Dentistry simplified

          FLUOROQUINOLONES This are quinolones antimicrobials having one or more fluorine substitutions.  Fluorination of the quinolone structure at position 6 and introduction of a piperazine substitution at position 7 resulting in a derivative called fluoroquinolones.  Classification- First Generation fluroquinolones- Norfloxacin                       ofloxacin Ciprofloxacin                     pefloxacin Second Generation fluroquinolones- Lomefloxacin                     sparofloxacin Levofloxacin                       Gatifloxacin                                           ...

                        Quinolones These are synthetic antimicrobials having a quinolone structure and are active against gram negative bacteria.  Nalidixic acid is the first member.                      Nalidixic acid 1.It is  active against gram- negative bacteria especially E. Coli, proteus, klebsiella. Adverse effects of Nalidixic acid  1.  Individuals with G-6PD deficiency may develop haemolysis.  2.  Phototoxicty is rare.  3.  Consist mainly of g. i upset and rashes.  4.  Most important toxicity is neurological- headche, drowsiness, vertigo, visual disturbance, seizures.  Uses of nalidixic acid- 1.  used as urinary antiseptic.  2.  Used in diarrhoea caused by shigella, E. Coli and proteus. 

         COTRIMOXAZOLE COTRIMOXAZOLE is the fixed dose combination of trimethoprim and sulfamethoxazole.  Sequential block in bacterial folate metabolism PABA-para aminobenzoic acid, DHFA-Dihydrofolic acid, THFA-Tetrahydrofolic acid.   brand names include are  Septra, Bactrim, Apo-Sulfatrim, or Novo-Trimel.  Cotrimoxazole  comes in tablet and liquid form. Adverse effects of cotrimoxazole a) Nausea, vomiting, stomatitis, headache and rashes - Are common manifestations.  b) Neonatal haemolysis and methhaemoglobinemia occurs.  c) Hypersensitivity- Hypersensitivity reaction like rashes, headache and stomatitis  occurs.  d) Blood dyscrasis occurs rarely.  e) Folate deficiency (megaloblastic anaemia)  Occurs only in patients with marginal folate levels.  f) Should not be given during pregnancy. Trimethoprim being an antifolate there is a teratogenic ...

                   SULFONAMIDES First antimicrobial agents effective against pyogenic bacterial infections were sulfonamides.  Chemistry They are considered as derivative of sulfanilamide(p-aminobenzene sulfonamides).  Examples of sulfonamides include: sulfamethoxazole/trimethoprim (Bactrim, Bactrim DS, Septra, Septra DS) sulfasalazine (Azulfidine, Sulfazine) sulfisoxazole (Truxazole) What formulations are sulfonamides are available? tablets, injections, and oral solutions. Classication 1.Short Acting (4-8hr) - Sulfadizine 2.Intermediate acting (8-12hr) - Sulfamethoxazole 3.Long Acting(~7days)  Sulfadoxine 4.Special purpose sulfonamides- Sulfacetamide sod., Mafenide, silver sulfadiazine, sulfasalazine.  Adverse effects of Sulfonamides a)   Nausea, vomiting and epigastric pain are common.  b) Neutropenia are rare....

          USES OF CHLORAMPHENICOL 1) H. Influenza Meningitis- Chloramphenicol is highly efficacious and it has excellent penetrability into CSF.  2) Intraocular Infections- Chloramphenicol given systemically attains high  concentration in ocular fluids. It is the preffered drug for endophthalmitis caused by sensitive organism.  3) Topically- In conjunctivitis, external ear infection chloramphenicol 0.5-5.0%is highly effective.  4) Enteric Fever- Till recently chloramphenicol was the drug of choice for typhoid fever. Chloramphenicol does not prevent or cure carrier state.  5) Anaerobic Infections- It is effective in anaerobic infections caused by Bact. fragilis and other wound infections and brain abscesses.  6) As second choice drug-drug- a)  To Erythromycin - for whooping cough.  b) To tetracycline- for brucellosis and rickettsial infections especially in children and pre...

               ADVERSE EFFECTS OF                                  CHLORAMPHENICOL Mnemonics to Remember adverse effects of chloramphenicol- Herschelle GIBbS   South African cricketer). H-  Hypersensitivity reactions, G- Gray baby syndrome, I-  Irritative effects, B-  Bone Marrow depression, S- superinfections.  1.Hypersensitivity Reactions Fever, Atrophic glossitis, Angioedema and rashes are infrequent.  2.Gray baby syndrome It  occurs at high doses(~100mg/kg)  in neonates especially premature. The baby stops feeding, vomited, become hypotonic and respiration becomes irregular. If gray cyanosis developed in many,  it is followed by cardiovascular collapse and death. It should be avoided in neonates and even if given doses should be ~25mg/kg/day. 3. Irritative effects Nausea, vomit...

     USES OF TETRACYCLINE 1) Orodental infections Tetracycline are of limited usefulness in treating acute dental infections.  They are useful in certain forms of periodontal diseases.  They are useful in periodontal inflammation by scavenging free radicals.  It has a adjuvant role in the management of chronic periodontitis and in juvenile periodontitis.  To control gingival inflammation tetracycline (1g/ day)  Or doxycycline (0.1-0.2g/day) therapy to be used.  Tetracycline are highly active against actinobacillus species which is responsible for destruction of gums and bone loss in juvenile periodontitis.  2) General Medicinal uses They can be used for initial treatment of mixed infections. Tetracycline are the first choice drugs: 1. Brucellosis- Tetracycline are highly efficacious. Therapy used is doxycycline 200mg/day+rifampin 600mg/day for 6 weeks. Gentamicin may be combined with doxycyclin...