Basic Dental Pharmacology

mahmoud.abdalaziz@hotmail.
com
Introduction:
• Our understanding of how antibiotics induce bacterial cell death is centered on
the essential cellular function inhibited by the primary drug-target interaction.
• Antibiotics can be classified based on the cellular component or system they
affect, in addition to whether they
• induce cell death (bactericidal drugs)
• inhibit cell growth (bacteriostatic drugs).
• Generalized structure of Bacterium ( cell wall , cell membrane , DNA , RNA ,
Ribosomes 50S and 30S subunits)
Most current bactericidal antimicrobials, which are the focus of this review, inhibit
• nucleic acid synthesis (DNA , RNA & Folate synthesis).
• Cell membrane synthesis.
• cell wall synthesis.
• protein synthesis.
• Mechanism of Action:
• Mechanism of Action:
1. Disruption of cell membrane : Polymyxin – polyenes (antifungal)
2. Inhibition of cell wall synthesis :
• β-lactam penicillin , carbapenem , monobactam and cephalosporin.
• Non β-lactam (Glycopeptides) Vancomycin and Bacitracin.
3. Inhibition of protein synthesis :
• 50S ribosome inhibitors [macrolide (e.g., erythromycin), lincosamide (e.g., clindamycin),
streptogramin (e.g., dalfopristin/quinupristin), amphenicol (e.g., chloramphenicol) and oxazolidinone
(e.g., linezolid) ]
• 30S ribosome inhibitors [ tetracycline and aminocyclitol which comprised of spectinomycin and the
aminoglycoside]
4. Inhibition of DNA replication :
• DNA synthesis Metronidazole
• DNA Gyrase Quinolones
5. Inhibition of RNA synthesis : Rifamycin
6. Inhibition of Folate synthesis : Sulfonamides and Trimethoprim
For more information : https://youtu.be/IVBCrzjOl40

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2896384/
• Beta-lactamase Resistance :
• β-lactam antibiotics (beta-lactam antibiotics) are a class of broad-spectrum
antibiotics, consisting of all antibiotic agents that contain a β-lactam ring in their
molecular structures.
• This includes penicillin derivatives, cephalosporin , monobactam ,
and carbapenem.
• Bacteria often develop resistance to β-lactam antibiotics by synthesizing a β-
lactamase enzyme that attacks the β-lactam ring (metabolize antibiotics).
• Bacteria secretes β-lactamase enzyme e.g. staph aureus , methicillin resistant
staph aureus (MRSA) , H. Influenza , E. coli , proteus & P. Aerugenosa.
• To overcome this resistance, β-lactam antibiotics are often given with (β-
lactamase inhibitors) such as clavulanic acid , Sulbactam , Tazobactam.
• β-lactamase inhibitors have no antibacterial activity of their own . They protect
antibiotic from metabolism.
• Used in combination with other penicillin e.g. :
• clavulanic acid + amoxicillin -----< augmentin
• Sulbactam + ampicillin -----< unasyn
• Microbiology of Dental Decay and Periodontal Disease:
1. Dental Decay
• Etiology
Streptococcus mutans is the main cause of dental decay. Various lactobacilli
are associated with progression of the lesion.(anaerobic bacteria)
2. Periodontal Disease
- Divided into two general groupings: gingivitis or periodontitis.
• Etiology
Periodontal infections are usually mixed, most often involving anaerobes
such as Treponema denticola , Porphyromonas gingivalis and B forsythus .
The microaerophile Actinobacillus actinomycetemcomitans causes a rare
form known as localized juvenile periodontitis.
• Treatment
• Penicillin is effective or (Erythromycin or Azithromycin) are alternative if
penicillin-allergy.
• Recent studies suggest that short-term use of antimicrobial agents,
especially metronidazole or doxycycline, is beneficial.
For more information : https://www.ncbi.nlm.nih.gov/books/NBK8259/
• Dental Abscess :
1. The term dentoalveolar abscess comprises 3 distinct processes, as
follows:
1. A periapical abscess
2. A periodontal abscess
3. Pericoronitis
2. Odontogenic infections are polymicrobial, with an average of 4-6 different
causative bacteria. The dominant isolates are strictly anaerobic gram-
negative rods and gram-positive cocci, in addition to facultative and
microaerophilic streptococci.
3. [Anaerobic bacteria outnumber aerobes 2-3:1].
4. In general, strictly anaerobic gram-negative rods are more pathogenic
than facultative or strictly anaerobic gram-positive cocci.
5. Generally, The predominant species associated with dental abscess
include Bacteroides, Fusobacterium, Actinomyces,
Peptococcus,Peptostreptococcus, and Porphyromonas as well as Prevotella
oralis, Prevotella melaninogenica, and Streptococcus viridans. (anaerobic)
6. Antibiotics
• Penicillins and cephalosporins
• Historically, the penicillins have been used as first-line agents in the treatment of
odontogenic infections.
• Increasing rates of penicillin resistance and treatment failures have been reported.
• Macrolides
• The newer macrolides, clarithromycin and azithromycin, offer improved
pharmacokinetics compared to erythromycin.
• The macrolides should not be considered as first-line therapy in treating odontogenic
infections and should be reserved for patients with penicillin allergy.
• Metronidazole
• Metronidazole is a bactericidal agent that is highly active against most anaerobes, but
it lacks activity against aerobic bacteria.
• Similarly, although it retains activity against penicillin-resistant anaerobic Gram-
negative bacilli, it only has moderate activity against microaerophilic Gram-positive
cocci.
• In serious infections, metronidazole is best used with penicillin to ensure coverage
against aerobic Gram-positive bacteria.
• However, a combination of two drugs with different dosing schedules may lower
patient compliance.
• Clindamycin
• Clindamycin has excellent activity against Gram-positive organisms, including
anaerobes and β-lactamase producing strains.
• Low concentrations of the drug are bacteriostatic, but bactericidal activity is
achieved clinically with the usual recommended doses.
• A number of clinical trials have demonstrated clindamycin's efficacy in treating
odontogenic infections.
• Clindamycin and penicillin V in the treatment of moderate to severe odontogenic
infections.
• In one study, moxifloxacin was significantly more effective in reducing pain at days 2-
3 of therapy than clindamycin.
• Clindamycin has recently been considered for the management of odontogenic
infections because of :
• the bacterial susceptibility to this drug
• great oral absorption
• low emergence of bacterial resistance
• good antibiotic levels in bone.
For more information : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3858730/
What are the possible side-effects?
• It is not possible to list all the possible side-effects of each antibiotic in this
leaflet. However, as with all medicines, there are a number of side-effects that
have been reported with each of the different antibiotics. If you want more
information specific to your antibiotic then you should read the information
leaflet that comes with the medicine.
• Most side-effects of antibiotics are not serious. Common side-effects include soft
stools (faeces), diarrhoea, or mild stomach upset such as feeling sick (nausea).
Less commonly, some people have an allergic reaction to an antibiotic and some
have died from a severe allergic reaction - this is very rare.
1. Severe watery diarrhoea and tummy (abdominal) cramps: signs of a serious bacterial
infection of the gut .
2. Shortness of breath, hives, rash, swelling (of the lips, face, or tongue), fainting.
3. Vaginal itching or discharge.
4. White patches on the tongue.
5. Being sick (vomiting).
• Antibiotics can kill off normal defence bacteria which live in the bowel and
vagina. This may then allow thrush or other bad bacteria to grow.
• Combinations of Antimicrobial Drugs
It is therapeutically advisable to treat patients with the single agent that is most
specific for the infecting organism.This strategy reduces the possibility of
superinfection, decreases the emergence of resistant organisms,and minimizes
toxicity. However, situations in which combinations of drugs are employed do
exist. For example, the treatment of tuberculosis benefits from drug
combinations.
• Advantages of drug combinations
Certain combinations of antibiotics, such as Î²-lactams and aminoglycosides, show
synergism;that is, the combination is more effective than either of the drugs used separately.
• Disadvantages of drug combinations
A number of antibiotics act only when organisms are multiplying. Thus, coadministration of an
agent that causes bacteriostasis plus a second agent that is bactericidal may result in the first
drug interfering with the action of thesecond. For example, bacteriostatic tetracycline drugs
may interfere with the bactericidal effect of penicillins and cephalosporins
Bacterial Classification
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3719496/table/T1
Anti-Microbial that are available at the Egyptian Market
1. Penicillin group & related antibiotics and Glycopeotide.
2. Cephalosporin
3. Aminoglycosides & Spectinomycin.
4. Tetracycline &doxycycline
5. Macrolids , lincosamide, oxazolidinone & chloramphenicol
6. Sodium fusidate
7. Quinolone
8. Sulfonamides and Trimethoprim
9. Metronidazole
10. Rifamycin
• Penicillin uses :
1. Abscesses
2. Pneumococcal Infections
• Pneumococcal Meningitis
• Pneumococcal Pneumonia
3. Streptococcal Infections
• Streptococcal Pharyngitis (including Scarlet Fever)
• Streptococcal Pneumonia, Arthritis, Meningitis, and Endocarditis
4. Staphylococcal Infections
5. Meningococcal Infections
6. Gonococcal Infections (gonorrhea)
7. Syphilis
8. Actinomycosis
9. Diphtheria
10. Anthrax
11. Clostridial Infections
12. Fusospirochetal Infections
13. Surgical Procedures in Patients with Valvular Heart Disease
• Penicillin
1- Short acting Penicillin
Penicillin-G sodium 1 vial 1 million international unit
Penicillin procaine 1 vial 1000 iu + p.procaine 3000 iu
Dose : 1-2 million i.u. /4:6 hours
2- Long acting Penicillin
Depo-pen 1 vial 1.20000 i.u
Duprapen-S 1 vial 1.20000 i.u
Lastipen 1 vial 1.20000 i.u
Penadur 1 vial 1.20000 i.u
Pencitard 1 vial 1.20000 i.u
Penicid L.A. 1 vial 1.20000 i.u
Retarpen 1 vial 1.20000 i.u
3- acid and β-lactamase resistant penicillin
effective orally in treatment of staph infection. Cloxacillin , Dicloxacillin , flucloxacillin and nafcillin.
4- Broad spectrum penicillin(ampicillin & amoxicillin)
Ampicillin
Dose : 500:1000 mg. /6-8 hrs. -- children : 50:100 mg./kg./day for 5-10 days.
Ampicillin 125 Dry susp 125 mg./5ml
Ampicillin 250 60 ml. susp 12 cap 1 vial 250 mg/ml 250mg cap 250mg/vial
Ampicillin 500 12 cap 1 vial 500 mg cap 500 mg/vial
Ampicillin 1000 1 vial 1000 mg/vial
Epicocillin 125 100 ml. susp 125mg/5ml
Epicocillin 250 Susp cap vial 250 mg/ml 250mg cap 250mg/vial
Epicocillin 500 Cap vial 500 mg cap 500 mg/vial
Epicocillin 1000 vial 1000 mg/vial
Ampicillin + Dicloxacillin
Ampiflux 250 Cap 60ml. susp Ampicillin 125 mg.+ Dicloxacillin 125 mg.
Cloxapen 250 Cap susp Ampicillin 125 mg.+ Dicloxacillin 125 mg.
Cloxapen 500 Cap Ampicillin 250 mg.+ Dicloxacillin 250 mg.
Combifloxin 1000 tab Ampicillin 500 mg.+ Dicloxacillin 500 mg.
Dipenacid 250 60ml. Susp vial Ampicillin 125 mg.+ Dicloxacillin 125 mg.
Dipenacid 500 Cap vial Ampicillin 250 mg.+ Dicloxacillin 250 mg.
Dipenacid 1000 vial Ampicillin 500 mg.+ Dicloxacillin 500 mg.
Ampicillin + sulbactam
Ampictam 375 Tab vial Ampicillin 250mg. + sulbactam 125mg.
Ampictam 250 60 ml. susp 250 mg. /5 ml.
Ampictam 750 Vial Ampicillin 500mg. + sulbactam 250mg.
Ampictam 1500 Vial Ampicillin 1000mg. + sulbactam 500mg.
Sigmacyn 250 60 ml. susp 250 mg. /5 ml.
Sigmacyn 375 Tab Ampicillin 250mg. + sulbactam 125mg.
Sulbin 375 Vial Ampicillin 250mg. + sulbactam 125mg.
Synerpen 250 Dry susp 250 mg. /5 ml.
Synerpen 375 Tab Vial Ampicillin 250mg. + sulbactam 125mg.
Synerpen 750 Vial Ampicillin 500mg. + sulbactam 250mg.
Synerpen 1500 Vial Ampicillin 1000mg. + sulbactam 500mg.
Ultracillin 375 Vial Ampicillin 250mg. + sulbactam 125mg.
Unasyn 250 60 ml. susp 250 mg. /5 ml.
Unasyn 375 Tab Vial Ampicillin 250mg. + sulbactam 125mg.
Unasyn 750 Vial Ampicillin 500mg. + sulbactam 250mg.
Unictam 250 60ml. susp 250 mg. /5 ml.
Unictam 375 Tab Vial Ampicillin 250mg. + sulbactam 125mg.
Unictam 750 Vial Ampicillin 500mg. + sulbactam 250mg.
Unictam 1500 Vial Ampicillin 1000mg. + sulbactam 500mg.
Amoxicillin
Dose : (25-50 mg/kg daily in 3 divided doses) 0-2 years 3x100 mg daily -- 2-5 years 3x125 mg daily -- 5-10 years 3x250
mg daily -- over 10 years 3x500 mg daily
Sever infections : 3x750-1000 mg daily children 100 mg/kg daily in 3 doses
Amoxicillin 500 Cap

