Over view of the most commonly prescribed antibiotics in dentistry

1. An#bio#cs
List
2012
Antibiotic Infection Example/ Mech of Action Metabolism Side Effects Pregnancy/
(Class) Typical Dose Excretion Breast Feeding
(5-7 days)
Penicillin/ Odontogenic Up to 2000mg load Bactericidal: Met: Hepatic Hypersensitivity Preg Cat: B
Amoxicillin Infection 250-500 mg t.i.d. Cell Wall Synthesis Excr: Kidney (rash): 5% BF: Enters breast
(Penicillins) Amox: IE (Take on empty inhibitor - binds to PBP Diarrhea: 5% milk - caution
Prophylaxis stomach) inhibit peptidoglycan recommended
IE: 2g 1 hr before appt synthesis
Tetracycline Periodontics 200 mg q.d. Bactericidal: Inhibits bacterial Met: CYP3A4 Photosensitivity Preg Cat: D
(Tetracycline) Antacids may dec protein synthesis by binding with Excr: Kidney/Fecal BF: AAP considers
the 30s and/or 50s ribosomal
absorption subunits of susceptible bacteria tetracycline to
“compatible”
Clindamycin Odontogenic 300 mg t.i.d. or q.i.d. Bacteriostatic or cidal: Met: Hepatic Diarrhea: 7% Preg Cat: B
(Lincosamide) Infection IE: 600mg 1hr before Binds to the 50s ribosomal Excr: Biliary/renal Pseudomembranous BF: AAP suggests
subunit of susceptible bacteria
IE Prophylaxis appt Colitis that it is “fairly” safe.
Static and/or cidal conc,
infections site, and organism
Metronidazole Anaerobic 500 mg b.i.d. or t.i.d. Bacteriostatic: Met: Hepatic Nausea/vomiting: B (Avoid 1st trimester)
(Nitroimidazole) Odontogenic Binds to bac DNA Excr: Biliary/renal 12% BF: AAP rates
Infection (Antabuse) “concern”
Augmentin Tx of orofacial 875 b.i.d Bactericidal: Met: Hepatic Diarrhea: 3-34% Preg Cat: B
Clavulanic Acid infections when b- Dose is based on Cell Wall Synthesis inhibitor - Excr: Kidney BF: Enters milk, use
binds to PBP inhib peptidoglcn
Amoxicillin lactamase prod amoxicillin w/ caution
syn Clavulanate binds/inhibs
bac present beta-lactamases
Azithromycin Odontogenic 250-500 mg q.d. Bacteriostatic: Met: Hepatic Diarrhea (4-9%) Preg Cat: B
(Macrolide) Infection alternative Binds to 50 ribosomal Excr: Kidney Nausea (<7%) BF: Enters milk, use
subunit w/ caution
Cephalexin Prophylaxis in total 250-1000mg every 6hrs Bactericidal: Met: Hepatic Diarrhea (4-9%) Rpeg Cat: B
(Cephalosporin) joint replacement Max: 4 g/day Cell Wall Synthesis Excr: Kidney Nausea (<7%) BF: Enters milk, use
patients inhibitor - binds to PBP w/ caution
inhibit peptidoglcn syn
Ciprofloxacin Periodontics 500 mg b.i.d. Bactericidal: Met: Hepatic Diarrhea (4-9%) Preg Cat: B
(Fluorquinolone) Inhibs DNA gyrase Excr: Kidney Nausea (<7%) BF: Enters milk, not
recommended