HISTORY LOUIS PASTEUR 1877 ALEXANDER FLEMMING 1929 DEFINITION

  • Slides: 24
Download presentation

HISTORY LOUIS PASTEUR 1877 ALEXANDER FLEMMING 1929

HISTORY LOUIS PASTEUR 1877 ALEXANDER FLEMMING 1929

DEFINITION SUBSTANCES PRODUCED BY MICRO-ORGANISMS, WHICH SUPPRESS THE GROWYH OF OR KILL OTHER MICRO-ORGANISMS.

DEFINITION SUBSTANCES PRODUCED BY MICRO-ORGANISMS, WHICH SUPPRESS THE GROWYH OF OR KILL OTHER MICRO-ORGANISMS.

RATIONALE OF THERAPY v NARROWEST SPECTRUM TARGETTING THE ORGANISM v USE ONE WITH MINIMUM

RATIONALE OF THERAPY v NARROWEST SPECTRUM TARGETTING THE ORGANISM v USE ONE WITH MINIMUM TOXICITY v PROPER DOSING v PROPER DIET AND FLUID INTAKE v CONCURRENT ANALGESICS v COMBINE WITH APPROPRIATE SURGICAL INTERVENTION v ADEQUATE PATIENT MONITORING v ENCOURAGE COMPLIANCE

CLASSIFICATION A. CHEMICAL STRUCTURE B. MECHANISM OF ACTION C. ORGANISMS ACTED UPON D. SPECTRUM

CLASSIFICATION A. CHEMICAL STRUCTURE B. MECHANISM OF ACTION C. ORGANISMS ACTED UPON D. SPECTRUM OF ACTIVITY E. MODE OF ACTION

PROBLEMS ASSOCIATED WITH ANTIBIOTIC THERAPY Ø TOXICITY Ø HYPERSENSITIVITY Ø DRUG RESISTANCE Ø SUPERINFECTION

PROBLEMS ASSOCIATED WITH ANTIBIOTIC THERAPY Ø TOXICITY Ø HYPERSENSITIVITY Ø DRUG RESISTANCE Ø SUPERINFECTION Ø NUTRITIONAL DEFIENCIES Ø MASKING AN INFECTION

DRUG RESISTANCE MUTATION GENE TRANSFER DRUG TOLERENCE DRUG DISTRUCTION IMPERMEABILITY CROSS RESISTANCE

DRUG RESISTANCE MUTATION GENE TRANSFER DRUG TOLERENCE DRUG DISTRUCTION IMPERMEABILITY CROSS RESISTANCE

CHOICE OF AGENT PATIENT FACTORS AGE RENAL AND HEPATIC FUNCTIONS LOCAL FACTORS DRUG ALLERGY

CHOICE OF AGENT PATIENT FACTORS AGE RENAL AND HEPATIC FUNCTIONS LOCAL FACTORS DRUG ALLERGY HOST DEFENCE STATUS PREGNANCY STATE GENETIC FACTORS PRESENCE OF: PUS AND SECRETIONS NECROTIC MATERIAL & FOREIGN BODY HEMATOMAS ANAEROBIC ENVIRONMENT PENETRATION BARRIER

ORGANISM RELATED CLINICAL DIAGNOSIS BACTERIOLOGICAL EXAMINATION Not available Available – immediate treatment need Available

ORGANISM RELATED CLINICAL DIAGNOSIS BACTERIOLOGICAL EXAMINATION Not available Available – immediate treatment need Available – chance of delaying treatment

DRUG FACTORS • • Spectrum of activity Type of activity Sensitivity Relative toxicity Pharmacokinetics

DRUG FACTORS • • Spectrum of activity Type of activity Sensitivity Relative toxicity Pharmacokinetics Route of administration Evidence of clinical efficacy

COMBINATIONS SYNERGISM REDUCE SEVERITY PRVENT RESISTANCE WIDE SPECTRUM MIXED INFECTION INITIAL TREATMENT TOPICAL APPLICATION