Amoxycillin 125 Susp
Amoxycillin 250 Susp Cap
Amoxycillin 500 Cap
Alemox 750 Tab
Alemox 1000 Tab
Amoxil 125 60 ml. susp
Amoxil 250 60 ml. susp Vial
Amoxil 500 Cap Vial
Amoxicid 125 Susp
Amoxicid 250 Cap Dry susp
Amoxicid 500 Cap
Biomox 125 80 ml. Susp
Biomox 250 Cap 80 ml. susp
Biomox 500 Cap
E Mox 125 60 ml. Susp
E Mox 250 60 ml. Susp
E Mox 500 Cap Vial
E Mox 1000 Vial
Delpedox 400 100 ml. susp
Delpedox 875 Tab
Farconcil 500 Vial
Farconcil 1000 Vial
Hiconcil 100 Drops 100 mg. /ml.
Hiconcil 125 Susp
Hiconcil 250 Cap Susp
Hiconcil 500 Cap
Ibiamox 125 80 ml. Susp
Ibiamox 250 80 ml. Susp Cap Vial
Ibiamox 500 Cap Vial
Ibiamox 1000 Vial
Ospamox 1000 Tab
Ospamox 1000 8 disp. Tabs.
Ospamox 750 Tab
Moxipen 125 Dry susp
Moxipen 250 Cap 80 ml. susp
Moxipen 500 Cap
Amoxicillin + Dicloxacillin
Amoclox 500 Cap Amoxicillin 250 mg + dicloxacillin 250 mg
Miclox 500 Cap Amoxicillin 250 mg + dicloxacillin 250 mg
Amoxicillin + flucloxacillin
Dose : Adults -- 500 mg. / 8 hours Children – 25 mg./kg. daily divided into 3 doses
Miclox 250 Cap 125 mg. + 125 mg.
Amoflux 250 Cap 100 ml. susp 125 mg. + 125 mg.
Amoflux 500 Cap Vial 500 mg. + 500 mg.
Amoflux 1000 Vial 1000 mg. + 1000 mg.
Amofluxin 500 Cap Vial 500 mg. + 500 mg.
Amofluxin 1000 Vial 1000 mg. + 1000 mg.
Floxamo 1000 Tab 1000 mg. + 1000 mg.
Flumox 250 Cap 100 ml. susp 125 mg. + 125 mg.
Flumox 500 Cap Vial 500 mg. + 500 mg.
Flumox 1000 Vial 1000 mg. + 1000 mg.
Flucamox 250 Cap 80 ml. susp 125 mg. + 125 mg.
Flucamox 500 Cap Vial 500 mg. + 500 mg.
Flucamox 1000 Vial 1000 mg. + 1000 mg.
Hiflucil 250 15 Packet 125 mg. + 125 mg.
Hiflucil 500 Cap 500 mg. + 500 mg.
Famox 250 60 ml. susp 125 mg. + 125 mg.
Famox 500 Cap 500 mg. + 500 mg.
Amoxicillin + Clavulinic acid (Co-amoxiclave)
Amoxilanic 228 60 ml. susp 200 mg. + 28.5 mg.
Amoxilanic 457 60 ml. susp 400 mg. + 57 mg.
Augmacillin 227 60 ml. susp 200 mg. + 27.5 mg.
Augmacillin 457 60 ml. susp 400 mg. + 57 mg.
Augmentin 62.5 20 ml. Drops 50 mg. + 12.5 mg. / 1 ml.
Augmentin 156 60 ml. susp 125 mg. + 31 mg.
Augmentin 375 Tab 250 mg. + 125 mg.
Augmentin 600 Vial 400 mg. + 200 mg.
Augmentin ES 75 ml. susp 500 mg. + 100 mg.
Augmentin 625 Tab 400 mg. + 225 mg.
Augmentin 1200 Tab Vial 800 mg. + 400 mg.
Curam 156 60 ml. susp 125 mg. + 31 mg.
Curam 228.5 75 ml. susp 200 mg. + 28.5 mg.
Curam 642.9 75 ml. susp 600 mg. + 42.9 mg.
Curam 625 Tab 400 mg. + 225 mg.
Curam 1000 Tab 875 mg. + 125 mg.
Deltaclav 228.5 60 ml. susp 200 mg. + 28.5 mg.
Deltaclav 457 60 ml. susp 400 mg. + 57 mg.
E moxclav 156 60 ml. susp 125 mg. + 31 mg.
E moxclav 312 60 ml. susp 280 mg. + 32 mg.
E moxclav 375 Tab 250 mg. + 125 mg.
Megamox 228 70 ml. susp 200 mg. + 28.5 mg.
Megamox 457 70 ml. susp 400 mg. + 57 mg.
Megamox 625 Tab 400 mg. + 225 mg.
Megamox 1000 Tab 875 mg. + 125 mg.
Hibiotic 156 60 ml. susp 125 mg. + 31 mg.
Hibiotic 312 60 ml. susp 280 mg. + 32 mg.
Hibiotic 375 Tab 250 mg. + 125 mg.
Hibiotic N 230 60 ml. susp 200 mg. + 30 mg.
Hibiotic N 460 60 ml. susp 400 mg. + 60 mg.
Klavox 156 60 ml. susp 125 mg. + 31 mg.
Klavox 375 Tab 250 mg. + 125 mg.
Klavox 625 Tab 400 mg. + 225 mg.
Klavox 1000 Tab 875 mg. + 125 mg.
Magna-biotic 156 60 ml. susp 125 mg. + 31 mg.
Magna-biotic 312 60 ml. susp 280 mg. + 32 mg.
Magna-biotic 375 Tab 250 mg. + 125 mg.
Magna-biotic 600 Vial 500 mg. + 100 mg.
Magna-biotic 625 Tab 400 mg. + 225 mg.
Magna-biotic Plus 1000 Tab 800 mg. + 200 mg.
Magna-biotic 1200 Vial 800 mg. + 400 mg.
Neoclav 457 70 ml. susp 400 mg. + 57 mg.
Neoclav extra 643 60 ml. susp 600 mg. + 43 mg.
Precautions :
1. If you are allergic to any drugs (especially cephalosporins such as Ceclor, Ceftin, Duricef, Keflex,
and others), or if you have:
1. asthma;
2. kidney disease;
3. bleeding or blood clotting disorder;
4. history of diarrhea caused by taking antibiotics
5. history of any type of allergy.
2. Patients known to be hypersensitive to penicillin should be given an antibacterial of an other
class.
3. However , sensitized patients may also react to the cephalosporins and other beta-lactam
antibiotics.(cross sensitivity)
4. Dose should be suitably reduced to patients with marked impaired renal function.
• Cephalosporin :
Therapeutic action of cephalosporins :
Cephalexin
Dose : ttt should continued for at least 2 days after symptoms have subsided
Adults : 500 mg. every 6 hrs. Children : 25-50 mg. / kg. daily in 4 divided dose.
Cephalexin 500 Cap
Ceporex 1000 Tab vial
Ceporex 500 Tab vial
Ceporex 250 Tab 60 ml. susp.
Ceporex 125 60 ml. susp.
Gramocef 1000 Tab
Keflex 125 50 ml. susp.
Keflex 250 Cap 60 ml. susp.
Keflex 500 Tab
Keflex 1000 Tab
Neocef 250 Cap susp.
Neocef 500 Cap
Ospexin 125 60 ml. susp.
Ospexin 250 60 ml. susp.
Ospexin 1000 Tab
Cefadroxil
Dose :
adults : 500-1000 mg. twice daily
Children : under 1y: 25 mg./kg. in divided doses 1:6 years: 250:500 mg. twice daily.
Biodroxil 250 60 ml. Susp.
Biodroxil 500 Cap 60 ml. Susp.
Biodroxil 1000 Tab
Cephadrol 125 60 ml. Susp.
Cephadrol 250 60 ml. Susp.
Curisafe 100 15 ml.
Curisafe 125 60 ml. Susp.
Curisafe 250 60 ml. Susp.
Curisafe 500 Cap
Duricef 100 10 ml. drops
Duricef 125 60 ml. Susp.
Duricef 250 Cap 60 ml. Susp.
Duricef 500 Cap 60 ml. Susp.
Duricef 1000 Tab
Ibidroxil 125 60 ml. Susp.
Ibidroxil 250 60 ml. Susp.
Ibidroxil 500 Cap
Ibidroxil 1000 Tab
Longicef 125 60 ml. Susp.
Longicef 250 60 ml. Susp.
Longicef 500 Cap
Roxil 250 100 ml. susp
Cephradine
• More Effective when administered parentrally (i.v. / i.m.)
Dose :
Adults : 500:1000 mg./8 hrs.
Children : 25:50 mg./kg./day. In 2:4 divided doses.
Cefadrin 125 100 ml. Susp.
Cefadrin 250 60 ml. Susp.
Cefadrin 500 Cap Vial
Cefadrin 1000 Vial
Cephradine 500 Cap
Cephradine 1000 Vial
Cephraforte 1000 Tab
Cephramedin 250 Vial
Cephramedin 500 Vial
Farcocef 250 Vial
Farcocef 500 Vial
Farcocef 1000 Vial
Fortecef 1000 Tab
Mepadrine 125 60 ml. Susp.
Mepadrine 250 Vial
Mepadrine 500 Cap Vial
Mepadrine 1000 Cap
Ultracef 125 60 ml. Susp.
Ultracef 250 Cap Vial 60ml. Susp.
Ultracef 500 Cap Vial
Velosef 125 60 ml. Susp.
Velosef 250 Cap Vial 100ml. Susp.
Velosef 500 Cap Vial
Velosef 1000 Tab Vial
Second generation Cephalosporin
Cefaclor
Dose :
Adults : maximum dose 2 gram per day. But for acute gonorrheal urethritis a single 3 gram dose is advised.
Children : 20-40 mg./kg/day divided in 3 doses but maximum dose up to 1 gram per day.
Bacticlor 125 60 ml. Susp.
Bacticlor 250 Cap 60 ml. Susp.
Bacticlor 500 Cap
Ceclor 125 75 ml. Susp.
Ceclor 250 75 ml. Susp.
Cefaclor 125 60 ml. Susp.
Cefaclor 250 Cap 60 ml. Susp.
Cefaclor 500 Cap
Cloracef 250 60 ml. Susp.
Cloracef 750 Tab
Serviclor 125 60 ml. Susp.
Cefuroxime
Dose :
Adults : 125-500 mg. twice daily for 5-10 days. Usual course 7 days.
Ceroxim 250 Tab
Hebiuroxime 125 Tab
Hebiuroxime 250 Tab
Zinacef 125 50 ml. Susp.
Zinacef 500 Tab
Zinnat 125 Tab 50 ml. Susp.
Zinnat 250 Tab Vial
Zinnat 500 Tab
Zinnat 750 Vial
Zinnat 1500 Vial
Cefprozil
Dose :
Adults : 250-500 mg. twice daily for 7-14 days.
Children : 15-20 mg. / kg. /day for 10 days divided into 2 doses , but not exceed 1 gram per day.
Cefzil 125 Susp.

Cefzil 250 Tab Susp.
Cefzil 500 Tab
Third generation Cephalosporin
• More broader anti-microbial activity especially against gram-negative.
• Use in meningitis due to passing BBB (blood brain barrier).
Cefixime
Dose :
Adults : 400 mg. daily as single dose is more preferred than 200 mg./12 hrs.
Children : 8 mg./kg./day in one or two doses.
Cefixime 100 30 ml. Susp. 100 mg./5 ml.
Hebixime 200 Cap
Hebixime 400 Cap
Ximacef 100 30 ml. - 60 ml. Susp.
Ximacef 200 Cap
Ximacef 400 Cap
Cefoperazone sodium
Dose : 2 to 4 grams per day administered in equally divided doses every 12 hours by IM or IV injection
Cefazone 1000 Vial
Cefazone 500 Vial
Cefozon 1000 Vial
Cefozon 2000 Vial
Cefobid 500 Vial
Cefobid 1000 Vial
Cefobid 2000 Vial
Cefoperazone 1000 Vial
Cefoperazone 500 Vial
Cefrazone 500 Vial
Cefrazone 1000 Vial
Cefrone 500 Vial
Cefrone 1000 Vial
Cefrone 2000 Vial
Peracef 500 Vial
Peracef 1000 Vial
Cefoperazone (sulperazone) + Sulbactam
• By IM or IV injection
Cefoctam 1500 Vial Cefoperazone 1000 mg. + sulbactam 500 mg.
Peractam 1500 Vial Cefoperazone 1000 mg. + sulbactam 500 mg.
Sulperazone 1500 Vial Cefoperazone 1000 mg. + sulbactam 500 mg.
Sulbactam : is penicillinase resistant antibiotic.
Cefdinir
Dose :
• Adults : 600 mg daily as single dose or 2 divided doses
• Children : 14 mg./kg. daily up to 600 mg.
• Doses reduced in pt. with renal impairment .
Cedenir 125 100 ml. Susp.
Cedenir 300 Cap
Cefdin 125 60 ml. Susp.
Cefdin 300 Cap
Denrocef 125 60 ml. Susp.
Denrocef 300 Cap
Dinar 125 60 ml. Susp.
Dinar 300 Cap
Omnicef 125 40 ml. Susp.
Omnicef 300 Cap
Cefditoren Pivoxil
Doses : 200-400 mg. twice daily
- in renal impairment dose should reduced to 200 mg. once or twice daily according to creatinine clearance.
Meiacton 200 Tab
Cefotaxime
• Effective against Gram+ , Gram- & anaerobic organisms too .
Dose :
• Adults : 1-2 g. (i.m. or i.v.) /12 hrs. Maximum dose 12 g. daily in 3-4 doses.
• Children : 50 mg./kg./day divided into 2 doses.
• Gonorrhea : 500-1000 mg. single dose.
Claforan 250 Vial
Claforan 500 Vial
Claforan 1000 Vial
Cefaxim 500 Vial
Cefaxim 1000 Vial
Cefotax 250 Vial
Cefotax 500 Vial
Cefotax 1000 Vial
Ceforan 500 Vial
Ceforan 1000 Vial
Foxime 500 Vial
Foxime 1000 Vial
Hebitaxime 500 Vial
Hebitaxime 1000 Vial
Pentatrox 1000 Vial
Rametax 500 Vial
Rametax 1000 Vial
Sigmataxim 1000 Vial
Xorin 250 Vial
Xorin 500 Vial
Xorin 1000 Vial
Cefpodoxim Proxetil
Dose :
• Adults : 100-200 mg. / 12 hrs. / day with meals.
• Children : 8 mg. / kg. / 12 hrs. daily with meals.
Cepodem 100 Tab

