Dr Sachin RathodEmail:-

drsachin.rathod@yahoo.com

Department of Pedodontics &

Preventive Dentistry

Analgesics in Pediatric Dentistry

Concepts About Pain in Children.1. Children have higher tolerance to pain.2. Pain perception is low because of biologic

immaturity.3. Little or no memory of a painful

experience.4. More sensitive to side-effect of

analgesics.5. Special risk for addiction to narcotics.

Classification of Analgesics

Centrally acting (narcotic) Peripherally acting (non-

narcotic)

Centrally Acting Analgesics These are more effective against acute

pain. But have a greater incidence of adverse effect.

They usually are administered parenterally and are devoid of anti-inflammatory and antipyretic effect.

Recent Opioid Analgesics1. Alfentanil2. Remifentanil3. Tramadol

Alfentanil & RemifentanilMechanism of action• Rapid onset (within 1-1.5 min)• Metabolized in liver• Half-life is 1-2 hoursUses • Short , pain full procedures requiring intense

analgesia and blunting of stress responses.• Remifentanil for longer neurosurgical

procedures where rapid emergence from anesthesia is important.

Commercial forms• ALFENTA (Alfentanil) • ULTIVA (Remifentanil)

TramadolMechanism of action• Weak agonist at all type of opioid receptors

with some selectivity for µ receptors.Uses • Mild to moderate pre-and postoperative pain.• Severe acute or chronic pain, cancer painCommercial forms• CONTRAMAL• CONTRAAL DT• DOLOMED• DOLOTRAM• TRAMOL

Peripherally acting Analgesics

These are less effective against severe pain. But have a lower incidence of adverse effects.

They usually are administered orally and are used for chronic low grade pain.

Some possess anti-inflammatory and antipyretic effect.

• Ibuprofen • Diclofenac• Nimesulide• Paracetamol.

Combination therapy for pain Ibuprofen & Paracetamol. Diclofenac sodium & Paracetamol. Nimesulide & Paracetamol. Mefenamic & Paracetamol.

Dose Calculation for Children

1. Clark’s rule child’s weight in Ib

X adult dose = child’s dose

150

2. Young’s rule Age of child

X adult dose = child’s dose Age + 12

Commonly used Antibiotics in children

AMOXICILLIN Action: interferes with cell wall replication

of susceptible organisms, the cell wall rendered osmatically instable, swells & bursts from osmatic pressure .

Dose: 20-40 mg/kg/day 3 divided doses Adverse reaction: increased thirst,

nausea, vomiting, diarrhea, pruritus urticaria, angione-urotic edema, bronchospasm, anaphylaxis.

Contra- indication: Hypersensitivity to penicillin, neonates.

AMOXICILLIN + CLAVUNATE POTASSIUM Action: interferes with cell wall

replication of susceptible organisms, the cell wall rendered osmatically instable, swells & bursts from osmatic pressure .

Dose: 20-40 mg/kg/day 3 divided doses Adverse reaction: Discolored

tongue,glossititis,increased thirst, nausea, vomiting, diarrhea, pruritus,urticaria, bronchospasm, anaphylaxis.

Contra- indication: Hypersensitivity to penicillin, neonates.

AMOXICILLIN + CLOXACILLIN Action: interferes with cell wall replication

of susceptible organisms, the cell wall rendered osmatically instable, swells & bursts from osmatic pressure .

Dose: 50-100 mg/kg/day 3 divided doses Adverse reaction: increased thirst, nausea,

vomiting, hyperkalemia, pruritus,urticaria, bronchospasm, anaphylaxis.

Contra- indication: Hypersensitivity to penicillin.

AMPICILLIN Action: interferes with cell wall

replication of susceptible organisms, the cell wall rendered osmatically instable, swells & bursts from osmatic pressure .

Dose: 50-100 mg/kg/day 3 divided doses

Adverse reaction: Discolored tongue, glossititis, rush, increased thirst, nausea, vomiting, diarrhea, pruritus,urticaria, glomerulonephritis, angioneurotic edema, bronchospasm, anaphylaxis.

