principles of antibiotics

8/6/2019 Principles of Antibiotics

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ANTIBIOTICSANTIBIOTICS

Presented by:Presented by:

IraIra GargGargAkritiAkriti MehtaMehta

RashiRashi SinghalSinghal


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PRINCIPLESPRINCIPLES OFOF

ANTIBIOTICSANTIBIOTICS

PRINCIPLES OF THERAPYPRINCIPLES OF THERAPY

PRINCIPLES FOR CHOOSING THEPRINCIPLES FOR CHOOSING THE

APPROPRIATE ANTIBIOTIC.APPROPRIATE ANTIBIOTIC.

PRINCIPLES OF ANTIBIOTICPRINCIPLES OF ANTIBIOTICADMINISTARTIONADMINISTARTION..

PATIENT MONITORINGPATIENT MONITORING


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1.1. PRINCIPLES OF THERAPYPRINCIPLES OF THERAPY

PRESENCE OF INFECTION

Classical signsClassical signs

LocalLocal--pain,swelling,erythema,pus formation,pain,swelling,erythema,pus formation,

limitation of motion.limitation of motion.

SystemicSystemic--fever,lymphadenopathy,malaise,elevatedfever,lymphadenopathy,malaise,elevated

white blood cell count.white blood cell count.


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All signs of infection are absent inAll signs of infection are absent in ::

Painful toothPainful tooth 33rdrd molar removal two days before beingmolar removal two days before being

seen with persistent pain and swelling.seen with persistent pain and swelling.

Major maxillofacial procedures underMajor maxillofacial procedures underGENARAL ANAESTHESIA.GENARAL ANAESTHESIA.


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STATE OF HOST RESPONSESTATE OF HOST RESPONSE

Antibiotics are used in depressed defenseAntibiotics are used in depressed defensemechanism.mechanism.

Causes of depressed mechanism:Causes of depressed mechanism:--

Physiological depression:Physiological depression:

shockshock

advanced ageadvanced age

obesityobesity

fluid imbalance.fluid imbalance.


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Disease related depression:Disease related depression:

Malnutrition syndrome.Malnutrition syndrome.

CancerCancer LeukemiaLeukemia

DiabetesDiabetes

Defective immune system:Defective immune system:

Congenital defectCongenital defect

Multiple myelomaMultiple myeloma

Total body radiation therapyTotal body radiation therapy

SplenectomySplenectomy

Drug related suppressions:Drug related suppressions:

Cytotoxic drugsCytotoxic drugs

Immunosuppressive drugs:glucocorticoids,cyclosporine.Immunosuppressive drugs:glucocorticoids,cyclosporine.


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SURGICAL DRAINAGE AND

INCISIONDeep tissue infection and cellulitis without pusDeep tissue infection and cellulitis without pus

formation.formation.

Accomplish by extraction of affected teeth.Accomplish by extraction of affected teeth.Necessary in both chronic abscess with pusNecessary in both chronic abscess with pus

formation and acute indurated cellulitisformation and acute indurated cellulitis..

DECISION TO USE ANTIBIOTICTHERAPY


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2.PRINCIPLES FOR CHOOSING2.PRINCIPLES FOR CHOOSING

THE APPROPRIATE ANTIBIOTICSTHE APPROPRIATE ANTIBIOTICS IDENTIFICATION OF CAUSATIVE ORGANISMIDENTIFICATION OF CAUSATIVE ORGANISM

-- chronic non advancing abscesschronic non advancing abscess anaerobicanaerobic

bacteria only.bacteria only.

--acute cellulitis without pus formationacute cellulitis without pus formation aerobicaerobic

bacteria only.bacteria only.

--Odontogenic infection is commonly caused by:Odontogenic infection is commonly caused by:

1.

1.

streptococci(anaerobic gram +ve cocci)streptococci(anaerobic gram +ve cocci)

2.2. prevotella and fusobacterium (anaerobic gramprevotella and fusobacterium (anaerobic gram

ve rods)ve rods)


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DETERMINATION OF ANTIBIOTICDETERMINATION OF ANTIBIOTICSENSITIVITYSENSITIVITY

--penicillinGpenicillinG-- odontogenic infections andodontogenic infections andstreptococcus infection.streptococcus infection.

--erythromycinerythromycin--streptococcus and prevotellastreptococcus and prevotella

infection.

infection.

--clindamycinclindamycin--streptococcus and anaerobicstreptococcus and anaerobicinfection.infection.

--metronidazolemetronidazole-- no activity againstno activity against

streptococcus and has excellent activitystreptococcus and has excellent activityagainst anaerobic infection.against anaerobic infection.


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USE OF SPECIFIC NARROW SPECTRUMUSE OF SPECIFIC NARROW SPECTRUM

ANTIBIOTICANTIBIOTIC

--maintain host flora.maintain host flora.

--reducing superinfection.reducing superinfection.

