ANTIBIOTICS,Presented by Dr.Pavan kumar.G P.G.STUDENT,CONTENTS,TERMINOLOGYHISTORY OF ANTIBIOTICSRATIONALE OF DRUG USEPATTERNS OF MISUSEDRUG LEGISLATIONSCLASSIFICATION OF AMASBACTERIAL GROWTH CURVEMODUS OPERANDI OF AMASPRINCIPLES OF ANTIBIOTIC DOSING,DRUG RESISTANCESULFONAMIDESCOTRIMOXAZOLEFLOUROQUINOLONESCEPHALOSPORINSCHLORAMPHENICOLAMINOGLYCOSIDESMACROLIDESMISCELLANEOUS ANTIBIOTICSANTI FUNGALS &ANTI VIRAL DRUGS,PENICILLINSTETRACYCLINESMETRONIDAZOLEANTIBIOTIC FAILURESNON-EFFECTIVE CONDITIONS IN DENTISTRYNEWER ANTI-MICROBIAL APPROACHESANTIBIOMA,BIBILOGRAPHY,PHARMACOLOGY & THERAPEUTICS FOR DENTISTRY- Yagiela. Dowd. Neidle 5th editionESSENTIALS OF MEDICAL PHARMACOLOGY- K.D.Tripathi 5th editionTEXTBOOK OF MICROBIOLOGY- R.Ananthanarayan & C.K.J.PanikerORAL & MAXILLOFACIAL INFECTIONS- Topazian 4th editionMICROBIOLOGY AN INTRODUCTION- Tortora,Funke,Case 8th edition,TERMINOLOGY,ANTIBIOTICS-Substances produced by micro organisms which suppressthe growth of or kill other micro organisms at very low concentrations.ANTI MICROBIAL AGENTS Substances produced synthetically as well As naturally obtained drugs that attenuate micro organisms.CHEMOTHERAPY Treatment of systemic infections with specific drugsthat selectively suppress the infecting microorganisms without significantlyaffecting the host.,DRUG Single active chemical entity present in medicine that is used for diagnosis,prevention,treatment/cure of a disease.,HISTORY,PERIOD OF EMPIRICAL USEUse of mouldy curd by chinese on boilsChaulmoogra oil by hindus in leprosyChenopodium by aztecs for intestinal wormsMercury by paracelsus for syphilisCinchona bark for fevers,EHRLICHS PHASE OF DYES& ORGANOMETALLICS (1890-1935),If dyes could selectively stain microbes,they could be selectively toxic also.Atoxyl for sleeping sickness.Arsphenamine &norarsphenamine for syphilisEHRLICH also coined the term “Chemotherapy”.,MODERN ERA,It was in 1929 that ALEXANDER FLEMING by serendipity elaboratedpenicillin from the mould of P.notatum.DOMAGK in 1935 demonstrated the therapeutic effect of PRONTOSILa sulfonamide dye.But it was from 1939-41when CHAIN & FLOREY carried on the studiesof Fleming which culminated in the use of penicillins.In 1940s WAKSMAN & colleagues developed streptomycin fromactinomycetes.,THIS IS THE MOST DRUGGED GENERATIONTHE MYTHA PILL TO CURE EVERY ILL,RATIONALE OF DRUG USE,NeedAimKnowledgeRoute & dosageAlternativesDurationObservationsElimination,Unwanted effectsPrecautionsContraindicationsPatients point if viewPatient,PATTERNS OF MISUSE,They are used as “drugs of fear” to cover for potential errors of omission or commission & thereby prevent a claim of negligence.In many cases they are given to prevent infection & to ensure that was done to avoid later criticism.Inappropriate use of antibiotics in dentistry include*Antibiotic therapy initiated after surgery to prevent infection* Failure to use prophylactic antibiotics* As analgesics in endodontics,*Overuse in situations in which pts are not at risk for metastaticinfections.*Treatment of chronic adult periodontitis almost totally amenableto mechanical therapy.*Administration instead of mechanical therapy for periodontitis.* Long term administration in th management of periodontal disease.*Antibiotic therapy instead of incision & drainage.*Administrations to avoid claims of negligence.* Administrations in improper situations, dosage & duration of therapy.,DRUG LEGISLATIONS,Under the perview of CHEMICAL & PETROLEUM MINISTRY.But drug controller (Dept. of health & family welfare) possesses the power over the drug & the manufacturer.Various drug acts includePoisons act of 1919Dangerous drugs act of 1930Drug & magic remedies act of 1945Drugs & cosmetics act of 1940 amended in 1955,60,62,64,72 &1982.,BACTERIAL GROWTH CURVE,ANTIBIOTIC MECHANISM OF ACTION,Inhibition of cell wall synthesis.Alteration of cell membrane integrity.Inhibition of ribosomal protein synthesis.Suppression of DNA synthesis.Inhibition of folic acid synthesis.,PRINCIPLES OF ANTIBIOTIC DOSING,M.I.CConc. Dependent v/s time dependent antibioticsPost antibiotic effects (PAE)Microbial persistence & regrowthDosing & resistanceAntibiotic loading doseDuration & antibiotic dosing,MICROBIAL DRUG RESISTANCE,Enzymatic inactivationModification/protection of target sitesAltered cell membrane permeabilityActive drug effluxFailure to activate the drugUse of alternate growth requirementsOver production of target sites,In addition drug resistance can also occur by MUTATION or GENE TRANSFER,SULFONAMIDES,First AMA effective against pyogenic infections.Sulfonamides still of clinical interest areShort acting (4-8hrs) sulfadiazineIntermediate acting (8-12hrs) sulfamethoxazole,etcLong acting (7days) sulfadoxineSpecial purposes sulfacetamide sod.,mafenide,silver sulfadiazine,ANTI BACTERIAL SPECTRUMPrimarily bacteriostatic agent against many gram+ve & gram_ve bacteria. Organisms still sensitive are St.pyogenes,H.influenzae,H.ducreyi,E.coli,V.cholera,Chalydiae,Actinomyces,Nocardia & Toxoplasma.,