Pharmacology reference by Michael L. Iczkovitz, D. D. S

Antibiotic Penicillin Derivative

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Action: Inhibits bacterial cell wall synthesis resulting in cell wall lysis.

Use: Treat aerobic gram positive cocci and anaerobic infections. Including dental, respiratory tract, otitis media, sinusitis, and urinary tract.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Candidiasis, glossitis, stomatitis, black hairy tongue, dry mouth, altered taste and blood dyscrasias.

Medical Considerations: >10%; nausea, vomiting, diarrhea

1-10%; hypersensitivity reactions


  • Penicillin Derivative (continued)

Medical Considerations: Other adverse reactions; coma, depression, convulsions, lethargy, hallucinations, anxiety, twitching, abdominal pain, colitis, anorexia, oliguria, proteinuria, hematuria, vaginitis, monoliasis, glomerulonephritis, hyperkalemia, hypokalemia and alkalosis.

Precautions: Severe renal impairment, seizure history and allergic to cephalosporins. Can reduce effectiveness of oral contraceptives. Pregnancy category B, lactation ok.

Dental Drug Interactions: When used with tetracyclines, erythromycin and lincomycin there is a decreased effectiveness. Acts synergistically with aminoglycosides. Probenecid increases blood levels of penicillins.

Penicillin V Potassium (Pen Vee K, V-Cillin K, Veetids)

First choice for common orofacial infections. Not for endocarditis or orthopedic prosthesis prophylaxis.

Amoxicillin (Amoxil, Biomox, Trimox)

First choice for endocarditis, prosthesis prophylaxis. Superinfections tend to develop rash with infectious mononucleosis.

Ampicillin (Amcill, Polycillin)

Alternative for dental prophylaxis. Severe abdominal cramps. Increases effect of oral anticoagulants. Can develop nonallergic rash, especially if viral and Salmonella infections, lymphocytic leukemia, hyperuricemia or taking Allopurinol.

  • Penicillin Derivative +

Amoxicillin and Clavulanate Potassium (Augmentin)

Clavulanate inactivates beta lactamase, can use with beta-lactamase staphylococci and bacteroides. Rash with Allopurinol. Treat otitis media, sinusitis, lower respiratory

tract, urinary tract, skin infections and gonorrhea. Increased diarrhea. Caution if hepatic dysfunction.

Ampicillin and Sulbactam (Unasyn)

Sulbactam is a beta-lactamase inhibitor. Treat severe orofacial infections from Staphylococci and Bacteroides.

Treat skin, intrabdominal and gynecological infections. Only given I.M. or I.V. May follow with oral Augmentin.

Good against beta-lactamase producers S. aureus, H. influenzae, E. coli, Klebsiella, Acinetobacter, Enterobacter and anaerobes.


  • Macrolide

Action: Inhibits RNA dependent protein synthesis by binding 50S ribosomal subunit.

Use: Alternative to penicillin for orofacial infections. Also treat M. pneumoniae, Legionella pneumophilia, diphtheria, pertussis, chancroid, Chlamydia and Campylobacter gastroenteritis.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Candidiasis and tinnitus. Pregnancy category B, lactation ok.

Medical Considerations: >10%; abdominal pain, cramping, nausea and vomiting.

1-10%; cholestatic jaundice and hypersensitivity reactions.

Medical Considerations: Other adverse reactions; heartburn, pruritis ani, psuedomembranous colitis, vaginitis, monoliasis and hearing loss.

Contraindications: Hepatic disease.

Dental Drug Interactions: Decreases action of clindamycin, penicillins, lincomycin and oral contraceptives. Increases effects of oral anticoagulants and benzodiazepines.

Medical Drug Interactions: Increases effects of alfentanil, carbamazepine, theophylline, felodipine, triazolam and ergotamine. Contraindicated with pimozole, terfenadine, astemizole, lovastin and cisapride.

Erythromycin (E.E.S., Ilosone, E-Mycin, Ery-Tab, Erythrocin)

Patients may be unable to tolerate due to abdominal pain. Used with neomycin to decontaminate bowel. Used to improve gastric emptying.

Clarithromycin (Biaxin)

Alternative for dental prophylaxis, endocarditis only. Effective against most respiratory pathogens including H. influenzae, C. pneumoniae and M. avium.

Headache. Used in combination with Omeprazole for H. pylori duodenal ulcer. Pregnancy category C, lactation ok. Also use with caution with renal disease.

Decreases effects of anticholinergics, rifabutin, rifampin and zidovudine. Increases effects of cyclosporine and digoxin.

Azithromycin (Zithromax)

Alternative for orofacial infections and dental endocarditis prophylaxis, good against most respiratory pathogens and gonorrhea, chancroid. Headache.

Clindamyacin (Cleocin)

Action: Reversibly binds to 50’s ribosomal subunits to prevent peptide formation and

inhibit bacterial protein synthesis. Can be bacteriostatic or bactericidal.

Use: Treat orofacial infections. Alternative for endocarditis and prosthetic

joint prosthesis prophylaxis. Treat aerobic and anaerobic streptococci (not

enterococci), most staphylococci, Bacteroides, Actinomyces. Alternative for

toxoplasmosis. Topically for severe acne, vaginally for Gardnerella vaginalis.

Dental Considerations: Local anesthesia with vasoconstrictor ok. Stevens Johnson

syndrome, blood dyscrasias, candidiasis.

Medical Considerations: >10%; Psuedomembranous colitis, GI upset. 1 to 10%;

hypotension, urticaria, rashes, polyarthritis, fungal overgrowth.

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