Answer c. Clindamycin with Flagyl(Metronidazole)
Pathways of the Pulp, 8th Ed, Cohen and Burns 2002
Endodontic Therapy 5th Ed, Weine 1996
1929 Pen G (IV), V, narrow spectrum, mainly for G+ aerobic and facultatives. And a few anaerobes. (Streptococci, Pneumococci, Bacillus, Clostridium, Neisseria). Antibiotic of choice for endodontic infections due to efficacy and low toxicity.
Extended spectrum PCN's, Ampicillin (IM/IV), Amoxicillin.
Amoxicillin - (combined with Clavulinic Acid, a beta-lactamase inhibitor, to form Augmentin). Enhanced activity vs. G- species. Broader spectrum and faster absorption than Pen VK
Cephalosporins
Bind to enzymes involved in cross linking of peptidoglycan strands of bacterial cell wall (Like PCN's). Expensive.
1. First gen. Cephlexin (Keflex), vs. G+ Cocci, G- bacilli (E.Coli, Klebsiella)
2. 2nd gen. Vs. Providencia, Proteus Cefaclor.
3. 3rd gen. Most effective vs. G- species, H.Influenzae, enterococci, Neisseria, Serratia, Pseudomonas, and anaerobes like B. fragilis.
Erythromycin 1952, macrolide, inhibits bacterial protein synthesis Narrow spectrum like Pen G. Less effective vs. anaerobic species found in endodontic infections.
Clindamycin 1970- spectrum like e-mycin, more effective vs. most G+ and G- anaerobes.
Not effective vs. most G- aerobes. Concentrates in bone. Pseudomembranous colitis risk only present in doses greater than that needed for endodontic infections.
Metronidazole- 1959 drug of choice for protozoal infections. Works vs. strict aerobic bacterial infection. ANUG application. Given with PCN to cover G+ and G- bacteria.
Quinolones - 1962, Ciprofloxacin, Broad spectrum, Highly active vs. G- enteric bacteria. Expensive.
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