Contra- indication: Hypersensitivity to penicillin,

CEPHALEXIN Action: inhibits bacterial cell wall synthesis,

rendering cell wall osmotically unstable. Doses: 50-100 mg/kg/day Adverse reaction: candidiasis, glossitis,

nausea, vomiting , diarrhea, anorexia, pseudomembranous colitis, nephrotoxicity, urticaria, rash, anaphylaxis.

Contraindications: hypersensitivity to penicillin, pregnancy, infants < 1 month.

COTRIMOXAZOLE (sulfamethoxazole + trimethoprim ) Action: sulfamethoxazole interferes with

bacterial biosynthesis of proteins by competitive antagonism of PABA, trimethoprim blocks synthesis of tetrahydrofolic acid, this combination blocks 2 consecutive synthesis of essential nucleic acids, proteins

Doses: 8mg/kg/day Adverse reaction; candidiasis, stevens-johnson

syndrome, anaphylaxis, SLE, nausea, vomiting, diarrhea, hepatitis, enterocolitis, leukopenia, agranulocytosis, renal failure.

Contraindication : hypersensitivity to trimethoprim or sulfame-thoxazole megaloblastic anemia, infants < 2 months, pregnancy and lactation.

ERYTHROMYCIN Action: binds to SDS ribosomal susceptible

bacteria and suppresses protein synthesis. Doses: 30-50 mg/kg/day Adverse reaction: candidiasis, rash,

pruritus, hypersensitivity, nausea, vomiting, diarrhea, hepatotoxicity, abdominal pain, pseudomembranous tinnitus.

Contraindications: hypersensitivity to pre- existing hepatic disease.

METRONIDAZOLE Action: in anaerobic microorganisms

metronidazole is converted to active form by reduction of its nitro group. This gets bound to DNA and prevents nucleic acid formation.

Doses : 5 mg/ kg Adverse reaction ; dry mouth, furry

tongue,, bitter taste, metallic taste, leukopenia, bone-marrow aplasia, rash, urticaria, nausea, vomiting, diarrhea, abdominal pain, nephrotoxicity.

Contraindication: hypersensitivity to this drug, renal disease, pregnancy, lactation, hepatic disease, alcoholic patients.

Recent advanced in Antibiotics

Fourth generation Cephalosporins Cefepime Developed in 1990s Antibacterial spectrum similar to 3rd generation Resistance to β-lactamases Cefepirome Recently marketed in India. Used for treatment of serious hospital-based

infection Better penetration through gram-negative

bacteria More potent than 3rd generation Resistance to β- lactamases.

Newer Macrolides

ROXITHROMYCIN Semi-synthetic, long acting, acid–stable with anti

microbial spectrum resembling erythromycin.Indication Respiratory infections ENT infections Skin & soft tissue infection Genital track infectionsDosage Adult 150 mg BD Children 2.5 -5 mg / kg BDCommercial forms ROXID ROXEM ROXIBID 150 mg & 50 mg kid tab.

CLARITHROMYCIN Antimicrobial spectrum resembling

erythromycin Indication First line drug in Mycobacterium avium

complex in AIDS patients.Dosage 250 mg BD for 7 days Severe cases 500 mg BD for 14 daysCommercial forms CLARIBID CELEX CLARIMAC

AZITHROMYCIN Antimicrobial spectrum expanded as compared to erythromycin. Active against H.influenzae. High activity on respiratory pathogens Good activity against Mycobacterium avium complex in AIDS

patients.Indication Pharyngitis Tonsillitis Sinusitis Staphylococcal & streptococcal skin & soft tissue infection MAC in AIDS patientsDosage 500 mg OD Children above 6 months 10 mg / kg of 3 daysCommercial forms ZITHROMAC AZITHRAL AZIWOK Available as 100 mg kids tab. Should be given 1-2 hours before

meal

THANK YOU

☺ Dr Sachin RathodEmail:- drsachin.rathod@yahoo.com