Drugs & Dentistry I drugs commonly prescribed by the dentist March 2002 Antimicrobial Drugs



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Drugs & Dentistry I

Drugs commonly prescribed by the dentist
March 2002
1. Antimicrobial Drugs

a. Antibiotics


Drug

Indications

Forms


Usual dose

Trade &price


Comments

Amoxicillin

-Routine drug of choice in infection.

-Prophylaxis regimen for subacute bacterial endocarditis

Cap. 250-500 mg

Sus. 125 mg/5ml

250 mg/5ml




Adult:

250-500 mg q8h



Child:

20 mg/kg/day in divided doses


-Amoxil


250 mg = 27 SR

500 mg = 53 SR

-Ultramox

500 mg = 25 SR

-Amoxidar

250 mg = 7 SR

500 mg = 13 SR

- 3% of population are

allergic to the drug



Co-Amoxiclav.

amoxicillin with



clavulanic acid”

-Infections caused by beta-lactamase producing strains.

-Sever dental infections

with spreading cellulites.


Tab. 375-625 mg

1g

Sus. 156 mg/5ml



228 mg/5ml

457 mg/5ml




Adult: 375-625 mg q8h

OR

1 g q12h

-Augmentin

375 mg = 48 SR

625 mg = 81 SR

156 mg = 22 SR

-Amoclan

375 mg =34 SR

-Amoclan forte

625mg = 44 SR

-Megamox

375mg =36 SR

625mg =43 SR

1g =75 SR

-Klavox

375mg = 44 SR



625 mg =76 SR

-Julmentin

375 mg = 40 SR

-Julmentin Forte

625 mg = 68 SR



Children 40kg

20-40 mg/kg/day amoxicillin with 5-10mg calvulanic acid in three

divided doses.


Erythromycin

-Routine second choice

to amoxicillin in infection or first choice if amoxicillin is allergic .

Tab. 250-500 mg

Sus. 200 mg/5ml


250-500 mg q6h

200 mg/5ml q6h

-Erythrocin

250mg = 14 SR

500mg = 27 SR

Sus. = 19 SR

-Eromycin


-50% of s.auruse is resistant

-GI intolerance is common

Tab. for tablet Sus. for suspension

Cap. for capsule q8h = every 8 hours

Syr. for syrup By Dr. KHALID AL - JOHANI

Inj for injection KING ABDULAZIZ UNIVERSITY

SCHOOL OF DENTISTRY

Drug

Indications

Forms
Usual dose

Trade &price

Comment



Clarithromycin


-Mild to moderate infection.

-Prophylaxis regimen for subacute bacterial endo-carditis for pt. allergic to amoxicillin.

Tab. 250-500 mg

Sus. 125 mg/ 5ml

250 mg/100ml


250-500 mg

bid

-Klacid


Some pt. is allergic to the drug.

-Caution when prescribed for pregnant or lactating women, hepatic, renal pt.

-It increases effects of cyclosporine, warfarinn & decreases the effects of clindamycin, penicillin &anticholingergic drugs.




Azithromycin

-Mild to moderate infection.

-Prophylaxis regimen for subacute bacterial endo-carditis for pt. allergic to amoxicillin.


Cap. 250 mg



500 mg qid on day1, then 250 mg qid on days 2-5

-Zithromax



-Contraindicated if the pt. is hypersensitive to the drug or to erythromycin.

-Caution when prescribed for pregnant or lactating women, hepatic, renal & cardiac pt. or with elderly & child < 16 y.

-It decrease the effects of clindamycin & penicillin

-Pt. instructed to take medication at least an hour before meal or 2 hours after the meal.



Tetracycline

-Second or third choice to amoxicillin in routine inf.

-Anaerobic bacterial infections & periodontitis associated with presence of AA (Actinobacillus actino-mycetemcomitans).

-ANUG

Tab. 250-500 mg Sus. 125 mg/5ml


250-500 mg q6h , 1 hour before or 2 hours after meals



-Tetracycline

250 mg = 13 SR


-Used in bone graft.

-Cause teeth discolora- tion, so it is not used in child  8y & in pregnant women.


Doxycycline

-Periodontitis associated with presence of AA (Actinobacillus actino-

mycetemcomitans).