Cepodem 40 60 ml. Susp.
Orelox 100 Tab
Orelox 40 50 ml. Susp.
Podacef 100 Tab
Podacef 40 60 ml. Susp.
Ceftriaxone
• Available in two forms i.v. and i.m. Vials
Dose : deep i.m. , i.v. Or i.v. infusion
• Adults : 1-2 gram daily and not exceed 4 grams.
• Children : 20-80 mg./kg. daily and not exceed 2 gram daily.
• Gonorrhea : single i.m. dose of 250 mg. is enough.
Cefaxone 250 Vial
Cefaxone 500 Vial
Cefaxone 1000 Vial
Cefotrix 250 Vial
Cefotrix 500 Vial
Cefotrix 1000 Vial
Ceftriaxone 250 Vial
Longacef 1000 Vial
Oframax 250 Vial
Oframax 1000 Vial
Rociphen 500 Vial
Rociphen 1000 Vial
Triaxone 500 Vial
Triaxone 1000 Vial
Wintriaxone 500 Vial
Wintriaxone 1000 Vial
Zoxon 1000 Vial
Fourth generation Cephalosporin
Cefipime
Dose : deep i.m. Or slow i.v. infusion
Adults : mild to moderate : 1-2 g. Daily in 2doses sever infections : 4 g. in 2 doses daily.
Children : 50 mg./kg. in 2 doses daily
Fabrile neutropenia : Adults : 2 g./8hrs. Children : 50 mg./kg. in 3 doses daily
Cefepime 500 Vial
Cefepime 1000 Vial
Maxipime 500 Vial
Maxipime 1000 Vial
Wincef 500 Vial i.v.
Wincef 1000 Vial i.v.
Cefrom 1000 Vial i.v.
Ceftazidime
• Cover gram-negative & most of the gram-positive bacteria.
Dose :
• Mild and moderate infections : 250-1000 mg. /12 hrs. i.m. Or i.v.
• Sever infections : 2 g. / 8 hrs. i.v.
• Maximum dose is 6g. /day
Cefidime 1000 Vial

Ceftazidime 1000 Vial
Cefzim 250 Vial
Cefzim 500 Vial
Cefzim 1000 Vial
Cetazime 1000 Vial
Fortum 1000 Vial
Fortum 500 Vial
Fortum 250 Vial
Kefadim 500 Vial
Kefadim 1000 Vial
• Glycopeotides (non lactam)
Vancomycin
Uses :
• treatment of septicemia , bone infection , lower resp. tract infection , skin infection , methicillin resistant staph
aureus (MRSA).
• Pass BBB in meningitis.
Side effects :
• Ototoxic (ear poisoning)
• Nephrotoxic
• Rapid infusion of Vancomycin may also cause flushing of the upper body (called "red neck" or "red man
syndrome").
Vancocin 0.5 gm Vial
Vancoled 500 mg Vial
Vancolon 500 Vial
Vancomix 500 Vial
Vancomix 1000 Vial
Vancomycin 500 Vial
• Aminoglycoside & Spectinomycin
Gentamicin
Uses :
- septicemia , neonatal sepsis , sever systemic infections - Surgical infection prophylaxis . - MRSA
- treatment and prophylaxis of endocarditis due to enterococci , some staphylococci + penicillin G.
Dose : i.v. Or i.m. 80 mg./8hrs. - Kids 3 mg./kg./day. - Sever infections 5 mg./kg./day.
In renal insufficiency the dose should be reduced.
Side effects : Ototoxicity (irreversible) , Nephrotoxicity (reversible) , malabsorption , skeletal muscle relax.
Epigent 20 3 Amp.
Epigent 80 3 Amp.
Garamycin 20 6 Amp.
Garamycin 40 6 Amp.
Garamycin 80 3 Amp.
Gentamicin 20 6 Amp.
Rigaminol 20 3 Amp.
Rigaminol 40 3 Amp.
Rigaminol 80 3 Amp.
Tobramycin
Uses :
Similar to Gentamicin.
Nebcin 80 Vial
Nebcin 20 Vial
Tobcin 80 3 Amp.
Tobcin 20 3 Amp.
Tobracin 80 3 Amp.
Tobracin 40 3 Amp.
Tobracin-Alex 20 5 Amp.
Streptomycin (anti tuberculosis agent)
Streptomycin 1000 Vial 1 gm. I.M. daily
Neomycin
Uses & Doses : as an adjunct in ttt of hepatic encephalopathy , Adult 4-12 g. daily in 4 divided doses for 5-6 days , Pt.
with chronic hepatic insufficiency may require up to 4 g. daily.
Preoperative intestinal antisepsis in Pt. undergoing colorectal surgery , for 24 hrs. and ot exceed 72 hrs.
Neomycin 500 20 Tabs
Amikacin
Uses :
for gram –ve organisms resistant to Gentamicin & intrathecal in meningitis .
Interaction :
loss of activity between it and penicillin & cephalosporin , incomptability with amphotericin , chlorothiazide ,
heparin calcium , nitrofurantoin , phenytoin , thiopentone , warfarin , K chloride , vit. B complex & vit. C
Dose :
i.v. Or i.m. 15 mg./kg./day divided into 2 doses.
Amikin 100 Ped. Vial
Amikin 250 Vial
Amikin 500 Vial
Likacin 500 Vial
Amikacin 100 Vial
Amikacin 250 Vial
Amikacin 500 Vial
Spectinomycin
Uses : active against Gram-negative organism including Niseria species
Its only indication is treatment of resistant species or in penicillin-allergic patient.
Dose : Inject 5 mL intramuscularly for a 2-gram dose. (2 gm. reconstitute with 5 mL of Sterile Water for Injection)
Togamycin 2 gm. Vial
• Tetracycline &doxycycline
Tetracycline
Uses :
active against mycoplasms , rickettsias , spirochaetes & many aerobic and anaerobic bacteria.
Drug of choise in Acne valgaris , chlamydia & trachoma of the eye (mycoplasma).
Interactions :
• Tetracyclines have a high affinity to form chelates with polyvalent metallic cations such as Fe+++, Fe++, Al+++,
Mg++ and Ca++. Many of these tetracycline-metal complexes are either insoluble or otherwise poorly
absorbable from the gastro-intestinal tract.
• Milk and other dairy products, antacids containing polyvalent cations, as well as various iron salts ingested
simultaneously with tetracycline derivatives, might interfere with their absorption by 50 to 90% or even more.
• An interval of 3 hours between the ingestion of tetracyclines and cations prevents the interaction.
Side effects :
• Teeth & bone abnormalities : yellow-brown tooth discoloration , bone deformity & enamel dysplasia .
• Tetracyclines are teratogenic and should be avoided during pregnancy , lactation & in children up to 8 years.
• GIT irritation : Clostridium difficile associated diarrhea (CDAD), Nausea , vomiting & abdominal pain.
• Hepatotoxic , nephrotoxic & hypersensitivity.
Tetracid 250 Cap

Tetracycline 250 10Caps or 16Caps
Oxytetracycline
Uses & Interactions : as tetracycline.
Oxytetracid 250 Cap
Doxycycline
Uses :
as tetracycline for otitis media , sinusitis , pharyngitis , tonsillitis , bronchitis, pneumonia , cystitis , urrthritis and
skin abscess. And also for cholera.
Interactions :
• has lower affinity for binding with calcium so absorption is less likely to be affected by milk or food , althought it
is still affected by antacids and iron preparations.
• GIT disturbances with doxycycline less frequent than with tetracycline , and less tooth discoloration.
Dose :
• 100 mg. every 2 hrs for the first day then 100 mg. once a day.
• Sever infections : 100 mg. twice daily
• Continued for 24-48 hrs after symptoms have subsided.
Doxy M.R. 100 Cap
Doxymycin 100 Cap
Farcodoxin 100 Cap
Granudoxy 100 Tab
Tabocine 100 Cap
Vibramycin 100 Cap
• Macrolids , lincosamide &oxazolidinone
Macrolids
Interactions :
• Action of macrolide (not Azithromycin & Spiramycin) on hepatic cytochrome P450 lead to inhibition of
metabolism of some drugs(carbamazepine , cyclosporin, terfenadine, astemizole and theophylline).
• Rare interactions and those of dubious clinical importance are those with alfentanil and sufentanil, antacids and
cimetidine, oral anticoagulants, bromocriptine, clozapine, oral contraceptive steroids, digoxin, disopyramide, ergot
alkaloids, felodipine, glibenclamide (glyburide), levodopa/carbidopa, lovastatin, methylprednisolone, phenazone
(antipyrine), phenytoin, rifabutin and rifampicin (rifampin), triazolam and midazolam, valproic acid and zidovudine.
Precautions : - Erythromycin and its derivatives should be avoided in those wo have previously developed jaundice.
- With care in pt. with hepatic dysfunction or renally compermized
Erythromycin
Uses :
• In upper & lower respiratory tract infections , otitis media , throat sinusitis , bordetella pertussis , gum
infections , soft tissue & urinary tract infections .
• Alternative for whom sensitive to penicillin.
Dose :
Adults : 250 mg every 6 hours; or 500 mg every 12 hours. Dosage may be increased up to 4 g per day according to
the severity of the infection.
Children : 30 to 50 mg/kg/day, in equally divided doses . Dosage may be doubled but should not exceed 4 g/day.
Eryped 400 60 ml. Susp.
Erythrin 500 Tab
Erythrin 200 60 ml. Susp.
Erythrocin 500 Tab
Erythrocin 250 Tab
Erythrocin 200 60 ml. Susp.
Erythromycin 500 Tab
Erythromycin 250 Tab
Erythromycin 200 60 ml. Susp.
Erythroriv 200 100 ml. Susp
Clarithromycin
Uses : as erythromycin and use to eradicate H. pylori in peptic ulcer.
Dose : 500 mg. / 12 hrs. for 7-14 days.
Claribiotic 250 Cap
Claribiotic 500 Cap
Clarikan 500 Tab
Clarimycin 500 Cap
Klacid 125 60 ml. susp
Klacid 250 30 ml. susp
Klacid 500 Tab
Klacid XL 500 Tab One tab for 24 hrs.
Klarimix 125 Susp
Klarimix 250 Tab
Klarimix 500 Tab
Azithromycin
• Have little or no effect on hepatic cytochromes , and produce fewer interactions than erythromycin.
Uses :
upper respiratory tract including sinusitis , pharyngitis and tonsillitis.
Infections of respiratory tract including bronchitis and bronchopneumonia. (Mycoplasma pneumonia)
Otitis media and infection of skin and soft tissues.
Dose : administrated on empty stomach (1 hour before meal or 2 hours after meal)
Over 45 kg. weight 500 mg. once daily kids : 30mg./kg./once daily for 3 days.
Azalide 200 15 ml. susp
Azalide 250 Cap
Azindamon 500 Tab
Azrolid 500 Tab
Aziwok 200 60 ml. susp
Aziwok 250 Cap
Azomycin 250 15 ml. susp.
Azomycin 250 Cap
Delzosin 600 Tab
Neozolid 600 Tab
Unizithrin 100 30 ml. susp
Xithrone 200 15 ml. & 25 ml. susp
Xithrone 250 Cap
Xithrone 500 Tab
Zisrocin 200 susp
Zisrocin 500 Cap
Zithrodose 100 60 ml. susp
Zithrokan 100 15 ml.
Zithrokan 200 15 ml.
Zithrokan 500 Cap
Zithromax 250 Cap
Zithromax 500 1 vial
Zithromax 600 15 ml. susp
Zithromax 900 22.5 ml. susp
Zithromax 1200 30 ml. susp
Spiramycin
Uses : Have little or no effect on hepatic cytochromes , and produce no or fewer interactions than erythromycin.
• Active against Gram + & anaerobic infections.
• Toxoplasmosis during pregnancy (not teratogenic and has been found to be safe in the pregnant woman, fetus,
and newborn) .
• Upper resp. tract infections
• Dental infections : used widely after dental extraction.
Precautions :
• Not accepted in the treatment of meningitis or in preventing toxoplasma encephalitis.
• Patients with hypersensitivity reactions to other macrolides may also have hypersensitivity to spiramycin.
Dose : administrated on empty stomach (1 hour before meal or 2 hours after meal).
Adults : 3 m.i.u. /12 hrs. Children : 0.75 m.i.u. /12 hrs.
(100,000 i.u. = 31.25 mg. So 3 million international units = 937.5 mg. )
Rovac 1.5 m.i.u. Tab
Rovac 3 m.i.u. Tab
Rovapex 3 Tab
Rovamycin 1.5 Ped. Tab
Rovamycin 3 Tab
Spirex 1.5 Tab
Spirex 3 Tab
Spiramycin 1.5 Tab
Spiramycin 3 Tab
Unispira 1.5 Tab
Unispira 3 Tab
Spiramycin + Metronidazole
Uses :
Used in treatment of H. pylori
Birodogyl Cap very expensive 750,000 i.u. + Metronidazole 125 mg.

Rodogyl Tabs 750,000 i.u. + Metronidazole 125 mg.
Spirazole Tabs 750,000 i.u. + Metronidazole 125 mg.
Spirazole forte Tabs 1,500,000 i.u.+Metronidazole 250 mg.
Linezolid (Oxazolidinone)
Uses :
Treatment of Gram + infections of skin and resp. tract including vancomycin resistant enterococci & MRSA .
Dose :
600mg. Every 12 hrs. for 10-14 days .
Averozolid 600 Tabs
Respenzo 600 Tabs
Zyvoxid 600 1 Vial very expensive
(Lincosamide)
Clindamycin
Uses :
• may use with pt. who are allergic to penicillin
• serious infections caused by susceptible anaerobic bacteria
• Serious respiratory tract infections; serious skin and soft tissue infections
• Bone and teeth infections.
Precautions :
• GIT disturbance [Clostridium difficile associated diarrhea (CDAD) has been reported. Because antibacterial
agents alters the normal flora of the colon, leading to overgrowth of C. difficile (which treated by Vancomycin or
Metronidazole)]. Use with caution in individuals with a history of gastrointestinal disease, particularly colitis.
• with caution in patient impaired liver function.
• with caution in patients with renal disease.
• with caution in elders over 60ys .
• should not be taken by nursing mothers.
• should not be used in the treatment of meningitis.
Dose :
Mild infections --- adults: 600 mg. per day in 3 or 4 equal doses children: 8-16 mg./kg./day in 3 or 4 equal doses
Sever infections – adults: 1200-1800 mg./day in 3 or 4 equal doses children: 16-20 mg./kg./day in 3 or 4 equal doses
Parentrally (I.M. or I.V.) adults – mild infections : 600-1200 mg. /day in 2,3 or 4 equal doses
- sever infections : 1200-2700 mg. /day in 3 or 4 equal doses
- extreme sever infections (e.g. septicemia) I.V. dose can be increased to 4.8 gm. daily
When administered I.V. , it has to be diluted at a rate of 300 mg. in 50 ml. or more.
Clinacyn 150 Cap
Clinacyn 300 Cap
Clindacine 150 Cap
Clindam 150 Cap
Clindam 300 Cap
Dalacin –C 150 Cap
Dalacin –C 300 Cap
Dalacin –C 300 1 Amp
Dalacin –C 600 1 Amp
Mepaclind 150 Cap
Mepaclind 300 Cap
Lincomycin
Uses :
Upper resp. infections , lower resp. tract infection , skin infections , septicemia by staph aureus & streptococcus ,
bone & joint infection including acute haematogenous osteomyelitis.
Dose :
adults : 500 mg. 3 times daily.
Lincocin 300 1 Amp
Lincocin 600 1 Amp
• Chloramphenicol & related antibiotics
Chloramphenicol
Uses :
Usually bacteriostatic, mixed aerobic and anaerobic infection ,Rickettsial infections & Vancomycin resistant
enterococci.
Precautions :
Never given for minor infections up to 6 years nor for newborn infants.
Side effects :
if used for long time result in : bone marrow depression – bleeding , optic atrophy , high doses in newborn or
children result in (Gray syndrome).
Contraindication :
pregnancy – breast feeding – sever anemia – thrombocytopenia & leukopenia .
Interactions :
inhibit metabolism of some drugs in liver (e.g. anticoagulants , aminophylline , ampicillin , erythromycin , Vit. C , B-
complex , gentamicin , tetracycline).
Dose :
25 mg./kg./day divided into 4 doses.
Chloramphenicol 250 Cap