USE OF LEAST TOXIC ANTIBIOTICSUSE OF LEAST TOXIC ANTIBIOTICS

PATIENT DRUG HISTORYPATIENT DRUG HISTORY

--previous allergy reactions.previous allergy reactions.

--previous toxic reactions.

previous toxic reactions.


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USE OF BACTERICIDAL RATHER THANUSE OF BACTERICIDAL RATHER THAN

BACTERIOSTATIC DRUGBACTERIOSTATIC DRUG

--bacteriostatic drugbacteriostatic drug inhibiting protein synthesis.inhibiting protein synthesis.

--bactericidal drugbactericidal drug--interference with cell wallinterference with cell wall

synthesis and nucleic acid synthesis.synthesis and nucleic acid synthesis.

ADVANTAGES OF BACTERICIDAL ANTIBIOTICSADVANTAGES OF BACTERICIDAL ANTIBIOTICS

--Less reliance on post resistanceLess reliance on post resistance

--Killing of bacteria.Killing of bacteria.

--Faster process.

Faster process.

--Greater flexibility with dosage interval.Greater flexibility with dosage interval.


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USE OF ANTIBIOTIC WITH PROVENUSE OF ANTIBIOTIC WITH PROVEN

HISTORY OF SUCCESSHISTORY OF SUCCESS

COST OF ANTIBIOTICCOST OF ANTIBIOTIC

ENCOURAGE PATIENT COMPLIANCEENCOURAGE PATIENT COMPLIANCE

--decreases with increasing number of pills perdecreases with increasing number of pills per

day.

day.


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PROPER TIME INTERVALPROPER TIME INTERVAL

--therapeutic dose of antibiotic is four times thetherapeutic dose of antibiotic is four times the

plasma half life.

plasma half life.

PROPER ROUTE OF ADMINISTRATIONPROPER ROUTE OF ADMINISTRATION

--parentral antibioticparentral antibiotic--choice of administration.choice of administration.

--antibiotic should be taken in fasting speed.antibiotic should be taken in fasting speed.

CONSISTENCY ROUTE OFCONSISTENCY ROUTE OF

ADMINISTRATIONADMINISTRATION

--recurrence of infectionrecurrence of infection--parentral to oral routeparentral to oral route

on 2on 2ndnd or 3or 3rdrd day of antibiotic therapy.day of antibiotic therapy.


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COMBINATION ANTIBIOTIC THERAPYCOMBINATION ANTIBIOTIC THERAPY

IndicationIndication

--when it is necessary to increase thewhen it is necessary to increase the

antibacterial spectrum with life threateningantibacterial spectrum with life threatening

sepsis of unknown cause.sepsis of unknown cause.

--when increased bactericidal affect againstwhen increased bactericidal affect against

specific organism is desired.specific organism is desired.

--prevention of rapid emergence of resistantprevention of rapid emergence of resistant

bacteria.

bacteria.

--emperic treatment of odontogenic infections.emperic treatment of odontogenic infections.


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4.PATIENT MONITORING4.PATIENT MONITORING

RESPONSE TO TREATMENTRESPONSE TO TREATMENT

--begin by 2begin by 2ndnd dayday--decrease in temperature,swelling,pain anddecrease in temperature,swelling,pain and

lessening of trismus.

lessening of trismus.--7 days course of antibiotic with supportive7 days course of antibiotic with supportive

therapy,adequate hydration,nutritional support istherapy,adequate hydration,nutritional support isessential.essential.

causes of failure in treatment of infection.causes of failure in treatment of infection.

-- Inadequate surgical treatment.

Inadequate surgical treatment.

-- depressed host defenses.depressed host defenses.

-- presence of foreign body.presence of foreign body.


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-- Antibiotic problemAntibiotic problem

_drug not reaching infection_drug not reaching infection

--dose not adequatedose not adequate

--wrong bacterial diagnosiswrong bacterial diagnosis

--wrong antibiotic.

wrong antibiotic.

-- DEVELOPMENT OF ADVERSEDEVELOPMENT OF ADVERSE

REACTIONREACTION

--too commontoo common--allergic reactionsallergic reactions--hypersensitivityhypersensitivity

--toxic reactionstoxic reactions--antibiotic associated colitis.antibiotic associated colitis.


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SUPERINFECTION AND RECURRENTSUPERINFECTION AND RECURRENT

INFECTIONINFECTION

--normal flora is altered or eliminated bynormal flora is altered or eliminated by

antibiotic.antibiotic.

--pathogenic bacteria resistant to antibiotic.pathogenic bacteria resistant to antibiotic.

--candidiasiscandidiasis--high dose long term penicillin.

high dose long term penicillin.

--use of broad spectrum antibiotic results inuse of broad spectrum antibiotic results in

super infections.super infections.

--recurrent infectionsrecurrent infections actinomycosis andactinomycosis and

osteomyelitis.osteomyelitis.

principles of antibiotics

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