500mg q.i.d. 250 if low grade infection
Doxycycline: Acute:200mg loading dose then 100mg b.i.d. In kiks 1.2mg/kg b.i.d day
one the 1-2mg once a day, p.o. NOTE: Contraindicated after 18 (16 wks postconception) weeks as they formations
of teeth and cause staining.
Augmentin: Acute 500mg t.i.d, p.o. In kids 80-90mg/kg b.i.d, p.o. based on amoxycillin
component.
Antifungals
Miconazole (or fluconazole/Ketoconazole): 2% gel 2.5mL q.i.d. for 21 days.
* Interacts with Warfarin, nifedipine, prednisone, midazolam, cyclosporin)
Nystatin: 100 000units q.i.d, p.o. for 21 days
Amphoteracin B 10mg lozenge q.i.d for 21 days
Antivirals
Aciclovir or Famciclovir: For Herpes Zoster & Bells palsy 800mg 5X a day for 7 days.
For primary herpetic gingivostomatitis 20mg/kg every 5 hours.
SITE OF ACTION, CLASS, EXAMPLE & MOA OF COMMONLY PRESCRIBED
ANTIBIOTICS

Cell membranes & cell wall peptidoglycan synthesis: -lactams ( penicillins -amoxycillin
cephalosporins - keflexin).
MOA: Inhibit cell wall synthesis in dividing bacteria via -lactam binding to penicillin binding proteins. This
prevents cell wall cross-linking. EG: Penicillins, Cephalosporins. More effective in gram positive bacteria.

Protein synthesis: tetracyclins, aminoglycosides (gentamycin), macrolides (erythro-, azithro-,
and clindamycin) and lincosamides (clindamycin).
MOA: Tetracyclins - Inhibit the 30S subunit in mRNA translation complex thus preventing the tRNA binding to
the mRNA-ribosome complex. Aminoglycosides: Some bind to the bacterial 30S ribosomal subunit
[
& some work by
binding to the 50S subunit. Macrolides: Bind to 50S ribosome subunit. Lincosamides: Block peptide bond at 50S
ribosome subunit and are only bacteriostatic.

DNA metabolism: nitroimidazoles (metronidazole, tinnidazole), sulfonamides (septra, bactrim),
rifamycin (rifampin) .
MOA: Nitroimidazoles passively disuse into cells and then the nitro group is reduced. The reduced product
oxidises DNA causing strand breaks and subsequent cell death. Sulfonamides - p-aminobenzoic acid (PABA) is
required to synthesize dihydrofolic acid which is required for nucleic acids synthesis. Sulfonamides are chemical
analogs of PABA, are competitive inhibitors of dihydropteroate synthetase. Sulfonamides therefore are reversible
inhibitors of folic acid synthesis and bacterostatic not bacteriocidal. Rifamycin Binds to RNA polymerase thus
inhibiting RNA synthesis which in turn prevents DNA synthesis.

Vitamin metabolism (eg folic acid): trimethroprim (alprim), sulfonamides (septra, bactrim).
MOA: Trimethoprim - Interfere with the action of dihydrofolate reductase thus prevent synthesis of
tetrahydrofolic acid which then prevents DNA replication and transcription. Only Bacteriacidal.

ANALGESICS COMMONLY USED IN DENTISTRY

NSAIDS:
2 types: selective and non-selective. Selective bind selectively to COX 1 or 2. COX-2 is usually
present at the site of inflammation thus this one is usually targeted (eg Celebrex).
ACTIONS: They have analgesic, antipyretic and anti-inflammatory actions.
MOA: Inhibit COX thus prevents the breakdown of arachidonic acid to prostaglandins (PGs).
PGs sensitise nociceptors. They act peripherally and centrally.
Peripheral mechanisms: Inhibition of PG synthesis at nociceptors.
Central mechanisms: Blocks PGs acting at spinal cord and higher centers to promote
pain transmission signals to brain.
ADVERSE EFFECTS: Gastric irritation, exacerbate asthma & exacerbate renal impairment.
TYPES: Aspirin, Ibuprofen, Diclofenac.
Prescription: Rx: 200-400mg (2X200mg) tablets every 4-6h, PRN.

PARACETAMOL:
ACTIONS: analgesic, antipyretic and anti-inflammatory actions.
MOA: Inhibit COX but only in CNS (i.e. central mechanisms above).
ADVERSE EFFECTS: hepatotoxicity in overdose.
NOTE: never give aspirin to children as it can cause REYES syndrome (liver damage and
encephalopathy leading to coma).
Prescription: Rx: 500-1000mg (2X500mg) tablets every 4-6h, PRN.

OPIOIDS:
Include: natural substances (opium poppy), synthetic substances (pethidine, fentanyl),
endogenous substances (encephalins, endorphins).
ACTIONS & ADVERSE EFFECTS: Analgesia, Euphoria, Respiratory depression, Antitussive,
Nausea/Vomiting, Pupil constriction, constipation, urinary retention.
MOA: Inhibit transmission of pain signals at spinal cord level by preventing primary afferent
neurons releasing neurotransmitters (presynaptic inhibition). Also prevent interneuron firing
thus allows descending inhibitory pathways to work (presynaptic inhibition).
TYPES: Codeine (panadeine forte), Oxycodone (oxycontin), Tramadol (tramal).
Prescription: Rx: Panadeine Forte tablets. Take 1 or 2, every 4-6h PRN. 40 tablets only.

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ANTIBIOTICS COMMONLY USED IN DENTISTRY

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