Cidocetine 250 Cap
Cidocetine 125 Susp
Cidocetine 1000 Vial
Miphenicol 250 Cap
Miphenicol 1000 Vial
Thiamphenicol
Uses :
As chloramphenicol but with less Ototoxicity & Hepatotoxicity .
Dose :
25 mg./kg./day divided into 4 doses.
Thiophenicol 250 Tab
Thiophenicol 750 Vial
• Sodium fusidate :
Use : staphylococcal infections (osteomyelitis, septicemia, pneumonia, endocarditis, surgical wound infections)
Interactions : with kanamycin , Gentamicin , Cefaloridin.
Defucin 250 Tab
Fucidin 250 Tab
Fucidin 500 Vial
Fucidin 250 Susp
• Quinolone :
• Quinolones has potent bactericidal activity by inhibiting DNA gyrase enzyme. The majority of
quinolones in clinical use are fluoroquinolones, which have a fluorine in ring system.
• Fluoroquinolones are more potent than quinolone and more broad-spectrum antibiotics
(effective for both gram-negative and gram-positive bacteria) e.g. serious bacterial infections,
especially hospital-acquired infections.
• Uses :
1. Urinary tract infections
2. Lower respiratory tract infections
3. Urethral and cervical gonococcal infections (norfloxacin & ofloxacin)
4. Prostatitis (norfloxacin & ofloxacin)
5. Due to sickle-cell disease patients' being at increased risk for developing osteomyelitis from
the Salmonella genus
6. Acute exacerbations of chronic bronchitis
7. Mycobacterial infections e.g. multi drug resistant TB. (ciprofloxacin)
8. Community-acquired pneumonia
• Contraindication :
• In children , adolesents , pregnant , breast feeding women.
• In patient has epilepsy , QT prolongation , pre-existing CNS lesions, or CNS inflammation, or pt. has suffered
a stroke .
• Interactions :
• Products containing multivalent cations, such as aluminium- or magnesium-containing antacids, and
products containing calcium, iron or zinc invariably result in marked reduction of oral absorption of
fluoroquinolones.
• drugs that interact with fluoroquinolones
include sucralfate, probenecid, cimetidine, theophylline, warfarin, antiviral
agents, phenytoin, cyclosporine, rifampin, pyrazinamide, and cycloserine.
• Fluoroquinolones have varying specificity for cytochrome P450, and so may have interactions with drugs
cleared by those enzymes; the order from most P450-inhibitory to least, is enoxacin > ciprofloxacin >
norfloxacin > ofloxacin, levofloxacin, trovafloxacin, gatifloxacin, moxifloxacin.
• Side effects :
• FDA in 2016 "An FDA safety review has shown that fluoroquinolones when used systemically (i.e. tablets,
capsules, and injectable) are associated with disabling and potentially permanent serious side effects that can
occur together. These side effects can involve the tendons, muscles, joints, nerves, and central nervous system.“
• Phototoxicity : Exposure to ultraviolet rays from direct or indirect sunlight should be avoided during
treatmen and several days (5 days) after the use of the drug. The degree of phototoxic potential of
fluoroquinolones is as follows:lomefloxacin > sparfloxacin > ciprofloxacin
• GIT : nausea, vomiting, diarrhea, constipation, and abdominal pain.
• CNS : Insomnia , Seizures, Headache, dizziness, and drowsiness
• Tendon damage (tendon rupture): risk increase in age >60 years, male gender, and concomitant use of
corticosteroids.
• Nephrotoxic or hepatotoxic : but not common.
• Generations :
• Third-generation
• First-generation • Unlike the first- and second-generations, the
• cinoxacin (Cinobac) third-generation is active against streptococci.
• nalidixic acid (NegGram, Wintomylon) • balofloxacin (Baloxin)
• oxolinic acid (Uroxin) • grepafloxacin (Raxar) (removed from clinical use)
• piromidic acid (Panacid) • levofloxacin (Leflox, Cravit, Levaquin, Tavanic)
• pipemidic acid (Dolcol) • pazufloxacin (Pasil, Pazucross)
• rosoxacin (Eradacil) • sparfloxacin (Zagam)
• temafloxacin (Omniflox) (removed from clinical use)
• Second-generation • tosufloxacin (Ozex, Tosacin)
• ciprofloxacin (Cipro)
• enoxacin (Enroxil, Penetrex) • Fourth-generation
• fleroxacin (Megalone, Roquinol) • Fourth-generation fluoroquinolones act at DNA
• lomefloxacin (Maxaquin) gyrase and topoisomerase IV.[80] This dual action
slows development of resistance.
• nadifloxacin (Acuatim, Nadoxin, Nadixa)
• clinafloxacin[76]
• norfloxacin (Lexinor, Noroxin, Quinabic,
Janacin) the first second-generation quinolone • gatifloxacin (Zigat, Tequin) (Zymar -opth.) (Tequin
removed from clinical use)
• ofloxacin (Floxin, Oxaldin, Tarivid)
• gemifloxacin (Factive)
• pefloxacin (Peflacine)
• moxifloxacin (Acflox Woodward, Avelox,Vigamox)
• rufloxacin (Uroflox)
• sitafloxacin (Gracevit)
• trovafloxacin (Trovan) (removed from clinical use)
• prulifloxacin (Quisnon)
Ciprofloxacin
Dose :
250-500 mg. /12 hours for 7-14 days , complicated infections may require prolonged therapy.
Bactiflox 500 Lactab
Bactiflox 250 Lactab
Ciprobay 250 Tab
Ciprobay 500 Tab
Ciprobay 750 Tab
Ciprinol 250 Tab
Ciprinol 500 Tab
Ciprocin 250 Tab
Ciprocin 500 Tab
Ciprocin 750 Tab
Ciprofar 250 Tab
Ciprofar 500 Tab
Ciprofar 750 Tab
Cipromax 250 Tab
Cipromax 500 Tab
Cipromax 750 Tab
Ciprofloxacin 250 Tab
Ciprofloxacin 500 i.v. infusion 200 mg./ 100 ml. bottle
Ciproquin 500 Tab
Ciproquin 750 Tab
Ciproxil XL 500 Tab
Ciproxil XL 1000 Tab
Karmaflox 750 Tab
Mifoxin 250 Tab
Mifoxin 500 Tab
Rancif 250 Tab
Rancif 500 Tab
Rancif 200 Vial
Serviflox 250 Tab
Serviflox 500 Tab
Serviflox 750 Tab
Norfloxacin
Uses : mainly bactericidal to most urinary tract pathogens, including pseudomonas aeruginosa.
Dose : 1 tab / 12 hrs. after meals for 7 days.
Epinor 400 Tab
Noracin 400 Tab
Neofloxin 400 Tab
Norbactin 400 Tab
Norbactin 800 Tab
Ofloxacin
Uses : acute & chronic urinary tract infections , (nose,ear&throat infection) , skin & soft tissues infections caused by G(-).
Dose : 1 tab / 12 hrs. for 5:10 days.
Epicoflocin 200 Tab
Jedcoflacin 200 Tab
Kiroll 200 Tab
Oflicin 200 Tab
Ofloxacin 200 Tab
Ofloxin 200 Tab
Tarivan 200 Tab
Tarivid 200 Tab
Tariflox 200 Tab
Tariflox 400 Tab
Nalidixic acid
Dose : 500-1000 mg./6 hrs. For 7-10 days.
Nalidram 500 Tab
levofloxacin
- Unlike other quinolones , it has a good activity against gram + organisms,including streptococcal spp. And anaerobes.
Dose : 500 mg. once daily for 7-14 days .
Alfacef 500 Vial
Alfacef 750 Tab
Kevork 500 Tab
Lee-flox 250 Tab
Lee-flox 500 Tab
Lee-flox 750 Tab
Levomagictam 500 Tab
Levoxin 250 Tab
Levoxin 500 Tab
Levoxin 500 Vial
Larivex 500 Tab
Mepafloxin 750 Tab
Targofloxin 750 Tab
Tavacin 500 Tab
Tavacin 750 Tab
Tavanic 250 Tab
Tavanic 500 Tab
Tavanic 500 Vial
Levanic 500 Tab
Unibiotic 250 Tab
Unibiotic 500 Tab
Venaxan 250 Tab
Venaxan 500 Tab
Venaxan 500 Infusion vial
Gemifloxacin mesylate
Dose : once daily for 5 days (ttt chronic bronchitis & pneumonia) - rashes is common with Gemifloxacin, so stop if it occur.
Flobiotic 320 5 tab
Floxgaurd 320 5 tab
Gemique 320 5 tab
Gatifloxacin
Indications : acute bronchitis , chronic sinusitis , urinary tract infections & community acquired pneumonia.
Dose : 400 mg. once daily for 7-14 days. with a full glass (8 ounces) of water.
Floxin 200 Tab
Floxin 400 Tab
Gaticin 200 Tab
Gaticin 400 Tab
Gatilox 400 Tab
Tequin 400 Tab
Tequin 400 1 Vial i.v.
lomefloxacin
Interactions : as ciprofloxacin & not interact with theophylline or caffeine.
Uses : mild to moderate lower respiratory tract infections and urinary infections.
Preoperative prophylaxis in pt. undergoing transurethral surgical procedures 400 mg. 2-6 hrs. before.
Dose : 400 mg. once daily for 5-10 days.
Lomeflox 400 Tab
Lomex 400 Tab
Lomoxen 400 Tab
Maxa-flox 400 Tab
Moxifloxacin
Precautions :
• Not be given to pt. receving class Ia antiarrhythmic drugs (e.g. quinidine) or class III antiarrythmics (e.g. amiodarone
‘’Cordarone’’ and sotalol - betacor)
• Not with pt. have a certain type of irregular heartbeat (eg, QT prolongation) or uncorrected low blood potassium
levels
• Not with a history of myasthenia gravis.
• MEDICINES MAY INTERACT with moxifloxacin :
• Corticosteroids (eg, prednisone) because the risk of tendon problems may be increased
• Erythromycin , medicines to help mental or mood problems, or tricyclic antidepressants (eg, amitriptyline)
because the risk of severe and possibly fatal irregular heartbeat may be increased
• Insulin or oral diabetes medicines (e.g. glyburide) because the risk of high or low blood sugar may be increased
• Warfarin because the risk of bleeding may be increased by moxifloxacin
• Nonsteroidal anti-inflammatory drugs (NSAIDs) (eg, ibuprofen, ketorolac) because they may increase the risk of
moxifloxacin's side effects.
Dose : 400 mg orally or IV every 24 hours for 7-21 days according to the severity of the infections.
Avalox 400 Tab
Idelox 400 Tab
Moxacin 400 Tab
Moxiflox 400 Tab
Moxifloxacin 400 Tab
Moxitrix 400 Tab
• Sulfonamides and Trimethoprim
Sulfonamides and Trimethoprim
• Sulfonamides : prevent the first step in folic acid synthesis in bacteria.
• Trimethoprim : prevent the second step in folic acid synthesis in bacteria.
• They combined have bactericidal effect.
• Uses : urinary tract infections , respiratory tract infections , bacterial gastro-enteritis and skin & soft tissue infections.
• Precautions :
• Adequate fluid intake is necessary to reduce the risk of crystalluria - with caution for children below 2 years.
• Stop immediately if rash appears because of the danger of sever allergic reactions such as Stevens-Johnson syndrome.
• With care to pt. with renal or hepatic impairment and contra –indicated in pt. with sever impairment or with blood
disorder & for children below 2 months & patient with anemia caused by low levels of folate in the blood.
• Does : enough quantity of water after each doses should be taken.
Adults : 1-2 tabs /12hrs. 1:5 years : 5 ml. / 12 hrs. 6:12 years : 10 ml. / 12hrs.
Chemotrim 100 ml. Susp. Trimethoprim 40mg. + Sulfamethoxazole 200 mg. /5 ml.
Chemotrim Tab Trimethoprim 80 mg. + Sulfamethoxazole 400 mg.
Chemotrim forte Tab Trimethoprim 160 mg. + Sulfamethoxazole 800 mg.
Cotril Tab Trimethoprim 80 mg. + Sulfamethoxazole 400 mg.
Cotril forte Tab Trimethoprim 160 mg. + Sulfamethoxazole 800 mg.
Septazole 100 ml. Susp. Trimethoprim 40mg. + Sulfamethoxazole 200 mg. /5 ml.
Septazole Tab Trimethoprim 80 mg. + Sulfamethoxazole 400 mg.
Septazole forte Tab Trimethoprim 160 mg. + Sulfamethoxazole 800 mg.
Sutrim Susp. Trimethoprim 40mg. + Sulfamethoxazole 200 mg. /5 ml.
Sutrim Tab Trimethoprim 80 mg. + Sulfamethoxazole 400 mg.
Sutrim forte Tab Trimethoprim 160 mg. + Sulfamethoxazole 800 mg.
Entrim Tab
Septrin 120 ml. susp. Trimethoprim 40mg. + Sulfamethoxazole 200 mg. /5 ml.
Septrin – D.S. Tab Trimethoprim 160 mg. + Sulfamethoxazole 800 mg.
Supristol Tab Trimethoprim 80 mg. + Sulfamethoxazole 400 mg.
Sutaprim D.S. Tab Trimethoprim 160 mg. + Sulfamethoxazole 800 mg.
Tripime – forte 300 Cap Trimethoprim 300 mg.
Erythromycin + Trimethoprim Or Sulfa
Erythroprim Tab Erythromycin 400 mg. + Trimethoprim 100 mg.
Erythroprim Susp Erythromycin 200 mg. + Trimethoprim 50 mg. / 5 ml.
Macrorim Tab Erythromycin 500 mg. + Trimethoprim 160 mg.
Pediazole Susp Erythromycin 200 mg. + Sulfisoxazole 600 mg. / 5 ml.
Primomycin Cap Erythromycin 400 mg. + Trimethoprim 100 mg.
Primomycin Susp Erythromycin 200 mg. + Trimethoprim 50 mg. / 5 ml.
• Metronidazole :
Metronidazole
Uses :
1. Treatment of protozoal infections e.g. amoebiasis infections , giardiasis & trichomoniasis .
2. Treatment and prophylaxis of anaerobic bacterial infections include bacterial vagenosis , acute ulcerative
gingivitis , pelvic inflammatory disease , tetanus & antibiotic-associated colitis.
Precautions :
Not use with breast feeding mother. - caution with blood thinner medicine such as warfarin (Coumadin, Jantoven).
Manufacturer makes no further recommendations regarding use during pregnancy so it preferred to use an
alternative. - contraindication : 1-Psychotic Reaction with Disulfiram 2- Alcohol
Dose :
Adults : 500 mg. 3 times for 7-10 days . Children : 125-250 mg. / 8 hrs. for 7-10 days.
Amrizole 200 Susp
Amrizole 250 Tab
Amrizole 500 Tab
Dumozol 125 100 ml. Infusion
Dumozol 500 125 ml. susp
Dumozol 500 Tab
Flagellat forte 200 Susp
Flagex 1000 5 Supp.
Flagyl 125 Susp
Flagyl 250 Tab
Flagyl 500 Tab
Flagyl 500 100 ml. infusion
Flagicure 250 Tab
Flagicure forte 500 Tab
Flazol 500 100 ml. infusion
Gedazole 500 Tab
Metrozole 125 120 ml. susp
Trichogyl 250 Tab
Trichogyl 10.5 % 100 ml. infusion Metronidazole 0.5%
Tinidazole
Uses : similar to metronidazole but effective in shorter courses.
Dose : Adults : 2 gm. Single daily dose for 3 days
Fasigen 500 4 tabs
Protozole 500 4 tabs
Tinifloxacin 1100 10 tabs Tinidazole600mg.+Ciprofloxacin500mg.
• Rifamycin
Rifampicin (Rifampin)
Uses :
• treatment of tuberculosis in combination with other antibiotics, such as isoniazid & non-
tuberculous mycobacterial infections including leprosy (Hansen's disease) and Mycobacterium kansasii in
combination with dapsone and clofazimine to avoid causing drug resistance.
• Treatment of (MRSA) in combination with fusidic acid
• Alternative treatment for infections by the tick-borne pathogens Borrelia burgdorferi and Anaplasma
phagocytophilum when treatment with doxycycline is contraindicated, such as in pregnant women or in
patients with a history of allergy to tetracycline.
Interactions :
accelerates the metabolism of some drugs by inducing microsomal liver enzymes and possibly by interfering with
hepatic uptake so increase dose of these drugs to maintain effectiveness.
Precautions :
care taken in alcoholic pt. or those with liver disease
Contraindicated in pt. with jaundice.
Dose : take on an empty stomach with a glass of water either at least one hour before meals or two hours after meals
450mg. + isoniazide 300mg. + ethambutol 1200mg. For 2 months then 450mg. + isoniazide 300mg. For 7 months
Rifactine 300 Cap
Rifactine 100 60 ml. Susp
Rifam 300 Cap
Rifam 100 60 ml. Susp
Rifampicin 300 Cap
Rifampicin 150 Cap
Rifampin 300 Cap
Rimactane 300 Cap
Rimactane 100 Syrup
Rifocin Amp
Rifamox 2% 20 ml. syrup 100mg. / 5ml.
Rifampicin + Isoniazide
Inhibex Tab Isoniazide 50mg. + B6 mg. + B3 5mg.
Isocid forte Tab Isoniazide 50mg. + B6 mg. + B3 5mg.
Isorifa Cap Isoniazide 150mg. + rifampicin 300mg.
Rifam plus Cap Isoniazide 150mg. + rifampicin 300mg.
Rimactazid Cap Isoniazide 150mg. + rifampicin 300mg.
Rimacure Tab Isoniazide 75mg. + rifampicin 75mg. + pyrazinamide 400mg.
Rimacure Ped Chew Tabs Isoniazide 30mg. + rifampicin 300mg. + pyrazinamide 150mg.
Riozid Cap Isoniazide 150mg. + rifampicin 300mg.
Rimstar Tab Isoniazide 30mg. + rifampicin 150mg. + pyrazinamide 150mg.
• References :
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3719496/
• https://www.ncbi.nlm.nih.gov/
• https://www.drugs.com/
• https://en.wikipedia.org/wiki/
• http://www.who.int/en/
• (Oral Microbiology at a Glance) book
by Richard J. Lamont & Howard F. Jenkinson
• (Master of Therapeutic Drugs) book.
mahmoud.abdalaziz@hotmail.com
Antiviral Agents
Human Herpesvirus (HHV) classification
- There are nine distinct viruses in this family known to cause disease in humans basic types are:
Name Synonym Disease Means of Spread
Oral and/or genital herpes Close contact (oral or
Herpes simplex virus-1
HHV-1 (predominantly orofacial), sexually transmitted
(HSV-1)
as well as other herpes simplex infections disease)
Oral and/or genital herpes Close contact (oral or
Herpes simplex virus-2
HHV-2 (predominantly orofacial), sexually transmitted
(HSV-2)
as well as other herpes simplex infections disease)
Respiratory and close
Varicella zoster virus
HHV-3 Chickenpox and shingles(herpes zoster) contact (including sexually
(VZV)
transmitted disease)
Cytomegalovirus Infectious mononucleosis-like syndrome,
HHV-5 Saliva, urine, breast milk
(CMV) retinitis
Classification of antiviral drugs according to
their therapeutic uses :
• Anti-herpes virus agents
Acyclovir, Famcyclovir, Gancyclovir, Idoxuridine, Foscarnet, Fomivirsen, Pencyclovir, Trifluridine,
Tromantadine, Valacyclovir, Valgancyclovir, Vidarabine, Cidofovir, Docosanol
• Anti-influenza Agents
Amantadine, Oseltamivir, Peramivir, Rimantadine, Zanamivir
• Other antiviral agents