-ANUG


-Syphilis


Tab. 100 mg

Cap. 100 mg

100 mg q12h


-Doxydar


-Vibramycin

100 mg=26 SR



-Some patients are hypersensitive to the drug.

-It cause candidiasis,teeth & tongue discoloration & dry mouth.

-It is not prescribed for child  8y &for pregnant women.


Drug

Indications

Forms
Usual dose

Trade &price

Comment


Clindamycin

Alternative to amoxicillin in prophylaxis regimen for subacute bacterial endocarditis if amoxicillin is allergic.

-Chronic osteomyelitis.


Tab. 150-300 mg

Inj. 300-600

900 mg


Adult

150-450 mg q6h



Child

8 -25 mg/kg in 3-4 divided doses.


-Dalacin-C

150 mg=21 SR

300 mg=37 SR



Cramps & diarrhea in 20% of patients after oral administration.

-Contraindicated if pt. is hypersensitive to the drug or had developed pseudo-membranous colitis.




Metronidazole

-Protozoal & anaerobic bacterial infections.

-Refractory adult peridontits.

Combined with penicillin in serious Odontogenic infection, especially in compromised patients.



Tab. 250-500 mg


250-500 mg q8h



-Flagyl

250 mg =13SR

500 mg =15SR

-Nidazol


-Elyzol

-Flazol


-Caution when the pt. complain of neutropenia,

hepatic disease, active CNS disease, or if the pt. on warfarin .

-Contraindicated if pt. is hypersensitive to the drug

or in the first trimester.



Cephalexin

Alternative to amoxicillin in the tretment of orofacial infections &in the prevention of SAB endocarditis except if the pt. had an immediate anaphylactic allergic reaction to amoxicillin.

Cap. 250-500 mg
Syr. 125 mg/5ml

Adult:

250-500 mg

q6h

Child:

6.5-50 mg/kg/ day in 4 doses



-Keflex

250mg = 29 SR

500mg = 42 SR

-Cefrin


10-15% cross reaction

sensitivity in pt. allergic to penicillin



Cefuroxime

Skin, soft tissue & bone infections.

Tab. 125-250 mg

Sus. 125 mg/5ml

250 mg/5ml


Adult:

1-2tab q12h



Child:

125mg q12h



-Zinnat

250 mg =87 SR

500 mg =95 SR


10-15% cross reaction

sensitivity in pt. allergic to penicillin





  1. The Antibiotics may decrease the activity of oral contraceptive. So the pt. should be instructed to use additional method of contraception during the antibiotic course.

  2. If the infection not improved within 3days, change the drug and do sensitivity test.

  3. Recommended antibiotics during pregnancy : Penicillin & Cephalosporine.

  4. Recommended antibiotics for lactating mother : Cephalosporine & Erythromycin.


Drug

Indications

Forms

Usual dose

Trade &price

Comment



Acyclovir

-Viral infections of:

-Herpes zoster.

-Herpes simplex.



-Chickenpox.

-Prevention of recurrence of the viral infections.


Tab. 400- 800 mg

Cap. 200 mg

Cream 2 g



Herpes zoter:

800 mg q4h for 7-10

days

Chickenpox:

20 mg/kg qid for 5 days


-Zovirax

200 mg=149SR

400 mg=697SR

Cream =23 SR

-Clovir



-It is contraindicated in patients with known hypersensitivity to the drug.

-It should be used with caution in-patient with renal impairment.

-It used in the tengling stage in the management of HSV before development of the lesion “vesicles “

-It could cause glossitis.

-Postpone dental treatment when oral herpetic lesions are present.


b. Antifungal



c. Antiviral


Drug

Indications

Forms

Usual dose

Trade &price

Comment

Miconazole

Treatment of candidal infections


Tab. 250 mg

Oral gel. 25 mg/ml


Adult 600-1800 mg in 3 divided doses daily for 3-20 weeks

Children 1 y

20-45mg/kg/day

in 3 divided doses.


Daktarin

Oral gel =17 SR




Oral gel

Apply twice / day up to 1 month.




Ketoconazol

-Systemic & cutaneous fungal infections.



Tab. 200 mg



Adult:

200-400 mg

qid

Children 2 y

3.5-6.6 mg/kg/ day in a single dose.



-Nizoral



-Contraindicated in patients with previous hypersensitivity.