COMBINATIONS SYNERGISM REDUCE SEVERITY PRVENT RESISTANCE WIDE SPECTRUM MIXED INFECTION INITIAL TREATMENT TOPICAL APPLICATION DISADVANTAGES More casual outlook Increased adverse effects Super infections Resistant strains if inadequate Increased cost

PROPHYLAXIS SPECIFIC RISK MANAGEMENT GENERAL

PROPHYLAXIS SPECIFIC RISK MANAGEMENT GENERAL

INDICATIONS FOR PROPHYLAXIS SYSTEMIC • • • Heart surgery within the past six months

INDICATIONS FOR PROPHYLAXIS SYSTEMIC • • • Heart surgery within the past six months Pacemaker Vascular surgery within the past six months Artificial heart valve History of rheumatic fever History of heart murmur (mitral valve prolapse) Previous bacterial endocarditis Systemic pulmonary shunt Congenital heart defect Acquired valvular dysfunction

PROPHYLAXIS RECOMMENDED DENTAL Dental extractions Intraligamental local anesthetic injections Periodontal procedures including surgery Scaling

PROPHYLAXIS RECOMMENDED DENTAL Dental extractions Intraligamental local anesthetic injections Periodontal procedures including surgery Scaling and root planing, probing, recall maintenance Prophylactic cleaning of teeth or implants where bleeding is anticipated Subgingival placement of antibiotic fibers/strips Dental implant placement and reimplantation of avulsed teeth Endodontic (root canal) instrumentation or surgery only beyond the apex Initial placement of orthodontic bands but not brackets

CURRENT REGIME For adults, v Amoxicillin 2 g PO 1 hour before procedure or

CURRENT REGIME For adults, v Amoxicillin 2 g PO 1 hour before procedure or Administer ampicillin 2 g for adults v Allergic to penicillin Clindamycin 600 mg PO/IV 1 hour before procedure v Alternatively Azithromycin / Clarithromycin 500 mg PO 1 hour before procedure s Pediatric patients • Amoxicillin 50 mg/kg P 50 MG mg/kg for children within 30 min before • Clindamycin 20 mg/kg PO/IV for pediatric patients • Azithromycin / Clarithromycin 15 mg/kg PO

SPECIFIC AGENTS IN DENTISTRY Prevents PABA synthesis Bacterial spectrum SULFONAMIDES: Short acting Intermediate acting

SPECIFIC AGENTS IN DENTISTRY Prevents PABA synthesis Bacterial spectrum SULFONAMIDES: Short acting Intermediate acting Long acting Special purpose Crystal urea Prescription: Sulfadiazine Str. Pyogens H. Influenza V. Cholerae G. , M. , P. cocci E. Coli Actinomyces 0. 5 g QID to 2 g TID Cotrimoxazole: Sulfonamide & Trimethoprim Two step inhibition

QUINOLONES Primarily against gram negative Newer fluoroquinolones against gram positive also Ampicillin resistant Shigella

QUINOLONES Primarily against gram negative Newer fluoroquinolones against gram positive also Ampicillin resistant Shigella enteritis: 0. 5 – 1 g TDS or QDS NORFLOXACIN OFLOXACIN CIPROFLOXACIN PEFLOXACIN LOMEFLOXACIN LEVOFLOXACIN SPARFLOXACIN GATIFLOXACIN MOXIFLOXACIN

BETA LACTUM RING ANTIBACTERIAL SPECTRUM BACTERIAL RESISTANCE ADVERSE EFFECTS TYPES BETALACTOMASE INHIBITORS USES CEPHALOSPORINS:

BETA LACTUM RING ANTIBACTERIAL SPECTRUM BACTERIAL RESISTANCE ADVERSE EFFECTS TYPES BETALACTOMASE INHIBITORS USES CEPHALOSPORINS: FIRST GENERATION SECOND GENERATION THIRD GENERATION SYNTHETIC ACID RESISTANT PENICILLINASE RESISTANT EXTENDED SPECTRUM BETA-LACTOMASE INHIBITORS

CEPHALOSPORINS q q Broadest spectrum against Gm+ cocci Effective against many Gm-- bacilli, including

CEPHALOSPORINS q q Broadest spectrum against Gm+ cocci Effective against many Gm-- bacilli, including E. coli and Klebsiella pneumoniae q Are not distributed into the CNS q Some used for dentoalveolar abscess 1 st generation cephalosporins: cefadroxil*, cephalexin*, cephradine* cephalothin, cefazolin cephapirin, *oral use

TETRACYCLINES BROAD SPECTRUM INHIBIT BACTERIAL PROTEIN SYNTHESIS TETRACYCLINE CHLORTETRACYCLINE OXYTETRACYCLINE 3 GROUPS DEMECLOCYCLINE METHACYCLINE

TETRACYCLINES BROAD SPECTRUM INHIBIT BACTERIAL PROTEIN SYNTHESIS TETRACYCLINE CHLORTETRACYCLINE OXYTETRACYCLINE 3 GROUPS DEMECLOCYCLINE METHACYCLINE LYMECYCLINE DOXYCYCLINE MINOCYCLINE TETRACYCLINE: AFFECTS TEETH AND BONE

AMINOGLYCOSIDES Œ SEMISYNTHETIC Œ PRODUCED FROM SOIL ACTINOMYCETES Œ PREVENTS BACTERIAL PROTEIN SYNTHESIS Œ

AMINOGLYCOSIDES ΠSEMISYNTHETIC ΠPRODUCED FROM SOIL ACTINOMYCETES ΠPREVENTS BACTERIAL PROTEIN SYNTHESIS ΠOTOTOXIC AND NEPHROTOXIC ΠNOT ABSORBED ORALLY ΠINJECTION, EYE/EAR DROPS, 0. 1% SKIN CREAM STREPTOMYCIN GENTAMYCIN KANAMYCIN TOBRAMYCIN AMIKACIN SISOMYCIN NETILMYCIN

MACROLIDES MACROCYCLIC LACTONE RING WITH ATTACHED SUGARS BACTERIOSTATIC IN LOW- AND BACTERICIDAL IN HIGH-

MACROLIDES MACROCYCLIC LACTONE RING WITH ATTACHED SUGARS BACTERIOSTATIC IN LOW- AND BACTERICIDAL IN HIGH- DOSES NARROW SPECTRUM - > GRAM POSITIVE & FEW GRAM NEGATIVE REMARKABLY SAFE – SUBSTITUTE FOR PENICILIN ERYTHROMYCIN MISCELLANEOUS: ROXITHROMYCIN CLINDAMYCIN LINCOMYCN CLARITHROMYCIN AZITHROMCIN OXAZOLINIDONE POLYMYXIN B & COLLISTIN BACITRACIN

ANTITUBERCULOUS AGENTS ISONIAZID RIFAMPICIN PYRAZINAMIDE ETHAMBUTOL STREPTOMYCIN FIRST LINE THIACETAZONE PARA AMINO SALICYLIC ACID

ANTITUBERCULOUS AGENTS ISONIAZID RIFAMPICIN PYRAZINAMIDE ETHAMBUTOL STREPTOMYCIN FIRST LINE THIACETAZONE PARA AMINO SALICYLIC ACID ETHIONAMIDE CYCLOSPORIN KANAMYCIN AMIKACIN CAPREOMYCIN SECOND LINE CIPROFLOXACIN CLARITHROMYCIN AZITHROMYCIN RIFAMBUTIN NEWER • CONVENTIONAL • SHORT COURSE CHEMOTHERAPY: Ccategories I - IV Multi-drug resistant tuberculosis