From Inflammation To Infection

Mefenamic Acid

Clindamycin HCL

Hussein H. Ahmad

® ®

Mefenamic Acid

®

Prostaglandins:

Hormone Like Substances which play a role in the Cell Metabolism.

Act as Chemical Mediators of the inflammatory response, increasing permeability (Vasodilatation) causing Inflammation.

Potentiate the effect of pain mediators (Histamine & Bradykinin) – They Sensitize the Pain Receptors.

They can cause PYREXIA by increasing their numbers due to an injection of a Pyrogen.

Mechanism of Action

Inhibits prostaglandin biosynthesis (Like All Other NSAIDS)

Blocks Prostaglandin Action by Blocking PG Receptor Cells. (UNIQUE ACTION)

PONSTAN FORTE Exerts a DOUBLE

BLOCKADE Action on Prostaglandins.

Pharmacokinetics and Metabolism

Well absorbed from the GIT.

Peak plasma concentrations 1 - 3 hours.

Rapid Onset of Action 30 min.

Pain Relief Maintained for 8 hours.

Extensively bounded to plasma proteins.

Metabolized by Gluco - conjugation in the liver.

> 50% is recovered in the urine as: unchanged drug or conjugated metabolites.

Indications

For the relief of pain in acute andchronic conditions including painof traumatic, arthritic or muscularorigin; primary dysmenorrhoea,

headache and dental pain.

In Dental pain…

Effective analgesia

Extirpation of pulp

owe N.H.et al. Oral Surg. 1981;51(6):575.

Analgesia in severe Dental Conditions

Rowe N.H.et al. Oral Surg. 1980; 50(3):257.

1- Rees M. et al. The Lancet , Sep. 3, 1988.2- Smith R.P. et al. A J Gynecol. 1980;137(3):314-319

500 mg 2-3 times daily

®

Unique Original Mefenamic Acid With analgesic,

anti-inflammatory & antipyretic properties .

Unique double action

Effective in controlling pain following: Removal of an impacted molar Extirpation of pulp Dental surgery

Low side-effect profile

Dosage : 500 mg 2-3 times daily

Clindamycin HCL

®

> 50%Chronic sinusitis and otitis media

90-100%

Dental and oral infections

> 75% Pleurae-pulmonary infections

50-90%

Intra-abdominal infections

85-95%

Diabetic foot ulcersSydney M. Anaerobic Infections - A Clinical Overview. 2001 by Academic Press.

Prevalence of anaerobic bacteria in some common

infections

Dalacin C®

In...

Dental Infections

Gram Positive Aerobes: Staph Aureus. Staph Epidermidis. Streptococci except Strept Faecalis. Pneumococci.

Gram Positive Anaerobes: Propionibacterium species. Eubacterium species. Peptococcus species. Peptostreptococcus sp. Actinomyces species.

Other microbes: Chlamydia Trachomatis. Toxoplasma Gondii. Plasmodium Falciparum Malaria. Mycoplasma Hominis. Gardnerella Vaginalis.

Gram Negative Anaerobes: Bacteroides Fragilis. Bacteroides species Melaninogenicus. Fusobacterium species. Clostridium species.

Targeted Spectrum

”Dalacin is one of the most active antibiotics against clinically significant anaerobic bacteria”

”Dalacin C is also effective against S. aureus, S. epidermidis and streptococcus species”

Vibhagool A.,et. Al, Therapy of bone and joints infections , Modern Medicine of the Middle East Vol.10/sept. 1993

Unique Benefit In Dental Infections

Unique Benefit In Dental Infections

High Penetration into the

Site of Infection

“Dalacin C was found to have the greatest bone-to-serum ratio”

“Dalacin C penetrates well into abscesses”

Vibhagool A.,et. Al, Therapy of bone and joints infections , Modern Medicine of the Middle East

Vol.10/sept. 1993

Unique Benefit In Dental Infections

High Clinical Efficacy

Refractory Periodontitis…

Scaling and Dalacin C 150 mg qid for 7 days decreased the incidence of active disease from an annual rate of 8% to 0.5% of sites per

patients.

1-Gordon J. et. Al, Efficacy of Clindamycin hydrochloride in refractory periodontitis, J Periodontol, 1990 Nov 61:686-91

2-Wilson DH, Br J Surg, 1980, 67:93.

Unique Benefit In Dental Infections

1- Gordon J. et. Al, Efficacy of Clindamycin hydrochloride in refractory periodontitis, J Periodontol, 1990 Nov 61:686-912- Wilson DH, Br J Surg, 1980, 67:93.

Soft Tissue Infection..

A Retrospective review of15,019 Patient treated withoral Dalacin C for soft

tissueinfections showed Excellentclinical results in 94.6% ofthe cases.

1-Gordon J. et. Al, Efficacy of Clindamycin hydrochloride in refractory periodontitis, J Periodontol, 1990 Nov 61:686-91

2-Wilson DH, Br J Surg, 1980, 67:93.

Oral Dose :

600 - 1,800 mg / day

8 - 25 mg / Kg / day

( Adult )

( Pediatric )

®

Availability :

Caps 150 & 300 mg ( 16 caps/Box )

High Penetration into the Site of Infection

Excellent Clinical Efficacy

Well Tolerated

1-Gordon J. et. Al, Efficacy of Clindamycin hydrochloride in refractory periodontitis, J Periodontal, 1990 Nov 61:686-912-Wilson DH, Br J Surg, 1980, 67:93.

Unique Benefit In Dental Infections

THANK YOU

Clindamycin, ampicillin, & cephalosporins were the 1st antibiotics associated

with CDAD ; the 2nd & 3rd generation cephalosp. , particularly cefotaxime,

ceftriaxone, cefuroxime & ceftazidime are now the agents most frequently

responsible for this condition … However all antibiotics , including

vancomycin & metronidazole (the agents most commonly used to treat

CDAD) have been found to carry a risk of subsequent CDAD ..

Pseudomembranous Colitis

Adapted from HARRISON’S Internal Medecine – 16th Edition

All 3 generations of cephalosporins, macrolides, clindamycin, & intravenous

β-lactam/β-lactamase inhibitors were intermediate-risk antibiotics with

similar AHRs …… Administration of Fluoroquinolones emerged as the most

important risk Factor for CDAD in Quebec during an epidemic …

Clinical Infectious Diseases 2005 ; 41: 1254-60

by 2005 Infectious Diseases Society of America

We found that association between Fluoroquinolones and CDAD is stronger

than the association between clindamycin and CDAD … Thus, our study is

consistent with more recent reports that implicate Fluoroquinolone use as

risk factor for CDAD …Emerging Infectious Diseases, Vol 9, No 6, June 2003

Clindamycin was the highest-risk agent for CDAD in the 1970s … By the

late 1980s and through 1990s , cephalosporin antimicrobials… had become

the agents with the highest relative risk of CDAD …

Clinical Infectious Diseases 2004 ; 38: 646-8

Margaret E. McCusKer, Anthony Harris, Eli Perencevich, Marie-Claire Roghmann : Fluoroquinolone use & Clostridium difficile associated Diarrhea

Dale N. Gerding ; Clindamycin, cephalosporins, fluoroquinolones and clostridiumDifficile associated diarrhea : This is an antimicrobial resistance problem.

Pseudomembranous Colitis