Fomivirsen, Enfuvirtide, Imiquimod, Interferon, Ribavirin, Viramidine
• Antiretroviral Agents
 NRTIs: Zidovudine, Didanosine, Stavudine, Zalcitabine, Lamivudine, Abacavir, Tenofovir
 NNRTIs: Nevirapine, Efavirenz, Delavirdine
 Protease Inhibitors: Saquinavir, Indinavir, Atazanavir, Ritonavir, Nelfinavir, Amprenavir, Lopinavir, Tipranavir
Antiviral Agent that are available at the Egyptian Market
Antiviral drug Viruses or diseases affected
Acyclovir Herpes simplex virus , varicella zoster virus & cytomegalo-virus
Ganciclovir Cytomegalo-virus
Famciclovir Herpes simplex virus , varicella zoster virus
Valacyclovir Herpes simplex virus , varicella zoster virus & cytomegalo-virus
Amantadine influenza A & varicella zoster virus
Ribavirin Respiratory syncytial virus (RSV) , herpes simplex virus

Acyclovir
Dose :
herpes simplex: initial therapy: 200 mg orally every 4 hours (5 times a day) for 10 days
Chronic suppressive therapy: Oral: 400 mg orally every 8 hours for 7 to 14 days
IV: 5 mg/kg IV every 8 hours for 7 to 14 days
Herpes zoster: 800 mg orally every 4 hours for 7 to 10 days ----- 10 mg/kg IV every 8 hours for 7 to 14 days
Varicella-Zoster: 800 mg orally four times a day for 5 days ----- 10 mg/kg IV every 8 hours for 7 to 10 days
Children: Oral: 1 g orally per day in 3 to 5 divided doses for 7 to 14 days
IV: 3 months to 11 years: 5 to 10 mg/kg or 250 to 500 mg/m2 IV every 8 hours for 7 to 14 days
Aciclovir Merck 250 Vial 250 mg.
Acivirax 800 Tab
Acyclovir 200 Tab
Acyclovir 400 Tab
Acyclovir 800 Tab
Cycloviral 200 Tab
Lovir 400 Tab
Novirus 200 125 ml. susp.
Novirus 200 Cap
Novirus 400 Cap
Virin 200 Cap.
Virin 400 Cap.
Zovirax 200 Tab
Zovirax 400 Tab
Zovirax 200 100 ml. susp.
Zovirax 250 Vial
Topical Antiviral
Dose : every 4 hours (4 – 6 times daily)
Acyclostad 5% 10 gm. Cream Acyclovir 5%
Acyclovir 5% 10 gm. Cream Acyclovir 5%
Novirus 5% 15 gm. Skin cream Acyclovir 5%
Zovirus 5% Skin cream Acyclovir 5%
Virustat 5% 5 gm. Cream Acyclovir 5%
Viracure 7.5% 15 gm. Cream Ribavirin 7.5%
Viru-merz 1% 5 gm. Serol gel Tromantadine 1%
Ganciclovir
• In life threatening cytomegalovirus infections in immunocompromised patients
Dose : 5 mg./kg./12 hrs. For 2:3 weeks and for 2 weeks as prophylaxis
Cymevene 250 Cap
Cymevene 500 Vial
Valacyclovir
Dose :
herpes zoster: 1 gm. 3 times daily for 7 days
herpes simplex : 500 mg. twice daily for 5 days
prevention of cytomegalovirus following renal transplantation: 2 gm. Daily for 3 months
Precautions:
maintain adequate hydration during treatment
not recommended in pregnancy and lactation
Valtrex 500 Tab
Valtrovir 1000 tab
Famciclovir
Dose:
herpes simplex: 250 mg orally 3 times a day for 7 to 10 days
herpes zoster: 500 mg orally / 8 hours for 7 days
Famclovir 250 Tab
Famvir 125 Tab
Famvir 250 Tab
Propencivir 125 Tab
Propencivir 250 Tab
Propencivir 500 Tab
Amantadine
Dose : herpes zoster:
Adults: 100 mg. daily for 2:4 weeks
Kids: 4:8 mg./kg./day
Adamine 100 Cap
Amantine 100 Cap
Amantadine 100 Cap
PK-Merz 100 Tab
Infex 100 Cap
Viraflu 100 Cap
Ribavirin
Dose : 1000 mg. daily in divided doses.
Copegus 200 Tab
Panvirin 200 Cap
Rebetol 200 Cap
Riba 200 Cap
Riba 400 Cap
Ribavirin 200 Cap
Ribavirin 400 Cap
Viracure 200 cap
Viracure 400 Cap
Virazole 200 Cap
Virokan 200 Cap
Virokan 400 Cap
References :
https://www.ncbi.nlm.nih.gov/
https://www.drugs.com/
https://en.wikipedia.org/wiki/
http://www.who.int/en/
(Master of Therapeutic Drugs) book.
Antifungal Agents
• Classes :
Polyene Antifungal Drugs Allylamine and Morpholine Antifungal Drugs
• pimaricin • Naftifine
• Amphotericin B • Terbinafine
• Candicidin • Amorolfine
• Filipin
• Hamycin
• Natamycin Antimetabolite Antifungal Drugs
• Nystatin • Fluorocytosine
• Rimocidin • fluorocytosine
• fluorouracil.
Azole Antifungal Drugs

• Fluconazole Others
• Miconazole • Griseofulvin
• Itraconazole • Ciclopirox
• Ketoconazole
• Voriconazole
Antifungal Agents that are available at the Egyptian Market
Oral antifungal agents
Miconazole
Use:
cure and prophylactic treatment of candida of oropharyngeal cavity and gastrointestinal tract
Dose:
infaunts: ¼ measuring spoon of gel 4 times/day
children and adults: ½ measuring spoon of gel 4 times/day
Buccazole 100 20gm. Oral gel Miconazole 100 mg./ 5ml.

Daktarin 125 40gm. Oral gel Miconazole 125 gm./1gm.
Micazole 2% Oral gel Miconazole 2%
Micoban 100 20gm. Oral gel Miconazole 100 mg./ 5ml.
Miconaz 100 20gm. Oral gel Miconazole 100 mg./ 5ml.
Nystatin
Use:
treatment of oral and intestinal mycotic infections caused by candida albicans and other candida species
Dose:
Oral candidiasis:
(1-2 dosing spoon of 2.5ml. 2-4 times/day)
Rinse well in the mouth then swallow the excess , If diabetic don’t swallow the excess.
Don’t swallow any other liquid for as long as possible.
Treatment should be continued for 2-3 days after a clinical cure is affected.
Intestinal cndidiases: do not swallow the full dose with diabetic patients
infants: 5-15 ml. daily divided in 4 doses.
Children: 10-30 ml. daily divided in 4 doses
Antimycot 30 ml. oral susp. 100000 i.u/ml.
Fungistatin 30 ml. oral susp. 100000 i.u/ml.
Mycostatin 30 ml. oral susp. 100000 i.u/ml.
Nystatin 30 ml. oral drops 100000 i.u/ml.
Introduction:
• An analgesic or painkiller is any member of the group of drugs used to
achieve analgesia, relief from pain, without causing loss of consciousness.
• In choosing analgesics, the severity and response to other medication
determines the choice of agent.
• Classification into main groups:
1- Opioid analgesics (Act on central nervous system)
2- Non-Opioid analgesics (Act on peripheral nervous system)
1- Non-steroidal anti-inflammatory drugs (NSAIDs)
2- Paracetamol (known in North America as acetaminophen or simply APAP)
• The World Health Organization(WHO) ,(pain ladder), specifies mild
analgesics as its first step.
• (Pain ladder)according to the World Health Organization(WHO):
• Opioid analgesics (Narcotic , Opiate):
• Opioids are substances that act on opioid receptors to produce morphine-like

effects.
• Opium (poppy tears) is the dried latex obtained from the opium poppy (scientific
name: Papaver somniferum).
• Opiates, an older term that refers to such drugs derived from opium,
including morphine itself.
• narcotic is an ancient Greek word meaning "to make numb“, also widely used to
describe drugs of addiction (cocaine and opioids).
• The terms opiate and narcotic are sometimes encountered as synonyms for opioid.
• Classifications :
• Opioid antagonists : opioid effects can be reversed with an opioid

