| - | narrow spectrum of activity, gram-positive pathogens only |
| + | covers several gram-positive anaerobic pathogens |
| + | effective in 90 % of odontogenic aerobic/anaerobic mixed infection |
| + | very well tolerated by patients, broad therapeutic range; may also be used during pregnancy and lactation and in children |
| Type of action | bactericidal |
| Spectrum | gram-positive (including anaerobic) bacteria IMPORTANT: penicillinase-producing staphylococci |
| Kinetics | absorption time: 45 minutes, impaired absorption if taken with food, renal elimination > 50 % |
| Contra-indications | allergies |
| Pregnancy | no signs of embryotoxicity or teratogenicity |
| Lactation | use only if absolutely necessary During lactation, diarrhoea, oral fungal infection (thrush) in, or sensitisation of, the infant may occur. |
| Adverse effects | gastro-intestinal disorders, nausea, vomiting, diarrhoea, flatulence, dry mouth, hypersensitivity reactions |
| Interactions | contraceptives |
| Indication | odontogenic infection |
| + | range of action similar to penicillin V, plus gram-negative bacteria |
| - | clearly less effective than penicillin V in the gram-positive spectrum |
| + | effective against infection with penicillinase-producing staphylococci and bacteroides spp. in combination with clavulanic acid |
| Type of action | bactericidal |
| Spectrum | like penicillin V, plus gram-negative pathogens; in combination with clavulanic acid also effective against penicillinase-producing pathogens |
| Kinetics | absorption time: complete absorption within 2 hours, regardless of meals, renale elimination 30 % |
| Contra-indications | allergies |
| Pregnancy | as with penicillin V; if administered in combination with Augmentin: use only if absolutely necessary |
| Lactation | use only if absolutely necessary |
| Adverse effects | gastro-intestinal disorders as with penicillin V; always consider possibility of pseudomembranous colitis should diarrhoea persist! - discontinue medication if this is the case; toxic ampicillin-induced exanthemata rarely occur (mainly with Coxsackie viral infection or infectious mononucleosis). dry mouth, changes in blood parameters; superinfection caused by resistant germs in case of prolonged or repeated administration. Increased inhibition of thrombocyte aggregation results in an increased risk of haemorrhage if acetylsalicylic acid (ASS) is administered. IMPORTANT: pseudomembranous colitis |
| Interactions | contraceptives, ASS |
| Indication | mixed infection, if penicillin V has no effect; in case of suspected infection with staphylococci |
| + | good antibacterial effect against gram-positive bacteria and staphylococci |
| +/- | varying effect against gram-negative and anaerobic bacteria. More recent cephalosporins (cefuroxim) show good antibacterial effects although with poorer kinetic parameters (poor absorption). |
| + | well tolerated |
| + | used if penicillin is contraindicated |
| Type of action | bactericidal |
| Spectrum | like penicillin V, plus staphylococci and gram-negative bacteria |
| Kinetics | cefaclor: very good absorption; cefuroxim: incomplete absorption, renal renal elimination 70 - 90 % |
| Contra-indications | possible cross-allergy with penicillin, IMPORTANT: caution is advised if renal function is impaired |
| Pregnancy | strict indication as the substance passes the placental barrier and there is still not sufficient experience as with penicillins. No embryotoxic/teratogenic effect. |
| Lactation | use only if absolutely necessary |
| Adverse effects | gastro-intestinal disorders, IMPORTANT: pseudomembranous colitis, hypersensitivity reactions |
| Interactions | contraceptives, ASS |
| Indication | odontogenic infection |
| - | bacteriostatic! |
| - | narrow spectrum, comparable with penicillin V; the more recent macrolides roxithromycin (e. g. Rulid®) and clarithromycin (e.g. Klacid®) are also effective against staphylococci |
| + | no known teratogenic/foetotoxic effect |
| - | metabolised almost completely in the liver |
| + | used when penicillin is contra-indicated |
| Type of action | bacteriostatic |
| Spectrum | like penicillin V, plus staphylococci |
| Kinetics | very good absorption of more recent macrolides, incomplete absorption of erythromycin, only minor renal excretion |
| Contra-indications | allergies to macrolides, impaired hepatic function, IMPORTANT: interactions |
