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Chapter 8
Antiinfective Agents
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Antiinfective Agents
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Types of Dental Infections
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Caries
• Caries are produced by Streptococcus mutans.
• Antibiotics are not used to treat or prevent caries.
Periodontal Disease
• Many different bacteria are involved in causing
periodontal disease.
• Treatments include the use of local or systemic
antibiotics.
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Antiinfective Agents
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Types of Dental Infections
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Localized Dental Infections
• Most localized dental infections are an extension of
periodontic or endodontic-related sources.
• Drainage is the normal course of therapy.
• Antibiotics are used if the patient is
immunocompromised.
• The choice of antibiotic depends on the infecting
organism.
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Antiinfective Agents
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Types of Dental Infections
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Systemic Infections
• These infections produce systemic symptoms such
as fever, malaise, and tachycardia.
• Infections need to be treated with antibiotics.
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Antiinfective Agents
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Indications for Antiinfective Drugs
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Most dental infections do not require
antibiotics.
 Patients that are immunocompromised may
require antibiotic therapy.
 Drainage is usually sufficient for localized
infections.
 Systemic infections may require antibiotics.
 The choice of antiinfective therapy depends on
the infecting organism.
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Antiinfective Agents
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Indications for Antiinfective Drugs
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Antibiotics are most often used in dentistry as
prophylaxis before a dental procedure.
Antibiotic prophylaxis is used when there is a
history of rheumatic or congenital heart
disease or the presence of a heart valve
prosthesis.
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Antiinfective Agents
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Antibiotic Prophylaxis
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Antibiotic prophylaxis is used to prevent infective
endocarditis.
Antibiotic prophylaxis depends on the specific
dental procedure being performed, the cardiac
and medical condition of the patient, and the drug
and dose necessary.
Always check the most current guidelines of the
American Heart Association and the American
Dental Association regarding antibiotic
prophylaxis.
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Antiinfective Agents
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Many different antiinfective drugs are
available to treat infections.
All antiinfective drugs share several
different adverse reactions and drug
interactions.
Review each antiinfective to determine
whether it has an adverse reaction or drug
interaction that is not shared by all.
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Antiinfective Agents
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General Adverse Reactions
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Superinfection
• All antiinfectives can produce an overgrowth of
organisms that is different from the infecting
organism.
• The wider the spectrum of the antibiotic, the higher
the risk for superinfection.
• This adverse effect can be minimized by giving the
most narrow spectrum antibiotic as possible.
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Antiinfective Agents

General Adverse Reactions
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Allergic Reaction
• All antiinfective drugs have the potential to cause an
allergic reaction.
• Allergic reactions can range from a mild rash to
anaphylaxis.
• Penicillin-type antibiotics are more allergenic than
other antibiotics.
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Antiinfective Agents

General Adverse Reactions
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Gastrointestinal Complaints
• All antiinfective drugs produce a variety of GI complaints.
• GI effects include stomach pain, increased motility, and
diarrhea.
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Chewable and Liquid Dose Forms
• Chewable and liquid dose forms contain sugar as a sweetener.
• Children or adults that use these dose forms should brush and
floss their teeth after each dose.
• Long-term administration of antibiotics may increase the risk for
caries.
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Antiinfective Agents
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General Drug Interactions
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Oral Contraceptives
• Antibiotics can increase the clearance of oral
contraceptives from the body, which makes the oral
contraceptive less effective.
• Women taking oral contraceptives should use an
additional method of contraception while receiving
systemic antibiotic therapy.
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Antiinfective Agents

General Drug Interactions
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Oral Anticoagulants
• Antibiotics can potentiate the effects of oral
anticoagulants.
• Antibiotics reduce the bacterial flora that produce
vitamin K.
• Vitamin K is the body’s natural clotting factor.
• Oral anticoagulants are vitamin K inhibitors.
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Antiinfective Agents
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Antibiotics Most Commonly Used in Dental
Health Care
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Penicillins
Cephalosporins
Macrolides
• Azithromycin
• Clarithromycin
Tetracycline
Clindamycin
Metronidazole
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Antiinfective Agents
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All the antibiotics used in dental health
care share similar adverse effects and
drug interactions.
Several antibiotics have adverse effects
that have significant concerns to a dental
healthcare practitioner.
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Antiinfective Agents
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Dental Concerns of Selected Antibiotics
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Tetracycline
• Tetracycline is absorbed into calcifying structures
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including unerupted teeth.
Tetracycline can cause permanent discoloration of the
teeth and enamel hypoplasia.
Tetracycline should not be used in children until they
have all of their adult teeth.
Tetracycline crosses the placenta and into breast milk
and affects the primary teeth.
Tetracycline should not be given to women who are
pregnant or nursing.
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Antiinfective Agents
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Dental Concerns of Selected Antibiotics
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Metronidazole
• If alcohol is ingested while a person is taking metronidazole, the
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person will experience a mild form of a reaction that occurs with
alcohol and disulfiram.
Symptoms include nausea, abdominal cramps, flushing, vomiting,
and headache. The reaction can happen if the patient ingests any
form of alcohol including foods, drinks, and mouth rinses containing
alcohol.
Some people have experienced the symptoms if they smell alcohol,
apply it to their bodies (e.g., perfumes, colognes, aftershave).
Alcohol should not be consumed during metronidazole therapy and
one day after finishing therapy.
Other oral adverse effects include dry mouth, unpleasant or sharp
metallic taste, glossitis, stomatitis, and a black-furred tongue.
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Antiinfective Agents
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Other Antiinfectives
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Many other agents are available for nondental
uses.
• Vancomycin
• Aminoglycosides
• Chloramphenicol
• Sulfonamides
• Nitrofurantoin
• Quinolones
 These antiinfectives share many of the same
adverse effects as other antibiotics manifest.
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