-Used cautiously in patients with impaired hepatic & or adrenal reserve.




Nystatin

-Intestinal candidiasis.

-Skin candidiasis.

-Oral candidiasis



Suspention 100000 inter. unit " iu " for oral use.




Adult:

Sus. 400000-600000 iu qid Children 3 months

250000-500000 iu qid

Newborn

100000 iu qid


-Mycostatin

-Nilstat

-Nystan -Rianest -Mikostat



Contraindicated with pt. has known hypersensitivity.

-Oral use can cause nausea, vomiting and diarrhea.

- To prevent reinoculation of candidal infection pt. is instructed to dispose the tooth brush or other contaminated oral hygiene devices used during period of infection




2. Analgesics


Drug

Indications

Forms

Usual dose

Trade &price

Comment

Acetaminophen

-Mild to moderate

pain & fever

Tab. 325-500 mg


Syrup 120 mg/5ml

125 mg/5ml





Adult

0.5-l g every

4-6 hours to

max.4gm daily



Children:

1 year: 60-120mg

1-5y 120-150mg 6-12y 250-500mg


-Adol

-Panadol


-Tylenol

-Fevadol


-Dafalgan -Panacetamol

syrup


-Tempra

-Caution with hepatic

disease pt.

-Contraindicated if the pt. is hypersensitive to acetaminophen or complain of Glucose 6-Phosphate Dehydrogenase Deficiency.



Ibuprofen


-Pain

-Fever


-Inflammatory diseases

-Rheumatoid disorders

-Gout


Tab. 200-400

600 mg
Syrup 100 mg/5ml



400 mg every

4-6 hours for

mild-moderat pain


-Brufen

400mg=12 SR

600mg=20 SR

-Ibofen


-Profinal

600 mg=13 SR -Sapofen

400 mg=10 SR

600 mg=10 SR



It is contraindicated in:

-Hypersensitivity

-Nasal polyp

-Angio-edema

-Bronchospastic reactivity

to aspirin or other

NSAID’s.

-Caution if the pt. on anticoagulant.

-Taken after food


Mefenamic acid

-Mild to moderate pain


Tab. 500 mg

Cap. 250 mg

Syrup 50 mg/5ml



Adult:

500mg initially

then 250 mg every 6 hours with food children 6 months :

25 mg/kg daily

in divided doses

-Ponstan


500 mg=13 SR

-Fendol


500 mg= 7 SR

-Mafepain

500 mg= 9 SR

-Avoid prescribing for dental pain in last trimester of pregnancy. -Caution if the pt. on anticoagulant.




Diclofenac Sodium

-Mild to moderate pain

-Pain of rhematoid arthritis & osteoarthri- tis. -Gout & Ankylosing spondylitis

Tab. 25-50-100 mg

Inj. 75 mg/ampoule

150-200mg/ day in 2-4 divided doses.



-Voltaren

50 mg =38 SR

-Olfen

50 mg =21 SR



-Rofinac

50 mg = 32 SR

-Diclogesic

50 mg = 17 SR

-Vortex

50 mg =10 SR

-Colfen

50 mg = 9 SR


-It can cause dry mouth &

stomatitis.

-Avoid prescribing for dental pain in last trimester of pregnancy.



Paracetamol 500 mg

with Caffeine 30 mg

& Codeine


Mild to moderate pain

________

2 tab. Every 4 hours to max. 8 tab. daily.

-Solpadeine

= 9 SR -Fevadol plus

= 8 SR


-Do not give if the pt. has allergy to propyphenazone

-Not recommended for pregnant, breast-feeding women & for children<12 years.



Paracetamol 250 mg , caffeine 50 mg

& propyphenazone

150 mg

-Treatment of

headache.


________

Adult: 1-2 tab 12-16y 1 tab.

Up to 3 doses / day



-Saridon

= 5 SR


________


3. Miscellaneous




Drug

Indications

Forms

Usual dose

Trade &price

Comment

Triamcinolone orabase

-Oral and perioral lesions

-Aphthous ulcers.

Orabase: contains

triacilmone 0.1% in adhesive basis

2-4 times daily


Kenalog in

Orabase

=7 SR



-Use is limited for 5 days

for children ,and short term for elderly.

-Contraindicated in the presence of fungal, viral or bacterial infections.


Pyralvex

-Treatment of oral

ulcers.


