ANTIBIOTICS USED IN

ORAL AND MAXILLOFACIAL

SURGERY
DR. MEGHA SHAH

GUIDED BY DR. GARDE

MDS I
DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGERY

PENICILLINS
1ST antibiotic to be used clinically in 1941
MOA
interferes with cell wall synthesis
bactericidal
Antibacterial spectrum
Oral aerobes and anaerobes

Natural penicillins, aminopenicillins and

penicillin resistance penicillins are mostly
useful

Commonly used to treat infections in oral

cavity
To be used with precaution in
Patients with hypersensitivity

NATURAL PENICILLINS
Penicillin G
Acid labile
Parenteral route
2-5 million units IM (Adult Dose)
Procaine penicillin G
Longer acting
Adequate serum levels for 8-12 hours, effective
for 1-2 days when administered IM

Penicillin G Benzathine
Even longer duration of serum levels
Drug detectable for 1-3 weeks
Penicillin V
Acid stable
500mg QID orally

Spectrum of natural penicillins most gram + aerobes

and most anaerobes. Staph. Aureus, bacteroides fragilis
and H. influenza are commonly resistant to natural
penicillins.

EXTENDED SPECTRUM - AMPICILLIN

Poorly absorbed from GIT
Parenteral route

EXTENDED SPECTRUM AMOXICILLIN

Currently indicated for treatment of orodental

infections.

Dosage / administration:

0.25 to 1 gm TDS. Mostly given orally.

Trade namesMox, novamox, Alphamox, Ambac, 250 / 500 mg
caps;
125 mg/ 5ml syrup
Antibacterial spectrum-

Gram +ve, gram ve bacteria & most oral

anaerobes.

ADVANTAGES
Concentrations that are higher & last longer

than an equivalent dose of Penicillin V.

Effective against infections involving streptococci or

other species resistant to Penicillin V.

DISADVANTAGES
Greater potential to produce superinfections of

the GIT & vagina, because of broader spectrum

of activity against gram ve aerobes.
Can produce skin rashes as a result of allergy.

PENICILLIN WITH B-LACTAMASE

INHIBITORS
Clavulanic acid
A potent and irreversible inhibitor of many betalactamases
Protects beta-lactam antibiotics from inactivation,
when combined with them.
Widens the antibacterial spectrum
Common brand name and dosage
Augmentin (amoxicillin 250/500mg + clavulanic acid
125mg) BD oral, Clavum
Also as i.m. or i.v. 6 8 hourly asAugmentin (amoxicillin 1g + clavulanic acid 0.2g vial)
Augmentin (amoxicillin 0.5g + clavulanic acid 0.1g vial)

Amoxicillin + Cloxacillin
Novaclox, Amoclox, Amotox Tab 250mg + 200
mg TDS
Adverse reactions
Gastritis
Hypersensitivity
Abdominal cramps

Sulbactam
Used with Ampicillin (Unasyn)

Improves ability to eradicate S.aureus and

H.influenza

EXTENDED SPECTRUM PENICILLINS

Spectrum includes aerobic gram-ve bacilli

including Ps. Aeruginosa

Carbenicillin
Ticarcillin
Piperacillin
Mecillinam
Limited benefits in head and neck infections

CEPHALOSPORINS
Less susceptible to b-lactamases as compared

to penicillin
As the generation increases, gram positive

coverage reduces, while effectiveness for

gram ve organisms increase and for
anaerobes the killing power decreases
Bactericidal

1st GENERATION CEPHALOSPORINS

Commonly used for maxillofacial infections and

prophylaxis
Cefadroxil
Cephalexin

Cefazolin
Cephradine

Brand name and dosage cefadur, cefadrox,

sporidex, phexin Tab 500mg BD

Active against streptococci sp, staph. Aureus and
not active against enterococci, listeria or MRSA

2nd GENERATION CEPHALOSPORINS

Greater gram ve spectrum
More resistant to beta-lactamase.

Cefaclor (250 mg cap; 125 & 250mg DT;

125mg/5ml dry syr)

Cefoxitin
Cefprozil
Cefuroxime
Brand name and dosage Ceftab, Ceftum - Tab 500
mg BD
Useful for treating upper & lower respiratory tract

infections, sinusitis & otitis media

3rd GENERATION CEPHALOSPORINS

Broad spectrum of activity with further increased activity

against gram ve organisms.

Cefixime
Ceftriaxone
Cefotaxime (0.25, 0.5 & 1 g per vial inj)
Ceftibuten
Cefdinir
Cefpodoxime

Brand Name and dosage Zifi, Taxim o tab 200mg BD

Promising for serious sinus and skin infections

4th GENERATION CEPHALOSPORINS

Extended spectrum agents, with similar activity against

gram +ve organisms as first generation cephalosporins.

Greater resistance to beta-lactamases than third

generation cephalosporins.

