Pharmacology for Dentistry

Beta Lactam Antibiotics 321

βββββ-LACTAMASE INHIBITORS

CLAVULANIC ACID

It ‘progressively’ inhibits a wide variety
of β-lactamases produced by gram positive
and negative organisms and is obtained
from Streptomyces clavuligerus. It has no anti-
bacterial activity of its own.

It is used along with amoxycillin in
various infections as discussed above.

SULBACTAM

It is another semisynthetic β-lactamase
inhibitor used along with ampicillin. It is
related to clavulanic acid both chemically
and in activity.

Adverse effects include diarrhoea, rash,
pain at site of injection and thrombophlebitis
of injected vein.

It is indicated in gynaecological, intra-
abdominal, skin and soft tissue infections.

ANTIPSEUDOMONAL PENICILLINS

These are indicated mainly to treat gram
negative bacilli infection by pseudomonas,
proteus and enterobacter.

CARBENICILLIN

It is a penicillinase susceptible and is
principally indicated for serious infection
caused by Pseudomonas aeruginosa. It is
effective against certain other gram negative
bacilli including Proteus species and
Bacteroides fragilis.

Adverse effects include platelet dys-
function, hypokalemia and hypersensitiv-
ity reaction.

It is indicated in bacteriaemia, septicae-

mia, genitourinary and respiratory tract in-

fections, endocarditis and postoperative in-

fections caused by pseudomonas or proteus.

PIPERACILLIN

The unique advantages of piperacillin

are broad spectrum of antibacterial activity

and excellent antipseudomonal activity.

They have a synergistic effect with

aminoglycosides (e.g. gentamicin or

netilmicin) and hence should be given con-

comitantly in pseudomonas septicaemia.

They should however, not be mixed in the

same syringe. Owing to the sodium content,

high doses may lead to hypernatremia.

Adverse effects include platelet dys-

function leading to bleeding, superinfec-

tion, local pain and thrombophlebitis.

It is indicated in systemic and local

infections, gynaecological infections, UTI,

RTI, neonatal and lifethreatening paediatric

infections, burns and septicaemia caused by

susceptible organisms.

TICARCILLIN

It is derived from penicillin nucleus 6-

aminopenicillanic acid. It has broad spectrum

of activity against both gram positive and

negative organisms. It is more potent than

carbenicillin against Pseudomonas.

Adverse effects include hypersensitiv-

ity, thrombocytopenia, neutropenia, leu-

copenia, pain at the site of injection and GI

disturbances.

It is indicated in bacterial septicaemia,

skin and soft tissue infections, acute and

chronic respiratory tract infections.