Clindamyacin (Cleocin) (Continued)
Contraindications: Ulcerative colitis, enteritis, pregnancy category B, lactation.
Dental Drug Interactions: Decreases activity of erythromycin, increases activity of
of nondepolarizing muscle relaxants and hydrocarbon inhalation anesthetics.
Cephalosporin (First Generation)
Action: Inhibits cell wall synthesis resulting in cell lysis. No problem with beta-lactamase.
Use: Alternative to dental prophylaxis and orofacial infections (aerobic gram positive and anaerobic bacteria). Also treat group A beta hemolytic Streptococcus, Klebsiella pneumoniae, E. coli, Proteus mirabilis and Shigella. Predominantly used for lower respiratory tract, urinary tract, skin and soft tissue, and bone and joint infections.
Dental Considerations: Local anesthesia with vasoconstrictor ok. Candidiasis, glossitis, headache, paresthesia, fever, and chills. Pregnancy category B, lactation ok. Blood dyscrasias and psuedomembranous colitis. Prolong use may result in superinfection.
Medical Considerations: 1-10%; diarrhea. Other adverse effects; dizziness, weakness, nausea, vomiting, anorexia, abdominal pain, GI bleeding and increased AST/ALT, bilirubin, increased LDH, alk phosphatase, BUN, dyspnea, nephrotoxicity, renal failure, proteinuria, vaginitis, pruritis, rash, urticaria and dermatitis.
Dental Drug Interactions: Decreased bactericidal effects with tetracyclines and erythromycin. May reduce effectiveness of oral contraceptives.
Medical Drug Interactions: Probenecid decreases elimination.
Precautions: Low incidence of cross-hypersensitivity with penicillin. Reduce dose with severe renal disease.
Cephalexin (Keflex, Keftab) #27 & 54 in 97’, alternative for dental endocarditis and orthopedic prosthesis prophylaxis.
Cefadroxil (Duricef) alternative for dental endocarditis prophylaxis.
Cephalosporin (Second Generation)
Actions, drug interactions, precautions same as first generation. For use has broader spectrum of activity.
Cephalosporin (Third Generation)
Outpatient therapy for serious soft tissue or skeletal infections, single dose treatment of uncomplicated N. gonorrhea.
Action: Inhibits protein synthesis by binding to 30s, possibly 50s ribosomes. May also alter cytoplasmic membrane. Bacteriostatic.
Use: Treat periodontitis due to Actinobacillus actinomycetemcomitans. Adjunctive therapy for recurrent aphthous ulcers. Also sinusitis.
Treat susceptible infections due to gram positive and negative organisms. Also unusual organisms; Mycoplama, Chlamydia and Rickettsia.
Also for acne, ophthalmic infections, exacerbations of chronic bronchitis, gonorrhea
and syphilis (if allergic to penicillin). In combination with other meds for H. pylori
Dental Considerations: Local anesthesia with vasoconstrictor ok. Candidiasis, tongue discoloration with hypertrophy of papilla, gingival bleeding, stomatitis, lichenoid drug reaction and erythema multiforme. Fever, headache, paresthesia, blood dyscrasias and dysphagia. Don’t use if pregnant, children < 8yrs. Lactation ok.
Medical Considerations: <1%; pericarditis, nausea, vomiting, abdominal pain, diarrhea, anorexia, hepatotoxicity, enterocolitis, flatulence and abdominal cramps, epigastric burning, increased BUN, rash, urticaria, photosensitivity, increased pigmentation, exfoliative dermatitis, angioedema and pruritis.
Dental Drug Interactions: Decreases effect of penicillin, cephalosporins, oral contraceptives. Increases oral anticoagulant effect.
Medical Drug Interactions: Dairy products, calcium, magnesium or aluminum containing antacids, iron, zinc, cimetidine reduces absorption.
Outdated drug can cause nephropathy. If given with Methoxyflurane anesthesia can cause fatal nephrotoxicity.
Precautions: Don’t use in pregnancy or children under age 8 as causes enamel hypoplasia and discoloration of permanent teeth. Use with caution if renal or hepatic impairment.
Tetracycline (Achromycin, Sumycin, Tetracyn)
Minocycline (Minocin) ANUG
Tetracycline Derivative (continued)
Doxycycline (Vibramycin) Used for ANUG, alternative to mefloquine for malaria prophylaxis and sclerosing agent for pleural effusions. Decreases effect of barbiturates, carbamazepine and hydantoins.
Tetracycline Periodontal Fibers (Actisite) Gingival inflammation, pain in mouth, glossitis, candidiasis, staining of tongue. No drug interactions reported, but birth control pill warning.
Chlorhexidine (Peridex, PerioGard, Hibiclens)
Action: Binds to bacterial cell wall, at low concentration is bacteriostatic causing leakage of potassium and phosphorous. At high concentration bactericidal, precipitates cytoplasmic contents.
Use: Dental rinse active against gram positive and negative organisms, facultative anaerobes, aerobes and yeast.