Cefluprenam
Cefozopran
Cefepime ( 0.5, 1 g inj)
Cefpirome
Cefquinome

Adverse effects:
MildStomach upset /
cramps
Nausea, vomitting
Diarrhoea
Sore tongue
Sores in the mouth
Vaginal yeast
infections

SevereBlack, tarry stools

Chest pain
Fever
Difficult / painful
urination
Allergic reactions
Serious colitis

MONOBACTAMS
Bactericidal effect similar to other drugs in

this class
Only Aztreonam is approved for use
No activity against g+ organisms, limiting its

use in head or neck infections

Dose 1-2 g every 8 hours

CARBAPENEMS
Broad antibacterial spectrum
Commonly used to treat P.aeruginosa

infections resistant to other antimicrobials

IMIPENEM
MEROPENEM

TETRACYCLINES
Bacteriostatic in nature
Limited use because of rapid development of

resistence
MOA binding to 30S ribosomes
Uses
Lower molar osteitis sicca (dry socket )

prevention
Acne therapy
Periodontal disease

Effective against g+cocci and few g-ve rods

Tetracycline, minocycline & doxycycline are used

for treatment of orodental infections

Tetracycline HCl (Alcyclin, Tetracyn) - Cap/ tab for
paediatric dose. Adult dose between 1 and 2 g/per
day in 3-4 divided doses.
Doxycycline - Sparadoz, Sydox Cap 100mg, Tab
200mg )D

Adverse effects:
Teratogenic
Stains developing teeth
Allergic manifestations like rash
Photosensitivity
Hepatic dysfunction
GI disturbance like nausea, vomiting,
epigastric distress
Antianabolic effect
Avoided in patients with renal impairment
can lead to aggravation of aztemia and
exaggerated anabolic effect
Reversible Fanconi-like syndrome
IV administration can lad tolocal thrombosis

VANCOMYCIN
Highly effective against MRSA, gram + cocci
MOA cell wall inhibition
Poor oral absorption and painful IM injection
IV dose 2g daily in divided doses 500mg over 60

mins every 6 hours or 1g every 12 hours

Vancocin CP Cap 250mg QID
Adverse reactions local thrombophlebitis,
generalised cutaneous reactions (Red Man
Syndrome) and auditory damage
Used with caution in patients with renal damage

CHLORAMPHENICOL
Broad spectrum, bactriostatic agent
Rarely used these days
Useful in ampicillin resistant H.influenza and

anaerobic bacteria
Useful for brain abscess and meningitis
S/E aplastic anaemia (rare)
- gray baby syndrome (neonates)

50mg/kg/day in divided 4 doses in older

children and adults

MACROLIDES
Useful for maxillofacial infections
MOA bacteriostatic and interferes with

protein synthesis by attaching to 50S

ribosome subunit
Antibacterial spectrum g+organisms,
G ve can resist it easily because of outer cell
membrane and Methicillin resistant staph.
Aureus is also resistant
Common macrolides Erythromycin,
Azithromycin, Clindamycin, Clarithromycin

ERYTHROMYCIN
Best known macrolide with g + spectrum

similar to penicillin, but less effective against

anaerobes.
But not used much because of its side effects
and other agents are preferred

CLINDAMYCIN
Bacteriostatic at low concentrations and

bactericidal at slightly higher concentration

Effective against gram + organisms, especially
Staphylococci, Pneumococci, certain Streptococci
Also useful for anaerobic infections
Cap clincin, Dalacin
150 450 mg orally QID / 300 mg BD
Adverse effect superinfection with Cl. Difficile
Commonly used ddrug for serious odontogenic
infections including osteomylitis

AZITHROMYCIN
Broad spectrum coverage including g+ and g-

ve aerobes and strict anaerobes

Oral absorption and tissue peneration is
better
Brand name and dosage Azith , Azec tab
500mg OD/BD

Adverse reactions :
Diarrhoea
Nausea
Vomiting
Flatulence
Headache
Rashes

NITROIMIDAZOLES METRONIDAZOLE
Stimulates production of toxic products to kill

susceptible bactera
Effective against strict anaerobic bacteria
(most responsible for oral/dental infectionsBacteroides, Prevotella, Porphyromonas,
Veillonella, Fusobacterium, Treponema etc.)
Trade names & dosage:

Metrogyl, Flagyl 400mg tab TDS orally

Can be given i.v. also (100 ml)

ORNIDAZOLE
Trade name and dosage Orni, Ornida Tab

500mg BD

Uses:
Pericoronitis
Certain periapical infections
Some cases of osteomyelitis
Infected extraction socket
Adverse reactions :
Anorexia
Nausea
Abdominal cramps
Dizziness
Metallic taste

Adverse effects :
Disulfiram reaction
Can increase the action of anticoagulants
Contraindicated in pregnant patients

FLUOROQUINOLONES:
Quinolones are a family of synthetic broad

spectrum antibiotics.

The parent of the quinolones class is nalidixic

acid.

Majority of quinolones in clinical use belong to

the subset of fluoroquinolones.

Generations:
Quinolones are divided into generations based
on their anti-bacterial spectrum.

1st generation
Cinoxacine
Nalidixic acid
Oxolinic acid
Rosoxacin
Pipemidic acid
Piromidic acid

2nd generation
ciprofloxacin
ofloxacin
norfloxacin
lomefloxacin
nadifloxacin

3rd generation:
(active against streptococci)
Levofloxacin
Sparfloxacin
Balofloxacin
Gatifloxacin
Grepafloxacin
Moxifloxacin

4th generation:
Plurifloxacin
Gemifloxacin
Clinafloxacin

Trade names:
Ciplox, Cifran 250, 500 or 750mg tabs.; 200mg/100ml
i.v.
Norflox 200, 400, 800mg tabs

REFERENCES
1. Pharmacology and pharmacotherapeutics by

R.S.Satoskar revised 20th edition

2. Essentials of medical pharmacology by K.D.
Tripathi 5th edition