antagonist Nalmefene, Naloxone, Naltrexone.
• Tramadol and tapentadol , which act as monoamine uptake inhibitors also act
as mild and potent agonists (respectively) of the μ-opioid receptor. Both drugs
produce analgesia even when naloxone, an opioid antagonist, is administered.
• Centrally-Acting Analgesics
Morphine & Morphine-like Agents
Precautions of opioids:
• Addiction, abuse, and misuse: can lead to overdose and death; assess each patient’s risk prior to prescribing
and monitor all patients regularly for the development of these behaviors or conditions
• Life-threatening respiratory depression: Serious, life-threatening, or fatal respiratory depression may occur,
Monitor for respiratory depression, especially during initiation or following a dose increase
• Prolonged use during pregnancy can result in neonatal opioid withdrawal syndrome.
• Avoid in patients with renal impairment, hepatic impairment, supraventricular tachycardia or acute alcoholism.
• In patients with phaeochromocytoma may result in hypertensive crisis.
• Use should be avoided in patients with diabetic acidosis where there is a danger of coma.
Dose: Morphine: 4 to 10 mg every 4 hours as needed administered slowly over 4 to 5 minutes.
Pethidine: 50-150 mg. every 4hrs.
Butorphanol: range from 0.5 to 2 mg every 4-6 hrs.
Morphine 10 Amp. Morphine 10mg./ml.
M.S.T. 10 Amp. Morphine 10mg./ml.
Pethidine 100 Amp. Pethidine 100mg./ml.
Pethidine 50 Amp. Pethidine 50mg./ml.
Stadol 2 vial Butorphanol 2mg./ml.
Tramadol
Dose:
Immediate-release: 25 to 100 mg orally every 6 hours as needed for pain
Maximum dose: 400 mg per day
- Maximum Geriatric Dose: 300 mg per day in divided doses
- Reduce dose in renal and hepatic impairment. Not exceed (200 mg. per day)
Amadol 100 Amp. Tab.
Amadol 50 Cap
Contramal 50 Cap
Contramal 100 Drops
Contramal 150 Tab
Contramal 200 Tab
Tamol 200 Tab
Tramacet Tab Tramadol 375mg.+ paracetamol 325mg.
Tramadol 50 Cap
Tramadol 100 Amp.
Tramal 50 Cap.
Tramal 100 Amp.
Tramal drops 100 10 ml. drops
Tramax 50 Cap
Trama SR 100 Tab
Tramundin 100 Tab.
Tramundin 150 Tab.
Tramundin 200 Tab.
Ultradol 100 Amp
Ultradol 150 Tab
Opioid Antagonist (Naloxone)
- Reverse opioid CNS depression
Dose:
Adult:
Initial dose: 0.4 mg to 2 mg IV; alternatively, may give IM or subcutaneously
-If desired response is not obtained, doses should be repeated at 2 to 3 minute intervals
-If no response is observed with a total dose of 10 mg, the diagnosis of opioid-induced or partial opioid-
induced toxicity should be questioned
Children:
Initial dose: 0.01 mg/kg IV; if desired response is not obtained, may give 0.1 mg/kg IV
Naloxone 0.4 Amp.
Narcan 0.4 Amp.
Narcan 0.04 Amp. (neonatal)
• Paracetamol (acetaminophen):
• Paracetamol, also known as acetaminophen or APAP, is a medication used
to treat pain (analgesic) and fever (antipyretic).
• It does not have significant anti-inflammatory activity.
• Paracetamol is generally safe at recommended doses. It appears to be safe
during pregnancy and when breastfeeding.
• In those with liver disease, it may still be used, but lower doses should be
taken because too high dose(10 mg. in adults or 4 mg. in children) can
result in liver failure. So it use in combination with methionine to reduce
the toxicity e.g. :
• paracetamol + methionine ---< Hepamol
• Use safely with anticoagulant drugs.
Paracetamol & combinations
Precautions: given with care to patients with impaired renal or liver functions or to patient with alcohol addiction.
Dose:
Adults (above 12 years): 500:1000 mg. every 4:6 hours (do not exceed 4 gm. In 24 hours.)
Children :
(6:12 years): 250:500 mg. / 6 hours. (don’t exceed 4 doses in 24 hours)
(1:5 years): 125:250 mg. / 6 hours. (don’t exceed 4 doses in 24 hours)
Infants: 60:120 mg. / 6 hours. (don’t exceed 4 doses in 24 hours)
Abimol 100 Drops 100 mg. / 1 ml.
Abimol 125 125 ml. syrup.
Abimol 300 5 pediatric supps.
Abimol 500 Tab
Abimol Extra tab Paracetamol 500mg. + caffeine 30mg.
Adol 100 Drops 100 mg. / 1 ml.
Adol 500 Tab
Adol Extra tab Paracetamol 500mg. + caffeine 65mg.
Aspicure-combi tab Paracetamol 250mg.+aspirin 250mg.+caffeine 65mg.
Cefacet plus cap Paracetamol 250mg.+aspirin 250mg.+caffeine 60mg.
Cetal 100 20 ml. drops 100 mg. / 1 ml.
Cetal 120 Supp.
Cetal 250 60 ml. syrup
Cetal 500 Tab
Cetamol 250 120 ml. syrup.
Cevamol 500 Tab
Distalgesic 325 tab Paracetamol 325mg.+ dextropropoxyphen 32.5
Fevano 200 120 ml. syrup Paracetamol 200ml./5ml. Mango flavor
Markadel tab Paracetamol 250mg.+aspirin 250mg.+caffeine 65mg.
Molfen eff. sachets Paracetamol 500mg. + caffeine 30mg.
Panadol 500 tab
Panadol actifast tab 500mg. + Sodium content 173mg
Panadol Extra tab Paracetamol 500mg. + caffeine 65mg.
Panadol cold & flu tab 500mg. + Chlorpheniramine 2 mg
Pseudoephedrine Hydrochloride 30 mg
Paracetamol 500 Tab
Paracetamol 120 120 ml. syrup. 120ml./ 5ml.
Paramol 120 125 ml. syrup 120ml./ 5ml.
Paramol 125 Supp
Paramol 500 Tab
Paralex 160 Supp
Perfalgan 1000 Vial 1000 mg. I.V.
Pronto plus Tab 400 mg. + caffeine 50 mg.
Pyral 100 Drops 100 mg. / 1 ml.
Pyral 100 Syrup 100 ml. / 5ml.
Pyral 250 Pedo. Supp.
Pyral 500 Tab
Pyral Extra Tab 400 mg. + caffeine 50 mg.
Pyremol 500 Tab
Stopain Tab 300 mg. + caffeine 50mg. + propyphenazon 150mg.
Temporal 250 60 ml. syrup
Tempra 100 Drops 100 mg. / 1 ml.
Tempra 160 120 ml. syrup
Tylenol 500 Cap
Tylenol forte Tab Paracetamol 500mg. + caffeine 65mg.
Tylenol children Chewable Tab. 80 mg.
Acetaminophen Supp 125 mg.
Paracetamol + Methionine
Methionine : reduce the toxicity of paracetamol on the liver
use for patients with hepatic insufficiency
Hepamol Tab paracetamol 500mg. + methionine 100 mg.
Methamol syrup paracetamol 120mg. + methionine 24 mg.
Methamol Tab paracetamol 500mg. + methionine 100 mg.
Paralex Plus Tab paracetamol 500mg. + methionine 100 mg.
Tempgesic Tab paracetamol 500mg. + methionine 100 mg.
Non-steroidal anti-inflammatory drugs (NSAIDs):
• Nonsteroidal anti-inflammatory drugs (NSAIDs) provide analgesic (pain-killing)
and antipyretic (fever-reducing) effects , and, in higher doses, anti-
inflammatory effects.
• Most NSAIDs inhibit the activity of cyclooxygenase-1 (COX-1) and cyclooxygenase-
2 (COX-2) and thereby the synthesis of prostaglandins and thromboxane.
• It is thought that inhibiting COX-2 leads to the anti-inflammatory, analgesic and
antipyretic effects and that those NSAIDs also inhibiting COX-1 (particularly
aspirin) may cause gastrointestinal bleeding and ulcers.
• COX-1 is a constitutively expressed enzyme with a "house-keeping" role in
regulating many normal physiological processes. One of these is in
the stomach lining, where prostaglandins serve a protective role, preventing the
stomach mucosa from being eroded by its own acid.
• Classification into two main groups:
1. Non-Selective inhibitors.
2. Selective COX-2 inhibitors (Coxibs).
• Note: All NSAIDs should taken after food.
• Classification:
• Salicylates • Enolic acid (Oxicam) derivatives
- Aspirin (acetylsalicylic acid) - Diflunisal (Dolobid) • Piroxicam
- Salicylic acid and other salicylates - Salsalate (Disalcid) • Meloxicam
• Propionic acid derivatives • Tenoxicam
• Droxicam
• Ibuprofen
• Dexibuprofen • Lornoxicam
• Naproxen • Isoxicam
• Phenylbutazone (Bute)
• Fenoprofen
• Ketoprofen • Anthranilic acid derivatives (Fenamates)
• Dexketoprofen • Mefenamic acid
• Flurbiprofen • Meclofenamic acid
• Oxaprozin • Flufenamic acid
• Loxoprofen • Tolfenamic acid
• Acetic acid derivatives • Selective COX-2 inhibitors (Coxibs)
• Indomethacin • Celecoxib
• Tolmetin • Rofecoxib
• Sulindac • Valdecoxib
• Etodolac • Parecoxib
• Ketorolac • Lumiracoxib
• Diclofenac • Etoricoxib
• Aceclofenac • Firocoxib used in dogs and horses
• Nabumetone • Sulfonanilides
• Others • Nimesulide (systemic preparations are banned by
- Clonixin - Licofelone several countries for the potential risk of
hepatotoxicity)
• Contraindications:
1. In patient with bronchial asthma.
2. In patient with Peptic ulcer or stomach bleeding.
3. Patients that suffer with inflammatory bowel disease (Crohn's disease or
ulcerative colitis).
4. Uncontrolled hypertension.
5. Kidney disease.
6. Hepatic disease.
7. Pregnancy and lactation
8. History of heart attack, stroke, or blood clot.
9. Past myocardial infarction
10. Coronary artery disease
11. Congestive heart failure.
N.B. use with caution in patient under anticoagulant drugs.
Diclofenac sodium (Na)
Dose:
100:150 mg. per day in divided doses. - maximum dose is 200 mg./day
Anuva 50 Tab
Baby relief 12.5 Supp
Baby relief 25 Supp
Declofenac 25 Tab
Declofenac 50 Tab
Declophen 12.5 Supp
Declophen 25 Supp Tab
Declophen 50 Tab
Declophen 75 Amp
Declophen 100 S.R. Cap
Declophen 100 Supp
Dolphin 12.5 Supp
Dolphin 25 Supp
Dolphin 50 Supp
Epifenac 12.5 Supp
Epifenac 25 Supp Tab
Epifenac 50 Tab
Epifenac 75 Amp
Epifenac 100 Supp
Olfen 25 Tab
Olfen 50 Tab
Olfen 75 Cap amp
Olfen 100 S.R. Cap supp
Olfen DA 75 Cap Declofenac K. 16mg. + diclofenac Na. 59mg.
Pharofen 100 Supp
Rheumafen 25 Tab
Rheumafen 50 Tab
Rheumafen 75 Cap amp.
Rheumafen 100 S.R. Cap Supp
Rheumarene 25 Tab
Rheumarene 50 Tab
Rheumarene 75 Amp
Rheumarene 100 Supp
Romalex 75 Amp
Sigmafenac 75 Cap
Voltaren 12.5 Pedo. Supp
Voltaren 25 Pedo. Supp tab
Voltaren 50 Tab
Voltaren 75 S.R. tab amp
Voltaren 100 Supp
Voltaren S.R. 100 S.R. tab
Diclofenac Potassium (K.)
• The real difference lies in the fact that potassium salt of Diclofenac is more soluble in water than sodium salt.
• So Diclofenac potassium absorbed quickly and starts analgesic activity quicker time than Diclofenac sodium.
• Diclofenac potassium is immediate release, while Diclofenac sodium is delayed release.
Dose:
recommended dosage is 150-200 mg./day in divided doses, 50 mg three times a day or four times a day.
For chidren under 18 years 50:100 mg./day in divided dose
Actifast 12.5 Tab
Actifast 50 Sachets
Adwiflam 12.5 Supp.
Adwiflam 25 Supp.
Adwiflam 50 Sachets
Adwiflam ER 50 Cap.
Adwiflam 75 Amp. Supp.
Antiflam 25 Tab.
Antiflam 50 Tab.
Antiflam 75 Tab.
Catafly 2 gm./ml. 100 ml. susp.
Catafast 50 Sachets
Cataflam 1.5% 15 ml. oral drops
Cataflam 25 Tab
Cataflam 50 Tab
Cataflam 75 Amp. Supp.
Dicalsium 50 Tab
Diclotazen 50 Sachets
Dolphin – K 1.5% 15 ml. oral drops
Dolphin – K 25 Tab
Dolphin – K 50 Tab
Dolphin – K 75 Amp. Supp. Cap.
Oflam 25 Tab
Oflam 50 Tab
Potafen 25 Tab.
Potafen 50 Tab.
Potafen 75 Amp.
Rapidus 50 Tab.
Rapiflam 25 Tab.
Rapiflam 50 Tab.
Ibuprofen
Dose:
Over 12 years old [ 600:1800 ]mg. per day in 3 or 4 divided doses, maximum dose 2400 mg. per day.
Below 12 years old [ 20:40 mg./kg./day ] , tablets shouldn’t be taken by children less than 7 kg.
600 mg. tablets shouldn’t be given to children under 12 years old.
Brufen 100 110 ml. syrup
Brufen 200 Tab.
Brufen 400 Tab.
Brufen 600 Tab. Sachets
Brufen 500 Supp.
Brufen Retard 800 Tab. Sustained release
Flabu 40 15 ml. drops
Flabu 600 Tab.
Ibufen 100 syrup
Ibufen 200 Tab.
Ibuprofen 400 Tab.
Marcofen 100 Syrup pedo. Supp.
Marcofen 300 Supp.
Marcofen 400 Tab. S.R. Cap.
Marcofen 500 Supp.
Mepabrufen 300 Supp.
Mepabrufen 400 Tab.
Mepabrufen 500 Supp.
Profinal 100 Syrup
Profinal 200 Tab.
Profinal 400 Tab.
Profinal 600 Tab.
Profusol 200 Cap
Profusol 400 Cap
Rapifen 200 Cap
Ultrafen 100 Syrup
Ultrafen 200 Tab. Supp.
Ultrafen 400 Tab.
Ultrafen 500 Supp.
Ultrafen 600 Tab.
Ketoprofen
• Suppositories may cause rectal irritation. And may be pain at the injection site with I.M. use.
Dose: Adults - 50 mg orally 4 times a day or 75 mg orally 3 times a day, Maximum dose: 300 mg/day.
Bi-profenid 150 Tab.
Profenid 50 Cap.
Profenid 100 Amp. Supp.
Alcofan 25 Tab.
Alcofan 50 Cap.
Alcofan 100 Supp.
Bi-alcofan 150 Tab.
Doloket 100 Amp.
Flamibru 75 Cap.
Flamoguard 150 Cap.
Ketoprof ER 200 Cap.
Ketoprof 100 Amp.
Ketofan 25 Tab.
Ketofan 50 Cap.
Ketofan 100 Amp.
Ketofan 150 Supp.
Ketofan 200 Cap.
Ketofan 12.5 Susp.
Ketofan S.R. 100 Cap.
Ketolgin 25 Tab
Ketolgin 50 Tab
Ketolgin 100 Supp. Amp.
Ketolgin 200 Cap.
Ketogesic S.R. 100 Cap.
Ketogesic S.R. 200 Cap.
Ketprek 75 Cap.
Ketoral S.R. 200 Cap.
Kupan 50 Cap.
Kupan 100 Supp.
Kupan S.R. 200 Cap.
Mepacofen 25 Tab.
Mepacofen 100 Cap.
Mepacofen 150 Cap.
Mepacofen 200 Cap.
Orudis 100 Amp. Supp.
Top fam 25 Tab.
Naproxen
• Suppositories may cause rectal irritation and occasional bleeding.
Dose: 500:1000 mg./day as single dose or in 2 divided doses.
Apranox 500 Amp.
Naprofen 500 Tab.
Naprogesic 250 Tab.
Naprogesic 500 Tab. Supp.
Naprosyn 250 Tab.
Naprosyn 500 Tab.
Naprosyn 500 Supp.
Myoprox 250 Tab.
Maxipan 250 Tab.
Maxipan 250 Supp.
Piroxicam
• Suppositories may cause rectal irritation and occasional bleeding.
• And may be pain and tissue damage at the injection site with I.M. use.
Dose:
20 mg. daily .
Initial dose could be 40 mg. for the first 2 days in single or divided dose.
Brexin 20 Tab. Sachets supp.
Dispercam 10 Tab.
Dispercam 20 Tab. Amp. Supp.
Feldene 10 Tab. Cap.
Feldene 20 Tab. Amp. Supp.
Feldene flash 20 Sublingual tab.
Feldoral 20 Cap. Supp.
Inflacam 10 Tab. Cap.
Inflacam 20 Cap. Amp. Supp.
Pirocam 20 Amp.
Piroxiden 20 Cap supp.
Piroxifar 20 Tab. Supp. Amp.
Vendocid 20 Cap.
Selective COX-2 inhibitors
Celecoxib
• Selective inhibitor of Cox-2 enzyme & has very low adverse effects on stomach.
Dose: Usual dose: 200 mg orally twice a day After food.
Arythrex 100 Cap.
Arythrex 200 Cap.
Celebrex 100 Cap.
Celebrex 200 Cap.
Celoxib 100 Ap.
Celoxib 200 Cap.
Eurocox 100 Tab.
Eurocox 200 Tab.
Rhuma max 100 Cap.
Etodolac
• Indicated in acute or long term treatment of rheumatoid arthritis & osteoarthritis.
• Selective inhibitor of Cox-2 enzyme & has very low adverse effects on stomach.
Dose: 200:300 mg. daily after food.
Etodine 200 Cap.
Etodine 300 Cap.
Etodolac 300 Tab.
Napilac 200 Cap.
Meloxicam (preferential inhibitor of Cox-2 enzyme )
Dose: 7.5:15 mg. as one dose daily after meal.
Anti-cox II 7.5 Cap.
Anti-cox II 15 Tab. Amp. Supp.
Melocam 7.5 Tab.
Melocam 15 Tab. Amp. Supp.
Meloflam 7.5 tab.
Meloflam 15 Tab.
Meloxicam 7.5 Tab.
Meloxicam 15 Tab. Amp. Supp.
Mexicam 7.5 Tab.
Mexicam 15 Tab. Amp. Supp.
Mobic 7.5 Tab. Supp.
Mobic 15 Tab. Amp.
Mobitil 7.5 Tab.
Mobitil 15 Tab. Supp.
Moxen 7.5 Tab.
Corticosteroid
• Corticosteroids:
• Uses in dentistry:
1. Denture induced ulcers
2. Recurrent ulcerative stomatitis
3. Erosive lichen planus
4. Erythema multiforme
5. Desquamative gingivitis
6. Angular stomatitis
7. Mucous Membrane Pemphigoid
• Adverse effects:
1. Disturbance in electrolyte balance which include sodium retention and potassium excretion that result in
water retention and hypokalemia.
2. Mobilization of calcium and phosphate with osteoporosis and spontaneous fractures, growth retraction
in children is reported
3. Hyperglycemia so its contraindicated in diabetes mellitus
4. Acute adrenal insufficiency may be occur during prolonged treatment
• Contraindications:
peptic ulcers, diabetes mellitus, hypertension, pregnancy & lactation, tuberculosis, osteoporosis,
herpes simplex virus, epilepsy, congestive heart failure and renal failure.
Note: Corticosteroids (systemic) must be stopped gradually to avoid adrenal insufficiency.
Classification:
• According to Chemical structure
1. Group A — Hydrocortisone type
Hydrocortisone, hydrocortisone acetate, cortisone acetate, tixocortol pivalate, prednisolone, methylprednisolone,
and prednisone (Short- to medium-acting glucocorticoids).
2. Group B — Acetonides (and related substances)
Triamcinolone acetonide, triamcinolone
alcohol, mometasone, amcinonide, budesonide, desonide, fluocinonide, fluocinolone acetonide, and halcinonide.
3. Group C — Betamethasone type
Betamethasone, betamethasone sodium phosphate, dexamethasone, dexamethasone sodium phosphate,
and fluocortolone.
4. Group D — Esters
5. Group D1 — Halogenated (less labile)
Halometasone, alclometasone dipropionate, betamethasone valerate, betamethasone
dipropionate, prednicarbate, clobetasone-17-butyrate, clobetasol-17-propionate, fluocortolone
caproate, fluocortolone pivalate, and fluprednidene acetate.
6. Group D2 — Labile prodrug esters
Hydrocortisone-17-butyrate, hydrocortisone-17-valerate, hydrocortisone-17-aceponate, hydrocortisone-17-
buteprate, ciclesonide and prednicarbate.
• Oral Corticosteroids:
• GENERIC NAME: triamcinolone acetonide 0.1% dental paste
• DISCONTINUED BRANDS: Kenalog Orabase, Oralone in the US, Kenacort, Geo oralog
• SIDE EFFECTS: Use of triamcinolone acetonide dental paste may cause some local
side effects such as
• burning,
• itching,
• irritation,
• dryness, and
• peeling where it is applied.
• Other side effects reported include
• peri-oral dermatitis,
• allergic contact dermatitis,
• maceration of the oral mucosa,
• secondary infection, and
• atrophy of the oral mucosa.
https://www.drugs.com/pro/kenalog-orabase.html
http://www.medicinenet.com/triamcinolone-dental/article.htm
• Systemic Corticosteroids:
Hydrocorisone
• For short term treatment only.
Dose:
1 vial I.V. / I.M. – can be repeated when need according to the case.
Solu-cortef Vial 100 mg.
Sigmacortin vial Hydrocortisone sod. Succinate 500 mg.
Prednisone
Dose: 30-60 mg. decreased gradually to reach minimum dose giving the maximum recommended effect.
Hostacortin 5 20 tab. 5 mg.
Prednisolone
• Have mainly glucocorticoid activity, 5 mg. of prednisolone is equivalent in anti-inflammatory activity to about 25 mg.
of cortisone acetate.
Dose: 30-60 mg. decreased gradually to reach minimum dose giving the maximum recommended effect.
• In most cases, 1 tablet 3 times daily after food for 3-5 days
Then 1 tablets 2 times daily after food for 3-5 days
After that 1 tablet daily after food for 3-5 days
Hostacotin-H 5 Tab.
Predilone 5 Tab
Prednisolone 5 Tab
Predsol 5 30 ml. syrup
Predsol forte 15 60 ml. syrup
Solupred 5 Tab
Solupred 20 Tab
Xilone 5 100 ml. syrup
Xilone forte 100 ml. syrup
Methyl prednisolone
Dose:
16-40 mg. daily devided into 2 or 3 doses,
decreased gradually to reach minimum dose giving the maximum recommended effect.
Depo-Medrol 40 Vial
Depo-medror 1000 Vial
M.P.A. 40 Vial
Urbasone 4 Tab
Urbasone 8 Tab
Betamethasone
Dose: short term treatment 2:3 mg. daily for the first few days, subsequently reducing the daily dose by
[0.25 : 0.5] mg. every 2-5 days.
Betasone 0.5 mg. Tab
Betafos Amp
Dexaglobe Amp Betamethasone dipropionate 10 mg. +
Betamethasone sod. Phosphate 4 mg.
Diprofos Amp Betamethasone dipropionate 10 mg. +
Betamethasone sod. Phosphate 4 mg.
Dexamethasone
• Have mainly glucocorticoid activity, 750 micrograms of dexamethasone is equivalent in anti-inflammatory activity to
about 5 mg. of prednisolone.
Dose: Adult : 0.75 to 9 mg per day in divided doses every 6 to 12 hours.