| Pregnancy | use only if absolutely necessary; no embryotoxic/teratogenic effects |
| Lactation | use only if absolutely necessary; erythromycin passes into breast milk (sensitisation, diarrhoea and oral fungal infection (thrush) may occur in the infant), roxithromycin does not pass into the milk and is, therefore, the drug of choice from the macrolide group during lactation. |
| Adverse effects | gastro-intestinal disorders, IMPORTANT: pseudomembranous colitis, hypersensitivity reactions, increase in liver enzymes |
| Interactions | the effects of carbamazepine, digoxin and theophylline are potentiated; life-threatening cardiac arrhythmia may be caused if combined with astemizol or terfenadine; (astemizol/terfenadine are antihistamines and used in the treatment of allergic symptoms) the effects of coumarin-type anticoagulants are intensified |
| Indication | second choice in odontogenic infections |
| +/- | bacteriostatic; bactericidal effect depends on the dose |
| + | good activity in the gram-positive range + gram-positive and gram-negative anaerobes and penicillinase-producing pathogens |
| + | pass well through tissue, high concentration of the active substance in bone |
| + | used when penicillin is contra-indicated |
| Type of action | bacteriostatic if 300 mg are administered 3 times a day; bactericidal if 600 mg are administered 3 times a day |
| Spectrum | like penicillin V, plus penicillinase-producing pathogens |
| Kinetics | absorption up to 75 % regardless of meals, peak blood levels after 45 - 60 minutes if taken without food, and after up to 2 hours if taken with food |
| Contra-indications | allergies to lincosamines, Crohn's disease, ulcerative colitis, myasthenia gravis |
| Pregnancy | contra-indicated There is no data long-term data available for pregnancy and lactation. So far, there is no evidence for embryotoxicity/teratogenicity in humans. |
| Lactation | contra-indicated |
| Adverse effects | gastro-intestinal disorders Very rarely hypersensitivity reactions. Serious adverse effects, however, are very rare (pseudomembranous colitis). IMPORTANT: pseudomembranous colitis, hypersensitivity reactions |
| Interactions | substances inducing neuromuscular blockade Neuromuscular transmission disorders are intensified. Interactions with antiepileptic drugs, benzodiazepines, etc. |
| Indication | drug of choice in odontogenic infections It is particularly indicated for osteitis/osteomyelitis/infected osteoradionecrosis (IORN) as very favourable levels of it are found in bone. |
| + | bactericidal |
| +/- | no good activity against aerobes, good activity against anaerobes |
| - | mutagenic/carcinogic in animal tests |
| + | good combination with penicillin due to the microbial spectra complementing each other |
| - | strictly no alcohol because of possible intolerance |
| Type of action | bactericidal |
| Spectrum | especially anaerobes |
| Kinetics | mainly renal excretion; absorption time of up to 2 hours if taken with food |
| Contra-indications | allergies to nitroimidazoles, serious damage to liver, diseases of the central or peripheral nervous systems, , neuromuscular transmission disorders are intensified! Haematopoietic disorders! |
| Pregnancy | contra-indicated during the first three months |
| Lactation | contra-indicated, high concentration in breast milk |
| Adverse effects | gastro-intestinal disorders, hypersensitivity reactions, disorders of CNS/peripheral nervous system, possible carcinogenic effect |
| Interactions | effect of coumarin-type anticoagulants may be intensified; risk of haemorrhage is increased during anticoagulant treatment. |
| Indication | inflammatory periodontopathy |
| Group | Substance | Trade name, e.g. | Daily dose |
|---|---|---|---|
| oral penicillins | penicillin V propicillin |
Isocillin® Baycillin® |
3-4 x 1.2 Mega 3-4 x 1.0 Mega |
| amino-penicillins | amoxycillin a. + clavulanic acid |
Amoxypen® Augmentin® |
3 x 0.4-1.0 g 2 x 875/125 mg |
| cephalosporins | cefaclor cefuroximaxetil |
Panoral® Elobact® |
3 x 500 mg 2 x 500 mg |
| macrolides | erythromycin roxithromycin clarithromycin |
Erythrocin® Rulid® Klacid® |
3 x 0.4-1.0 g 1 x 300 mg 2 x 250 mg |
| lincosamide | clindamycin | Clindasaar® | 3 x 300-600 mg |
| nitromidazoles | Metronidazol | Clont® | 2 x 500 mg |
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