10 ml with brush

3-4 times daily


Norgine

Not recommended for children under 12 years.

Lignocaine Hydrochloride

lidocaine”



-Pain due to ulcers

Jelly 2%

Ointment 5%

Spray 80 g


When needed

Xylocaine 5%

35 g=11 SR

Spray 80g =29 SR


_____________

Sodium fluoride

Prevention of dental caries & decrease teeth hypersensitivity


Tab. 1 mg





-Zymafluor

1mg = 18 SR


-Adults should be expectorate after use & not to eat, drink or rinse for 30 minutes.

-Child ages 6-16y should be expectorate after use, rinse mouth thoroughly to avoid swallowing fluoride.

-Must ascertain fluoride conc. In-patient’s drinking water before prescribing.


Baclofen

-Relief of muscle spasm.

Tab. 10-25 mg

5 mg tid×3 days

then, 10 mg tid×

3days then,

15 mg tid×3 days

then 20 mg tid×

3days then triturated to response, not to exceed 80 mg/day



Lioresal

25 mg =121 SR



-Some pt. has hypersensitivity to the medicament.

-It may cause dry mouth

-The medicament has a sedative effect.


Chlorzoxazone

-Relief of muscle spasm.

Tab. 250-500 mg

(DSC)


Adult 250-750 mg

tid-qid


Child

20 mg/kg/day in 3-4 divided doses.



Parafon

500 mg=19 SR



-Combination of the drug with aspirin or NSAIDs will improve the response.



4. Mouthwashes





Mouthwash

Indications

Forms

Usual dose

Trade &price

Comment

Chlorhexidine

Mouth wash

-Antibacterial mouth

rinse

-Denture stomatitis



-Oral hygiene and

plaque inhibition.


-Oral rinse 0.2%


Swish 15ml

undiluted oral rinse around

in mouth for one minute, then expectorate

2 times daily

Corsodyl


=12 SR

- Contraindicated if pt. has hypersensitivity

-Pt. instructed not to eat, drink or rinse mouth with water after use for several hours.

-It my cause taste changes.

-Do not swallow the medication.

-Perform scaling before starting rinse.

-It causes staining of teeth & esthetic restorations.



Hexetidine


-Oral hygine


Mouth wash or gargle 0.1%


15ml undiluted 2-3times daily


Oraldene


= 7 SR

________


Povidone-lodine

Treatment &prevention

of microbial infections

-Cleanser: skin7.5%

“30 m1-118 ml”

-Foam 7.5% 170 g


10ml undiluted

for up 30 sec. up to 4 times daily

-Betadine

=15 SR

-Poviderim



-Do not swallow the

medication

-Avoid contact with eyes.

-Contraindicated in pt. with

hypersensitivity to iodine .

-Cautions with pregnancy &

breast feeding.




Orasept

Ingredients:

Benzoic acid,

Thymol, Menthol,

Methyl salicylate

& Eucalyptol

-Prevention & reduction of gingivitis.

-General oral hygiene

& bad breath.


-Mouthwash 250 ml



Swish 15 ml

undiluted oral rinse around

in mouth for one minute, then expectorate

2 times daily


Orasept


250ml =10 SR

________
Colgate - Plax

Ingredients:

Triclosan 0.03 %

Sodium fluoride

0.025 %


-Fight plaque

-Fight caries

-Treatment of halitosis

250-500 ml



15ml undiluted for one minute

2 times daily



-Classic /red

-Soft mint /

green

250 ml=14 SR



500 ml=22 SR

-Not recommended for child < 6 years.
Sensodyne

-Anti plaque

-Relieves minor mouth irritation


250 ml


15ml undiluted for 30 seconds

2 times daily



250 ml=16 SR



-Not recommended for child<6 years.

-Not recommended if the pt.

sensitive to cytylpyridinium.

-Used after brushing.




Pearl drops

Smokers 1+1

-Helps in the removal of tar.

-Fight tobacco odor.

-Fight plaque

-Fight caries


400 ml

15ml undiluted for 30 seconds

2 times daily



400 ml=13 SR



-Not recommended for child < 6 years.



Oral-B

Fight plaque & cavities


300 ml


15ml undiluted for 30 seconds

2 times daily



300 ml=16 SR



-Not recommended for child < 6 years.

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