pediatric : 0.08 to 0.3 mg/kg/day in divided doses every 6 to 12 hours.
Deltasone 0.25 120 ml. syrup
Deltasone 0.75 Tab
Dexamethasone 8 Amp
Dexamethasone 100 ml. syrup
Dexazone 0.5 Tab
Dexonium 8 Amp
Epidron 4 Vial
Orazone 0.5 Tab
Orazone 0.5 100 ml. syrup
Fortecortin 8 amp
Triamicinolone
Amsinol 40 Vial
Kenacort-A 40 Vial
Kenacort-A 4 Tab
Flucortolone
Ultralan 5 Tab
Topical Corticosteroids
Dose:
Cream - apply a thin film to the affected skin areas once daily
Ointment - apply a thin film to the affected skin areas twice daily
Hydrocortisone
Hydrocotisone 1% 10 mg. Cream or 20mg. Ointment
Hydrocortisone 2.5% 10 mg. cream
Hydrocortisone acetate 1% 15 mg. cream
Micort 1% 20 mg. cream
Triamcinolone acetonide
Topicort 1% 20 mg. cream
Betamethasone
Betaderm 0.1% 15 g. cream or oint.
Betamethasone 15 g. cream
Betamethasone valerate 0.1% 15 g. Oint.
Betaval 0.1% 15 g. cream
Betnovate 0.5% 15 g. cream or oint.
Diprosone 0.5% 10 g. cream or oint.
Mometasone
Borgasone 0.1% 20 g. cream or oint. /or 20 ml. solution
Elocon 0.1% 10 g. cream or oint. /or 15 ml. solution
Elocortin 0.1% 15 g. cream or oint. /or 15 ml. solution
Metaz 0.1% 30 g. cream or oint.
Fluticasone
Cutivate 0.05% 15 g. cream or oint.
Dermaflutisone 0.05% 30 g. cream
Dermatop 2.5% 10 g. cream or oint. Prednicarbate 2.5%
Muscle Relaxant
• Systemic muscle relaxant:
Chlorzoxazone ‫باسط للعضالت (يوقف الشد العضلي) مع مسكن لأللم‬
• Centrally acting muscle relaxant.
• Adverse effects: the most common are dizziness and drowsiness.
• Dose: 1:2 caps. 3 times daily.
Flexofan 20 cap.
Mark-fast 20 cap.
Myofen 20 cap.
Myoflex 10 cap.
Myolax 10 cap.
Myolgin 20 cap.
Parafon 18 cap.
Profenazone 20 cap.
Relax 10 cap.
Relaxiged 20 cap.
relaxon 30 cap.
• Topical muscle relaxant:
Topical
Myolax 50 g. cream
Myorel 50 g. cream
Myorel 60 ml. spray
Relax 50 g. cream
Radian massage 40 g. cream
Moov 40 g. cream
Pain free 30 g. gel
Trypsin, Chymotrypsin & α-Amylase
Anti-edema
• Trypsin & Chymotrypsin :
• Function within the intestine to help break down protein molecules.
• Because these two enzymes break down proteins, they classified as proteases.
(also called proteolytic enzymes or proteinases)
• Proteases refer to a group of enzymes whose catalytic function is to hydrolyze
peptide bonds of proteins.
• It has anti-inflammatory, anti-exudative (reduces swelling) and mucolytic
(breaks down bronchial secretion) effects.
• Mechanism of action:
1. During the inflammatory process, in tissue there is hampered blood circulation
and lymph flow.
2. The trypsin and chymotrypsin, with their proteolytic activity at the site of the
pathological process, tear a long polypeptide chains in less suitable for resorption.
(split proteins into amino acids and peptides)
3. Disappearance of the edema, exudate and hematoma, leads to normalizing of
locally disturbed blood circulation and lymph flow.
• Precautions: Symptoms of an allergy can include:
• skin rash
• redness of the skin
• itching of the skin
• swelling of the throat, tongue and face
• trouble breathing
• Side Effects:
- Nausea, vomiting, abdominal pain, bloating, blood in the urine, allergy.
• Drug Interactions:
- Alcohol -Chloramphenicol
• Contraindication:
- not be used in case of known hypersensitivity to its active ingredients.
- not be used by patients with severe inborn or gained coagulation disorders. (E.g- hemophilia,
severe liver damage, dialyzed patients).
• Pregnancy and Lactation:
- Administration during pregnancy and breastfeeding is not recommended.
Trypsin & Chymotrypsin
• Dose:
One to two tablets 3 times daily to be swallowed and not chewed.
Be taken on empty stomach 1 hrs. before meal or 2 hrs. after meal.
• Precautions In case of infections should be associated with antibiotics.
Alphintern Tab
Ambezim-G Tab
Newbezim Tab
Alphachymotrypsin Vial
N.B. Alphachymotrypsin may cause Anaphylactic shock, So it is must to do allergy test before use.
Alpha-Amylase
• α-Amylase is a protein enzyme that hydrolyses alpha bonds of large alpha-linked polysaccharides.
• Has Anti-edema and anti-inflammatory effect as proteolytic enzyme.
• Dose:
children: 1 teaspoonful 3 times daily
Adult: 1 tablet or 1 tablespoonful 3 times daily
Maxilase Syrup
Megalase Syrp
Megalase Tablets
Oral preparations
• Oral preparations :
1. Mouthwash.
2. Other oral gel , sprays and drops.
3. Adhesive creams for dentures and cleansing tablets.

Mouthwash Ingredients:
• Alcohol
• act as a carrier agent for essential active ingredients such as menthol, eucalyptol and thymol which
help to penetrate plaque
• alcohol is a drying agent, which encourages bacterial activity in the mouth, releasing more malodorous
volatile sulfur compounds.
• Therefore, alcohol-containing mouthwash may temporarily worsen halitosis in those who already have
it, or indeed be the sole cause of halitosis in other individuals.
• Many mouthwashes have alcohol in them – some as much as 20%, which is a big problem, and that
increases the risk of mouth or oral cancer.
• Mouth wash containing alcohol is contraindicated for children.
• Betadine Povidone/iodine
• A 2005 study found that gargling three times a day with simple water or with a Povidone-
iodine solution (although with less effectiveness) was effective in preventing upper respiratory
infection and decreasing the severity of symptoms.
• A later study found that the same procedure did not prevent influenza-like illnesses.
• Other sources attribute the benefit to a simple placebo effect.
• Cetylpyridinium chloride (CPC) (antiseptic, antimalador)
• It is an antiseptic that kills bacteria and other microorganisms.
• It has been shown to be effective in preventing dental plaque and reducing gingivitis.
• Cetylpyridinium chloride (e.g. 0.05%) is used in some specialized mouthwashes for halitosis.
• Cetylpyridinium chloride mouthwash has less anti-plaque effect than chlorhexidine.
• may cause staining of teeth, or sometimes an oral burning sensation or ulceration.
• Chlorhexidine digluconate and Hexetidine (antiseptic)
• Chlorhexidine digluconate is a chemical antiseptic and is used in a 0.12-0.2% solution as a
mouthwash. It has significant anti-plaque action, but also some anti-fungal action. It is especially
effective against Gram-negative rods.
• It is sometimes used as an adjunct to prevent dental caries and to treat periodontal disease, although it
does not penetrate into periodontal pockets well.
• Chlorhexidine mouthwash alone is unable to prevent plaque, so it is not a substitute for regular
toothbrushing and flossing.
• It is not suited for use in acute necrotizing ulcerative gingivitis
• Rinsing with chlorhexidine mouthwash before a tooth extraction reduces the risk of dry socket.
• Other uses of chlorhexidine mouthwash include prevention of oral candidiasis
in immunocompromised persons, treatment of denture-related stomatitis.
• Chlorhexidine has good substantivity (the ability of a mouthwash to bind to hard and soft tissues in the
mouth). However, chlorhexidine binds to tannins, meaning that prolonged use in persons who consume
coffee, tea or red wine is associated with extrinsic staining of teeth.
• Side effect:
• Main one is Brown discoloration of the teeth and some restorative materials and the dorsum of the tongue.
• Chlorhexidine is rarely associated with other issues like overgrowth of enterobacteria in persons
with leukemia, desquamation and irritation of oral mucosa, salivary gland pain and swelling, and
hypersensitivity reactions including anaphylaxis.
• Recent studies suggest that, The chlorhexidine mouthwashes have a residual effect, so using it for
2 weeks and then stopping for 3 months is as good as using it every day.
• Hexetidine also has anti-plaque, analgesic, astringent and anti-malodor properties but is considered as
an inferior alternative to Chlorhexidine.
• Essential oils and phenols (e.g. Listerine )
• phenolic compounds include essential oil constituents that have some antibacterial-properties
, like phenol, thymol, eugenol, eucalyptol or menthol.
• Mouthwashes based on essential oils could be more effective than traditional mouthcare for
Anti-gingival treatments.
• They have been found effective in reducing halitosis, and are being used in several commercial
mouthwashes.
• Benzydamine (analgesics)
• (also known as Tantum Verde and branded in some countries as Difflam)
• It is powerful analgesic with weak anti-inflammatory effect.
• In painful oral conditions such as aphthous stomatitis, analgesic mouth rinses are sometimes used to
ease pain, commonly used before meals to reduce discomfort while eating.
• Side effect: Numbness or a stinging feeling in your mouth, SO dilute it with an equal amount of water.
• Tetracycline (antibiotic)
• Tetracycline is an antibiotic which may sometimes be used as a mouthwash in adults (it causes staining
of teeth in children). It is sometimes use for herpetiforme ulceration (an uncommon type of aphthous
stomatitis),
• but prolonged use may lead to oral candidiasis as the fungal population of the mouth overgrows in the
absence of enough competing bacteria. Erythromycin is similar.
• Cetrimide
• Antiseptic which is a mixture of different quaternary ammonium salts including Cetrimonium bromide.
• Avoid contact with eyes, middle ear, body cavities. - Caution needed for pregnant and breastfeeding.
• Methyl salicylate
• Multiple functions - Anti-septic, Anti-inflammatory, Analgesic, Flavoring and Fragrance(sweet
smell).
• Methylsalicylates have some anti-plaque action but less substantivity than chlorhexidine.
• Do not stain teeth.
• Hydrogen peroxide
• Hydrogen peroxide can be used as an oxidizing mouthwash (e.g. Peroxyl, 1.5%).
• It kills anaerobic bacteria & has a mechanical cleansing action when it froths as it comes into
contact with debris in mouth.
• It is often used in the short term to treat acute necrotising ulcerative gingivitis.
• Side effects with prolonged use might occur, including hypertrophy of the lingual papillae.
• Fluoride (anticavity) (e.g. sodium fluoride)
• Anti-cavity mouth rinses use fluoride to protect against tooth decay.
• Most people using fluoridated toothpastes do not require fluoride-containing mouth rinses.
• Fluoride mouthwashes are sometimes used in individuals who are at high risk of dental decay, or
people with xerostomia.
• Use this medication in children younger than 6 years not recommended.
• Prefer Not use with pregnant nor breast-feeding because it passes into breast milk.
• Zinc
• zinc chloride provide a pleasant-tasting sensation and shrink tissues. Zinc when used in
combination with other anti-septic agents can limit the build-up of tartar.
• Sodium chloride (salt)
• Salt water mouth wash is made by dissolving 0.5–1 teaspoon of table salt into a cup of hot water
for two or three weeks.
• Saline has a mechanical cleansing action and an antiseptic action as it is a hypertonic solution in
relation to bacteria, which undergo lysis.
• The heat of the solution produces a therapeutic increase in blood flow to the surgical site,
promoting healing. Hot salt water mouthwashes also encourage the draining of pus from dental
abscesses.
• Gargling with salt water is said to reduce the symptoms of a sore throat.
• Hot salt water mouth are also routinely used after oral surgery, to keep food debris out of healing
wounds and to prevent infection. Some oral surgeons consider salt water mouthwashes the
mainstay of wound cleanliness after surgery.
• In dental extractions, hot salt water mouthbaths should start about 24 hours after a dental
extraction. The term mouth bath implies that the liquid is passively held in the mouth rather than
vigorously swilled around, which could dislodge a blood clot. Once the blood clot has stabilized,
the mouth wash can be used more vigorously.
• These mouthwashes tend to be advised about 6 times per day, especially after meals to remove
food from the socket.
• Longer term, the salt water is acidic, so there would be a problem if you were to use it every day,
it could erode the teeth, but is not necessarily abrasive to the teeth. It is the acidity of the salt
water that could eat away and soften the enamel on the teeth making them more susceptible to
wearing, chipping and cavities.
• Most common Mouthwash in Egyption market :
Hexitol Chlorhexidine 0.125 %
Antiseptol 0.1% Chlorhexidine 0.1 %
Betadine 1% Povidone - iodine
Lodosept 10% Povidone - iodine
Povidin 1% Povidone - iodine
B-fresh Cetylpyredinium + amine fluride
Dg-wash Chlorhexidine + propolis + clove oil
Listermix Methyl salicylate + Eucalyptol + Menthol + Thymol + ethanol
Listermix plus Chlorhexidine 0.1% + Eucalyptol 0.092% + Menthol 0.042% + Thymol 0.064%
Listerine Methyl salicylate 0.060% + Eucalyptol 0.092% + Menthol 0.042% + Thymol 0.064%
Lysoplac Chlorhexidine + sodium citrate + dimethicone
Kenara Thyme Extract + Menthol + Chlorhexidine + Glycerin
Oraldene Hexetidine
Orovex Chlorhexidine + Menthol + Thymol + Saccharine Sodium + Glycerin + Sodium
Monofluorophosphate + Peppermint, Orange, Banana, Strawberry and Clove Flavors
Tantum verde Benzydamine
Colgate Plax 0.05% Cetyl Pyridinium Chloride
Colgate peroxyl HYDROGEN PEROXIDE 1.5%
Maxoral TIBEZONIUM IODIDE 0.05%
Fittydent Glycerin, Potassium Nitrate, Sodium Fluoride, Sodium Saccharin, Sodium Benzoate
Sensodyne (cool mint) or 3% Potassium Nitrate and 0.048% Sodium Fluoride
(extra fresh)
Sensodyne Gentle Cetylpyridinium Chloride, Glycerin, Sorbitol, Hydrogentate Castor Oil, Sodium
Benzoate, Flavour, Methyl Paraben, Sodium Fluoride, Sodium Saccahrin, Disodium
Phosphate, Sodium Phosphate
Perox Hydrogen peroxide, menthol, peppermint
Gengigel mouthrinse hyaluronic acid
Oradent Methyl salicylate + Eucalyptol + Menthol + sod. fluoride
Ezaflour Cetylpyredinium + amine fluride
Oramint cetyl pyridinium chloride , eucalyptol, menthol, sod. Fluoride, thymol, zinc sulphate
Orasan Thyme, menthol, triclosan, clove oil, citrimide
Oracin Citrimide, eugenol, menthol, methyl benzoate
Act mouthwash sodium fluoride
Emoform Potassium nitrate, sodium fluoride, potassium chloride and cetylpyridinium.
Emoform F With floride
• Other oral gel , paste , sprays and drops
Oral gel , paste , sprays and drops
Aphthtab Tabs • Buccal Bioadhesive tablets for aphthous ulcer
• Place tablets on mouth ulcer by firmly pressing for few seconds.
• Do not swallow or chew the tablet.
Dentocalm Oral oint. Benzocaine + clove oil (not use with babies under 2 years)
Dento-gel Oral gel Lidocaine
Dg-care Oral gel Chlorhexidine + propolis + sod. Laurylsulphate
Elugel 2% Gel Chlorhexidine
Oracure Gel Lidocaine + Cetylpyridinium chloride
Jogel Gel Lignocaine + jojoba (used for ulcer & inflamed mucosa)
Solcoseryl Dental Paste
Salivex-L Oral paint Lignocaine + salicylic acid + glycoside
Gengigel Gel For oral ulcer and inflamed gingiva (hyaluronic acid 0.2 %)
Aftamed Gel hyaluronic acid 2.4 %
EZ Care Gel Chlorhexidine
Elugel Gel Chlorhexidine
Dentocaine 7.5% Gel benzocaine 7.5% (not use with babies under 2 years)
Canyon Gel cetyl pyridinium chloride 0.2mg, chlorcresol, clove oil , lidocaine
Medijel Gel aminacrine 0.05%, lidocaine 0.66%

Dentinox cetyl pyridinium chloride 0.1 %, lidocaine 0.3 %
Uci fresh Spray cetyl pyridinium chloride 0.1 %, lidocaine 0.3 %
PansoraI Gel cetalkonium , choline salicylate (with teething in babies)
Dentibaby teething gel • provides relief from pain for babies cutting their first teeth.
• Formulated using natural extracts of:
• Camomile flower: with softening and soothing properties
• Propolis and valerian root: with calming properties
• Dentibaby should be applied delicately, massaging directly onto
the baby’s gum. Its vanilla flavour and pleasant texture will
bring an almost immediate and welcome sense of relief.
Ez-Cure 10 mg. Gel Periodontal local delivery system. (Chlorhexidine digluconate)
For the treatment of periodontal pockets. (apply every 48 hrs.)
• Antibiotics (trimethoprim, sulfonamides, and dapsone), local anesthetics (especially articaine, benzocaine,
and prilocaine) not use with babies under 2 years: can lead to a rare but serious condition called
methemoglobinemia (a disorder in which oxygen amount carried through blood stream is greatly reduced->If left
untreated or if treatment is delayed->permanent injury to brain and body tissues and even death).
• Symptoms of methemoglobinemia include: pale gray or blue-colored skin, lips & nail beds, shortness of breath ,
fatigue, confusion , headache, rapid heart rate.
• Adhesive creams for dentures and cleansing tablets
Adhesive creams for dentures and cleansing tablets
Use:
• Tablets: place one tablet in glass of warm water then immerse the dentures to completely covered by the solution
and leave it for 15 minutes or overnight, rinse under running water before reuse.
• Adhesive cream: apply directly before fixing the denture in the mouth.
Corega Cleansing tab
Corega Cream
dentipur Tablets
Ez-fresh 15 ml. cleansing drops With mint flavour
Fitty dent Cleansing tablets
Fitty dent Cream
Protefix 20 g. adhesive powder
Protefix Cleansing tablets
Protefix Cream
Y kelin adhesive powder
• References :
• https://www.ncbi.nlm.nih.gov/
• https://www.drugs.com/
• https://en.wikipedia.org/wiki/
• http://www.who.int/en/
• (Oral Microbiology at a Glance) book
by Richard J. Lamont & Howard F. Jenkinson
• (Master of Therapeutic Drugs) book.

Basic Dental Pharmacology

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Amoxicillin 500 Cap

Cefzil 125 Susp.

Cepodem 100 Tab

• Cover gram-negative & most of the gram-positive bacteria.

Cefidime 1000 Vial

Tetracid 250 Cap

Birodogyl Cap very expensive 750,000 i.u. + Metronidazole 125 mg.

Chloramphenicol 250 Cap

• Other antiviral agents

Antiviral drug Viruses or diseases affected

Acyclovir Herpes simplex virus , varicella zoster virus & cytomegalo-virus

Famciclovir Herpes simplex virus , varicella zoster virus

Valacyclovir Herpes simplex virus , varicella zoster virus & cytomegalo-virus

Amantadine influenza A & varicella zoster virus

Ribavirin Respiratory syncytial virus (RSV) , herpes simplex virus

Azole Antifungal Drugs

Oral antifungal agents

Buccazole 100 20gm. Oral gel Miconazole 100 mg./ 5ml.

• Opioids are substances that act on opioid receptors to produce morphine-like

• Opioid antagonists : opioid effects can be reversed with an opioid

Dose: Adult : 0.75 to 9 mg per day in divided doses every 6 to 12 hours.

2. Other oral gel , sprays and drops.

3. Adhesive creams for dentures and cleansing tablets.

Medijel Gel aminacrine 0.05%, lidocaine 0.66%

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